Understanding the Current MAP Employment Crisis & how to Protect Yourself
Please note that this document is not intended to constitute legal advice and should not be relied upon as such. The information provided herein is for general guidance and informational purposes only. In the event of any legal or professional disputes, we strongly recommend that all MAPs seek advice from their union, a qualified employment lawyer, or an appropriate legal professional before taking any action or making decisions. The content of this document is not a substitute for professional legal counsel.

Summary

If your employer decides to change your scope of work, it’s essential to understand your rights and the steps you can take to protect them. Changes to the scope of your role can involve altering your duties, responsibilities, working hours, or even your location. Whether the changes are small or significant, your employer must follow the correct legal process.

If an employer were to attempt to implement a document like the BMA’s scope of practice for Medical Associate Professions (MAPs) (even though the BMA is not a union for MAPs), and this action would lead to a limitation of the employee’s existing scope of practice, several employment law issues might arise.

The BMA has put a caveat on their website, to protect themselves from legal claims, in case employers wrongfully implement their guidance document:

“The Safe Scope of Practice for MAPs Recommendations are aimed at NHS Employers and Trusts and should not be treated as employment advice to members on their current interactions with MAPs. In respect of the Safe Scope of Practice for MAPs Recommendations and this document, reference should be made to individual employment contracts, work schedules, etc. before taking any action that may be in breach of contract and/or GMC guidance. Nothing in this document is intended to displace the requirements of GMC GMP. The BMA will keep this document and the Safe Scope of Practice for MAPs Recommendations under review and may update them from time to time.”

The RCGP, upon releasing their guidance, caveated it as follows:

“While it is not within the RCGP’s remit to enforce this guidance, it may be taken into account by NHS Resolution and the Medical Defence Organisations in a case of alleged negligence or clinical or professional mistakes. Ultimately, it is the decision of employers whether to follow this guidance, and the employer’s responsibility to ensure the appropriate treatment and handling of existing PA contracts.”

The key areas of concern for employees in such a situation would be related to contractual rights, changes in job duties, consultation requirements, and potential legal claims like constructive dismissal, unfair dismissal, redundancy or breach of contract.

If you are an ARRS funded employee, a PA’s scope of practice is set by the Minimum Role Requirements section within the PCN DES Specification 2024-25 (section B6.2 a-h), the thrust of which includes:

‘…provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems by utilising history-taking, physical examinations and clinical decision-making skills to establish a working diagnosis and management plan in partnership with the patient…’

Compliance with these minimum role responsibilities are the basis for receiving ARRS funding from the relevant local ICB.

As with most generalist clinicians (for example ANPs, ACPs) it is not possible to absolutely define a scope condition-by-condition as it will be heavily dependent on an individual’s skills and experience which develops over time – as is the case for doctors themselves. A useful starting point however, which describes the minimum skills set for a newly qualified PA who has just passed their registration exams can be found in the GMC Physician Associate Registration Assessment Content Map, which itself evolved from the Faculty of Physician Associates Competence and Curriculum Framework 2012.

Safe practice also involves identifying areas where skills and knowledge needs to be developed, and PAs are required to demonstrate continuing professional development as a condition of remaining in good standing on the register.

The GMC has clarified that MAPs are responsible for their own actions and are responsible for providing safe care within the standards of Good Medical Practice.

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Changing a Contract

As an employee, here’s what you should do if your employer tries to change your scope of work:

1. Seek Legal or Union Advice

  • Employment Lawyer: If you’re unsure about your rights or if negotiations with your employer are not progressing, it’s a good idea to seek advice from an employment lawyer. They can help you understand your contract, assess the fairness of the changes, and guide you on how to respond.
  • Union Support: If you are a member of a trade union, reach out to them for advice and support. Unions can assist in negotiations with your employer and may represent you if the situation escalates to a legal dispute.

2. Understand the Changes

  • Get Clarity: When your employer proposes a change to your job role, ask for specific details. Find out what the new responsibilities will be, how your current duties will be affected, and whether there are any changes to your working hours, pay, or location.
  • Request Written Confirmation: Ask your employer to confirm the changes in writing. Having the proposal in writing will help you understand the scope of the changes and give you something to refer to if needed.

