Rebuttal: ITV News Report 12/12/2023

An open letter on Behalf of Medical Associate Professionals members across the UK,

ITV NEWS REPORT 12/12/2023 ON BMA SURVEY ON ROLE OF PHYSICIAN ASSOCIATES AND ANAESTHESIA ASSOCIATES

We write as representatives of United Medical Associate Professionals (UMAPs) to correct misleading and potentially damaging information presented in your report on the results of the recent BMA survey (see ref. 1 below) to doctors on the role of Physician Associates (PAs) and Anaesthesia Associates (AAs) – collectively known as, Medical Associate Professionals (MAPs). We also give notice that we have referred this matter pre-emptively to Ofcom.

As you know, PAs are qualified professionals who support the delivery of clinical care (see ref. 2 below). Whilst relatively new to the UK, PAs have been successfully established in similar positions in countries around the world including the United States, New Zealand, and Canada, where they complement the care provided by doctors. In a modern clinical environment this diverse range of experiences and skills has worked well as part of balanced NHS care teams.

As with all such changes, there is process of engagement required with the public and other professionals to explain the role of PAs. Unfortunately, however, certain members of the doctors’ union, the BMA, have seen PAs as a challenge to the role of doctors – which is not and has never been the case. Disappointingly, without reference to us, this antipathy culminated in a heavily loaded questionnaire on the role of PAs being sent out by the BMA, on which you have reported. The questionnaire was open only to BMA members, of which under 10% of their membership responded.

Given the numbers of respondents, this survey cannot reasonably be seen as representative of doctors’ experiences of PAs in general and is certainly not the basis of an assessment of their competence.

Despite the animosity of some in the BMA, as a profession we remain open to work with doctors to further develop the clinical framework for PAs. Those we represent work under extremely challenging conditions both under the present crisis in the NHS and during the preceding COVID-19 pandemic. It is therefore disheartening to these dedicated professionals when their role and abilities are mispresented by a reputable news organisation such as yourselves and we hope that you will work with us to correct the doubtless unintentional inaccuracies and aspersions in your report.

Specifically, your report stated in its headline that, based on the BMA survey, “87% of doctors worry about patient safety [due to the use of Physician Associates]”. In fact, the stated question was “Do you believe the way that PAs and AAs currently work in the NHS is a risk to patient safety?”. This was published by the BMA with the statistic that 31.6% answered “yes” and a further 55.2% stated “sometimes”. Of course, the expected answer to this question for any professional would be “yes, sometimes” – in that all professionals could act outside their competencies, or that organisational inadequacies, such as staffing or communication issues, could compromise patient safety.

As of the 2023 GMC report there are 296,182 registered doctors in the UK, only 190,366 of which are members of the BMA. Just under 19,000 of BMA members responded to the questionnaire. You stated in your report that “doctors in the UK have overwhelmingly rejected plans to increase the use of Physician Associates and Anaesthesia Associates”. Such a conclusion cannot reasonably be reached based on, according to the numbers published by the BMA, approximately 2% of the registered doctors in the UK. It is unclear why the full context of this survey has not been published by the BMA.

The BMA has been actively campaigning against PAs and AAs, predominantly via X (formerly Twitter), in the name of patient safety. Numerous studies have found PAs to have a positive impact on patient care (see refs. 3, 4, 5 below).

A review of the literature demonstrates that there is no independent data to support the BMA’s assertion that care by PAs is unsafe. Nevertheless, the way forward to address genuine concerns over the management of PAs/AAs would be to progress with the current proposals for regulation by the GMC – however, mystifyingly, the BMA remains opposed to these efforts, as you correctly reported.

Health Education England have issued a statement to the BMA expressing their concern over the campaign (see ref. 6 below), not only for its negative effect on the wellbeing of MAPs and professional working relationships, but also its negative effect on patients – something that your article has, inadvertently, contributed towards.

As we have set out above, your report as it currently stands is untrue, misleading and without evidence impugns the competency of all MAPs. We therefore trust that you will act quickly to correct this. We would be happy to work with you to provide a fair and balanced response to the BMA survey which recognises the important role PAs and AAs play in UK healthcare.

We look forward to hearing from you.

Yours failthfully,

UMAPs

United Medical Associate Professionals

(1) New survey shows “Shocking scale” of concern from doctors over use of … Available at: https://www.bma.org.uk/bma-media-centre/new-survey-shows-shocking-scale-of-concern-from-doctors-over-use-of-physician-associates (Accessed: 24 December 2023).

(2) Physician associate title and introduction guidance for PAs, supervisors, employers and organisations: https://www.fparcp.co.uk/file/media/652d35a68d9a6_FPA_Physician_Associate_Titles_and_Introductions_Guidance_FINAL_5_10_23.pdf

(3) Drennan, V.M. et al. (2019) ‘The role of Physician Associates in secondary care: The pa-SCER mixed-methods study’, Health Services and Delivery Research, 7(19), pp. 1–158. doi:10.3310/hsdr07190.

(4) Halter, M. et al. (2017) ‘Patients’ experiences of consultations with physician associates in Primary Care in England: A qualitative study’, Health Expectations, 20(5), pp. 1011–1019. doi:10.1111/hex.12542.

(5) NHS choices. Available at: https://www.hee.nhs.uk/our-work/medical-associate-professions/impact-case-studies/physician-associate-role-secondary-care-impact-case-study (Accessed: 24 December 2023).

(6) NHS choices. Available at: https://www.hee.nhs.uk/our-work/medical-associate-professions/open-letter-bma-regarding-regulation-supervision (Accessed: 24 December 2023).