UMAPs Statement in Response to the RCP Recommendations to Council document released 21/05/2024 

Written by UMAPs Ltd

June 2, 2024

Dear Dr Clarke FRCP, 

UMAPS would like to thank Dr Hilary Williams FRCP, and the post-RCP EGM short-life working group team for their efforts in participating. We appreciate your recognition of the difficult year PAs have endured since the DoctorsVote has led a campaign against the Physician Associate (PA) role. We also agree that the medical leadership exhibited during this time has been lacking, key decisions delayed, and responses muted. We thank you for acknowledging our work concerning the mental health crisis in the PA workforce to which these factors have contributed. It is reassuring to hear that you are supportive of PAs and their career development going forward. 

Following our own workgroup’s meeting on Monday, May 10th, aimed at identifying the most detrimental actions that could result from the post-RCP EGM workgroup, we wrote to you to express our concerns. Specifically, we were troubled by the terminology of Motion 5 and its potential impact on newly qualified PAs and their employment opportunities. Consequently, we have found learning of your recommendations challenging.   

We have appraised your recommendations and wish to raise the following points: 

  1. We agree the NHS can support both doctors and PAs. However, UMAPs refutes any suggested relation between PAs and the doctor’s trade disputes. 
  1. The BMA “represents, supports and negotiates on behalf of all UK doctors and medical students”, therefore, to influence stakeholder recommendations on another profession should be considered outside of their remit [2]. Although limitations to specialty training post availability holds no relation to PAs, we understand the urgent need to increase the quantity of specialty training posts and we support any projects that attempt to do so.   
  1. UMAPs agrees further guidance is required regarding supervision and scope. This guidance was mandated by the RCP Council in October 2023 and was due for publication within 3-4 months [3]. It is difficult to ascertain, and perhaps it would be helpful for the RCP to explain, why these documents have been withheld from publication thus far? Concerning their release, we would like to ask the RCP how it plans to uphold professional standards, including following agreed procedure and confidentiality. 
  1. It was announced 5 years ago that the General Medical Council (GMC) would be the professional regulatory body for PAs and AAs. We, like many organisations, have been equally frustrated by slow progress. Thankfully, legislation has now been passed and the GMC will commence regulation of PAs and AAs in December 2024. Impending regulation and the publication of apparently existing scope and supervision documents would surely negate the perceived necessity to challenge the long-term workforce plan. 
  1. Regarding your specific concern for training opportunities for junior doctors, recommendations to limit PAs are counterproductive to the goal of increasing doctor training opportunities and improve patient access to care. PAs expand access to high-quality care for patients, helping to reduce waiting lists and times, which in turn can create greater capacity for training doctors whilst they rotate through the department. By attempting to limit the skillset PAs can offer not only will there be reduced training capacity, but patients also face potential delays in accessing timely care and procedures, such as, for example, diagnostic endoscopies. 
  1. The RCP’s statement indicates its intention to acknowledge heavily biased information from the BMA, during an ongoing trade dispute, and fails to mention existing peer-reviewed evidence into the PA workforce. We welcome the reintroduction of established research and literature which had been accessible until recently on both your website, and the BMA’s. This research, conducted during the introduction and early years of PAs in the UK and globally, holds valuable insights. Immediately prior to industrial action, the BMA’s stance on PAs, as supported by materials and literature on their website, was significantly different from its current position [4]. We expect therefore, for the BMA to present robust evidence when referenced in your recommendations.  
  1. We also welcome the creation of additional, independent research on which to base further development of all roles. The conduction of further surveys, however, is unlikely to prove beneficial given results are easily manipulated by pressure groups that aim to eradicate the role by promoting scripted answers. Participation in such detrimental surveys is contradictory to your earlier statement of support, instead, we would request the RCP to use a higher-grade study to inform its members of the benefits and/or impacts of PAs. This should review the impact on service provision and patient care, as much as it does on training opportunities.  

For example, the RCGP recently undertook a survey only to find that 90% of its membership abstained from participation [5], likely refusing to engage in the anti-MAP bullying campaign. The RCP should reflect on this before repeating the same approach. 

  1. Originally, Motion 5 was changed from “pause” to “caution” in the rollout of PAs. The recommendation to close the PA Managed Voluntary Register (MVR) confirms the workgroup has unilaterally decided to revert to the original phrasing for Motion 5. This suggestion was our greatest cause for concern, as for many PA employment opportunities, participation in the MVR is a condition of employment. By manipulating the MVR, you not only prevent newly qualified PAs from securing employment but threaten experienced PAs by preventing re-registering. Employers may now lose faith in the MVR’s efficacy and recruit outside of the register. This is an unnecessary act and poses a problem for both patients and professionals reliant on this register to maintain their safety. 
    In recommending this, it suggests the workgroup’s purpose was not to focus on patient safety but to reinforce the BMA’s unjust descent on 4200 PAs reliant on the impartiality and candour of the RCP. In implementing this alongside the other obvious recommendations to evoke the RCP into endorsing a trade dispute, the workgroup calls into question the appropriateness of the RCP to directly manage the Faculty of Physician Associates (FPA). The RCP needs to think carefully about its duty of care in this to PAs and student PAs. 
  1. Throughout this letter, we have highlighted the conflation of issues between educational concerns versus trade union disputes. The RCP has stated they wish to create secure and fulfilling careers for PAs moving forward. However, this was already underway and contradicts the BMA stance on PAs. Can the RCP please state overtly whether it intends to take a stance on the BMA-led trade union dispute? 
  1. We ask the RCP to clarify its recommendation around prescribing. As part of their training, PAs are taught to propose medications to an independent prescriber. We remind the RCP that the GMC has clear guidelines for doctors on prescribing based on a colleague’s recommendation. 

In conclusion, UMAPs wishes to see the PA role support patients and trainee doctors and to maintain its current trajectory of being a valued member of the MDT with fulfilling careers. We welcome further unbiased, independent, peer-reviewed research and insights from the GMC regarding the potential for future MAP prescribing.  

Our current skillsets must remain for the benefit of service provision for patients, as it has done for 20 years. UMAPs does not agree with the conflation of MAPs in the doctor’s trade union disputes and would like the RCP to consider its involvement, given its position as a professional college. UMAPs agrees with the workgroup’s recommendation to limit the RCP’s role overseeing enhanced scope and supervision of PAs within the physician specialities.   

PA Stephen Nash 

On Behalf of the Caretaker Council 

United Medical Associate Professionals  

References: 

  1. Royal College of Physicians debates the recommendations from its short life working group on the role of physician associates [Internet]. www.rcp.ac.uk. [cited 2024 May 26]. Available from: https://www.rcp.ac.uk/news-and-media/news-and-opinion/royal-college-of-physicians-debates-the-recommendations-from-its-short-life-working-group-on-the-role-of-physician-associates/  
  1. [Internet]. [cited 2024 May 30]. Available from: https://www.bma.org.uk/what-we-do 
  1. RCP (2024) Summary Consensus of Council Discussions and Action Plan to address Council Priorities. [Internet] Available from:  https://www.rcp.ac.uk/media/p54fnnak/rcp-council-pa-consensus-statement-full_nov_2023_dated_1_0.pdf 
  1. BMA (2018) Principles for effective working with medical associate professions working together – BMA [Internet] https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/workforce/effective-workingwith-medical-associate-professions [cited 2024 May 26] 
  1. Physician Associates [Internet] 2024 [Cited 2024 May 24]. Available from: https://www.rcgp.org.uk/representing-you/policy-areas/physician-associates   

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