3. Review Your Employment Contract

  • Check for a Variation Clause: Your employment contract may include a variation clause, which allows your employer to make certain changes to your duties. However, this clause does not give your employer unlimited power to change your role, especially if the changes are significant or not reasonable.
  • Look for Specific Terms: Review your contract carefully to understand your duties, working hours, and any limitations on changes your employer can make. If your contract does not allow for the proposed changes, you have the right to object.

4. Know Your Rights

  • Consent is Required: Your employer cannot make major changes to your scope of work without your consent. If the changes are substantial, such as increasing your workload, reducing your responsibilities, or changing your working hours, they must seek your agreement.
  • Consultation: Your employer is legally required to consult with you about any significant changes to your role. During the consultation, you have the right to voice concerns, ask questions, and provide feedback.
  • Refusing Unreasonable Changes: If the proposed changes are unreasonable or detrimental to you, you have the right to refuse them. Your employer cannot impose changes unilaterally (without your consent) unless your contract specifically allows for it, and even then, they must act reasonably.

5. Raise Concerns or Objections

  • Discuss the Changes: If you’re uncomfortable with the proposed changes, arrange a meeting with your manager or HR to discuss your concerns. Be clear about why you feel the changes are unfair or inappropriate.
  • Offer Alternatives: You might want to propose alternatives that are more acceptable to you. For instance, if the employer wants to change your hours, you could suggest different shifts or a phased transition to the new role.
  • Grievance Process: If discussions don’t resolve the issue, you can file a formal grievance. This is the official way to raise concerns within the company. Keep a record of all communications related to the grievance process.

6. Consider the Legal Implications

  • Unilateral Changes: If your employer changes your role without consulting you or without your consent, it could be considered a breach of contract. In this case, you may have legal options to challenge the change.
  • Constructive Dismissal: If the changes are so significant that they fundamentally alter your job, and if your employer refuses to negotiate or consult properly, you may feel forced to resign. In such cases, you could claim constructive dismissal, arguing that the employer’s actions breached your contract and made your position untenable. This is a serious step, so it’s important to seek legal advice before taking action.
  • Discrimination: Ensure that the changes do not disproportionately affect you because of a protected characteristic (e.g., age, gender, disability, race). If the changes indirectly discriminate against you, you may have grounds for a claim under the Equality Act 2010.

7. Negotiate and Agree on Changes

  • Be Open to Negotiation: While you have the right to object to changes, sometimes it’s possible to negotiate a solution that works for both you and your employer. If you’re open to the changes but have concerns about certain aspects, try to negotiate for better terms (e.g., additional pay or flexibility in working hours).
  • Get Agreement in Writing: If you agree to the changes, ask your employer to provide a written variation to your contract that outlines the new scope of work. Make sure that any agreed-upon changes are documented and signed by both you and your employer.

8. Monitor the Transition

  • Adapting to the New Role: If you agree to the changes, keep track of how the transition goes. Are the new responsibilities manageable? Is the employer honoring any agreements made during the consultation process? If problems arise, raise them with your employer promptly.
  • Regular Check-ins: If your role has changed significantly, it can be helpful to have regular meetings with your manager to discuss how you are adapting and to address any challenges you may face in your new responsibilities.

9. Understand the Consequences of Refusal

  • Fire and Rehire: If you refuse to agree to the changes, your employer may threaten to dismiss you and then offer to rehire you under the new terms. This practice, known as “fire and rehire”, is legally risky for employers and could lead to claims of unfair dismissal. If this happens, it’s important to seek legal advice as you may have grounds to challenge the dismissal.
  • Redundancy: In some cases, if you refuse the new scope of work and there are no alternative roles available, the employer may consider your position redundant. If this happens, you are entitled to a fair redundancy process, including consultation, selection for redundancy based on objective criteria, and redundancy pay if eligible (after 2 years of service).

10. Filing a Claim if Necessary

  • Unfair Dismissal: If your employer dismisses you for refusing the changes and you have 2 years’ continuous service, you may be able to claim unfair dismissal at an employment tribunal. You must file your claim within 3 months less one day of your dismissal.
  • Constructive Dismissal: If you resign because the changes were imposed without your consent and made your working conditions intolerable, you could claim constructive dismissal. Again, you must file your claim within 3 months less one day of your resignation.
  • Discrimination Claim: If the changes indirectly discriminate against you based on a protected characteristic, you can file a discrimination claim within 3 months less one day of the discriminatory act.

Summary of Steps for Employees

  1. Seek legal or union advice if negotiations fail or if you feel the changes are unfair.
  2. Understand the proposed changes and request written confirmation from your employer.
  3. Review your contract to check whether the changes are allowed or require your consent.
  4. Know your rights and ensure that any changes are done with your agreement.
  5. Raise concerns or file a grievance if you do not agree with the changes.
  6. Consider legal implications.
  7. Negotiate for better terms or a compromise if you’re willing to accept some of the changes.
  8. Document any agreed changes and ensure they are reflected in a written variation to your contract.
  9. Monitor the impact of the changes and address any issues as they arise.
  10. File a claim if you believe your employer acted unlawfully by imposing changes without consent.

References

Types of Dismissals

A quick overview of the different types of dismissals in employment law. There are several ways an employee can be dismissed, and each type carries different legal implications. Here are the key types:

1. Fair Dismissal

This is when an employer dismisses an employee for a legitimate reason. Common reasons for fair dismissal include:

  • Misconduct: When the employee breaks workplace rules or behaves inappropriately (e.g., theft, violence, or harassment).
  • Capability or Performance: If the employee is not capable of doing their job, either due to lack of skills or poor performance.
  • Redundancy: When the job the employee was hired for no longer exists.
  • Legal Restrictions: If the employee can no longer legally perform their job (e.g., losing a required license).
  • Some Other Substantial Reason (SOSR): A catch-all for dismissals that don’t fall under the other categories but are still considered legitimate.

2. Unfair Dismissal

Unfair dismissal happens when an employee is dismissed without a valid reason or if the dismissal process was not fair. Although Employees usually need to have worked for the company for a minimum period of 2 years in the UK to claim unfair dismissal, there are certain actions that are considered as causing an automatic unfair dismissal (for example discrimination or whistleblowing). Grounds for unfair dismissal include:

  • Being dismissed for asserting a statutory right (e.g., asking for maternity leave).
  • Discrimination based on gender, race, age, disability, or other protected characteristics.
  • Whistleblowing (reporting wrongdoing by the employer).
  • Dismissing you without following a proper procedure or having a fair/genuine reason for doing so
  • Redundancy when it is not a true redundancy situation
  • Misconduct without proper evidence of misconduct
  • Poor performance without following a proper procedure or evidence of poor performance

3. Constructive Dismissal

This occurs when an employee feels forced to resign because the employer’s behavior has made the working environment unbearable. Examples include:

  • Not paying wages.
  • Harassing or bullying the employee.
  • Changing job terms without agreement (e.g., reducing pay or demoting the employee).
  • While the employee resigns, the employer’s actions are considered as forcing that resignation, making it a form of dismissal.

4. Wrongful Dismissal

Wrongful dismissal refers to the breach of contract by the employer when terminating the employment. This usually happens when an employer dismisses an employee without giving the required notice or violating the terms of the employment contract. It’s about whether the correct contractual process was followed, regardless of the reason for dismissal.

5. Summary Dismissal

This is an immediate dismissal without notice due to gross misconduct. Common examples of gross misconduct include theft, violence, fraud, or severe insubordination. Summary dismissal must be justified and proportionate to the offense. 

6. Mutual Agreement Dismissal

In some cases, both the employer and employee agree to terminate the employment relationship. This may involve a settlement agreement where the employee agrees not to bring any legal claims in exchange for compensation or other benefits.

7. Redundancy

While a form of fair dismissal, redundancy is specific to situations where the employer needs to reduce the workforce, often due to economic reasons, changes in technology, or the closure of a business. Redundancy dismissals have specific legal procedures to ensure fairness, such as consulting employees and offering redundancy pay.

8. Automatic Unfair Dismissal

Certain dismissals are automatically considered unfair, regardless of the employer’s reasoning, such as:

  • Dismissal for being pregnant or on maternity leave.
  • Dismissal for joining or forming a union.
  • Dismissal for asserting statutory rights.

Contesting Dismissals

Below is an overview of the types of dismissals from an employee’s perspective, including what you need to be aware of, what time frames apply, and the documentation you should gather to contest dismissals. Each type of dismissal includes steps for you as an employee to protect your rights.

1. Fair Dismissal (Misconduct, Performance, Redundancy, Legal Restrictions)

What to Know:

If you are dismissed for a legitimate reason, your employer must follow proper procedures. The dismissal must be for a fair reason, and they should have taken reasonable steps to resolve issues (e.g., warning for poor performance or offering alternative roles during redundancy).

Steps to Contest:

  • Ensure Procedures Were Followed: Check if the employer conducted a fair investigation, held meetings with you, issued warnings, or consulted you during redundancy.
  • Right to Appeal: If you believe the decision was wrong, appeal the dismissal decision within your employer’s appeal time frame (usually a few weeks).

Time Frames:

  • Employees typically need 2 years of continuous service to claim unfair dismissal.
  • Appeals against dismissal must be made quickly (often within 5–14 days).
  • Claims to a tribunal must be filed within 3 months less one day of the dismissal.

Documentation:

  • Gather copies of performance reviews, warnings, consultation records (in redundancy cases), and any appeal letters.
  • Keep copies of any correspondence related to the dismissal.

2. Unfair Dismissal

What to Know:

If you believe you’ve been unfairly dismissed (without valid reason or without following fair procedures), you can contest the dismissal if you meet the qualifying period (typically 2 years of service in the UK, but this can vary).

Steps to Contest:

  • Challenge Through Appeals: File a formal appeal with your employer if they haven’t followed fair procedures (e.g., no warnings, no investigation).
  • Submit a Tribunal Claim: If you cannot resolve the issue internally, submit an unfair dismissal claim to an employment tribunal within 3 months less one day.

Time Frames:

  • Appeals usually need to be lodged within 5–14 days.
  • Tribunal claims must be submitted within 3 months less one day of your dismissal date.

Documentation:

  • Keep records of disciplinary procedures, warnings, and any meeting notes where you discussed your dismissal.
  • Collect emails, letters, and any other correspondence that supports your case.

3. Constructive Dismissal

What to Know:

If your working conditions become intolerable due to your employer’s actions (e.g., bullying, harassment, unpaid wages), you can resign and claim constructive dismissal. However, it’s essential to prove that your employer’s behavior forced you to leave.

Steps to Contest:

  • Resign Promptly: Don’t delay after the intolerable act. Resign promptly if you believe you can’t continue working under those conditions.
  • File a Tribunal Claim: You must bring a constructive dismissal claim within 3 months less one day of your resignation.

Time Frames:

  • You should resign soon after the incident that makes working intolerable, or else it might weaken your claim.
  • You have 3 months less one day from resignation to file a claim.

Documentation:

  • Document all instances of your employer’s unreasonable behavior, such as emails, wage slips, and grievance complaints.
  • Keep records of any attempts you made to resolve the issue, like grievance filings or HR meetings.

4. Wrongful Dismissal

What to Know:

If your employer breaches the terms of your contract when dismissing you (e.g., they do not give you the required notice period), you can claim wrongful dismissal. This type of dismissal is based on contract law rather than the fairness of the dismissal.

Steps to Contest:

  • Check Your Contract: Review your employment contract to ensure the employer provided the required notice or payment in lieu of notice.
  • File a Legal Claim: You can file a claim for wrongful dismissal either in an employment tribunal or court, depending on the compensation amount and region.

Time Frames:

  • Tribunal claims for wrongful dismissal must usually be filed within 3 months less one day.
  • Claims through civil courts (for breach of contract) typically have a longer time frame, often 6 years (in the UK).

Documentation:

  • Collect a copy of your employment contract, pay slips, and evidence that the proper notice was not given.
  • Include correspondence that shows the dismissal took place without following the correct notice procedure.

5. Summary Dismissal (Gross Misconduct)

What to Know:

Summary dismissal occurs when you are dismissed without notice due to serious misconduct. While employers can dismiss you immediately, they must still investigate the misconduct and give you a chance to defend yourself.

Steps to Contest:

  • Challenge the Fairness: Argue that the misconduct was not severe enough to warrant dismissal without notice or that the dismissal process was flawed.
  • Appeal: File an internal appeal with your employer.
  • Tribunal Claim: If unsuccessful, file a claim for unfair dismissal within 3 months less one day.

Time Frames:

  • You should appeal the dismissal internally within 5–14 days.
  • You have 3 months from the dismissal date to file a tribunal claim for unfair dismissal.

Documentation:

Gather evidence showing that the incident didn’t warrant dismissal, such as witness statements, emails, or previous warnings that show the incident’s context.

6. Mutual Agreement Dismissal (Settlement Agreement)

What to Know:

In some cases, your employer may offer you a settlement agreement to leave the company voluntarily in exchange for compensation. You cannot bring legal claims afterward if you sign this agreement.

Steps to Contest:

  • Legal Advice: Seek independent legal advice before signing any settlement agreement. This is a legal requirement in many jurisdictions (e.g., UK).

Time Frames:

You must sign the agreement by the agreed deadline, but you should be given 10–14 days to seek advice.

Documentation:

  • Ensure you receive a copy of the settlement agreement and legal advice certificate before signing.
  • Keep copies of all correspondence related to the settlement discussions.

7. Redundancy

What to Know:

Redundancy occurs when your role is no longer needed due to economic, technological, or structural reasons. Employers must follow fair procedures, including consultation and offering alternatives (where available).

Steps to Contest:

  • Challenge Selection Criteria: If you believe you were unfairly selected for redundancy (e.g., based on age, race, or poor process), you can file a claim for unfair dismissal.
  • Claim Redundancy Pay: Ensure you receive redundancy pay if eligible (usually after 2 years of service).

Time Frames:

  • Redundancy claims must be filed within 3 months less one day of the dismissal.
  • Consultation periods last 30 days for 20–99 redundancies and 45 days for 100+ redundancies.

Documentation:

  • Keep records of the consultation process, selection criteria, and any redundancy payment details.
  • Collect any written communications about the redundancy process.

8. Automatic Unfair Dismissal

What to Know:

Some dismissals are automatically considered unfair, such as being dismissed for reasons related to pregnancy, maternity leave, whistleblowing, or trade union membership. You don’t need 2 years of service to bring these claims.

Steps to Contest:

  • File a Tribunal Claim: If you believe you were dismissed for an automatically unfair reason, file a claim to an employment tribunal within 3 months less one day.

Time Frames:

You have 3 months less one day from the dismissal to bring a tribunal claim.

Documentation:

  • Collect evidence showing the reason for your dismissal, such as medical records (for pregnancy), union membership records, or whistleblowing reports.
  • Include any correspondence from your employer that may link your dismissal to the automatically protected reason.

References

Frequently Asked Questions (FAQs) for MAPs

What should I do if my employer tries to change my scope of practice?

If your employer proposes changes to your scope of practice, it’s important to:

  • Request details: Ask for written confirmation of the proposed changes.
  • Review your contract: Check your employment contract to see if it allows for changes to your role.
  • Consult your union: Speak to your union representative to understand your rights and the best course of action.
  • Negotiate: You have the right to discuss and, if necessary, refuse unreasonable changes. Your employer must seek your consent before making significant changes to your role.

Can my employer change my job role without my consent?

In most cases, no. Your employer cannot unilaterally change your job role without your consent, especially if the changes are significant. If your contract includes a variation clause, it may allow for some flexibility in your duties, but any major changes must be reasonable and agreed upon.

What is a variation clause, and how does it affect me?

A variation clause in your employment contract allows your employer to make certain changes to your role, such as adjusting your duties or working hours. However, this clause is not a free pass for your employer to make drastic changes. If the changes are unreasonable or significantly affect your role, they still need your agreement.

Can I refuse changes to my role?

Yes, you can refuse changes to your role if they are unreasonable or not allowed by your contract. Your employer should consult with you and get your agreement before making significant changes. If you feel pressured to accept changes or if changes are imposed without consultation, you should contact your union for support.

What should I do if I disagree with the changes my employer is making?

If you disagree with the changes, you should (assisted by your union and/or employment lawyer):

  • Discuss your concerns with your employer in a meeting and explain why you believe the changes are unfair or inappropriate.
  • Negotiate: You can suggest alternatives that might work for both you and your employer.
  • File a grievance: If the issue cannot be resolved informally, you can use your company’s formal grievance process to challenge the changes.

What happens if I refuse the changes to my job role?

If you refuse the changes, your employer has a few options:

  • Negotiate: They may try to reach a compromise with you.
  • Dismiss and rehire: In extreme cases, they may dismiss you and offer to rehire you under new terms (known as “fire and rehire”). However, this practice is legally risky for employers and could lead to a claim for unfair dismissal if not handled properly.
  • Redundancy: If the changes significantly affect your role and there is no suitable alternative role, the employer may consider redundancy, in which case you are entitled to redundancy pay if eligible.

What is constructive dismissal, and when can I claim it?

Constructive dismissal occurs when you resign because your employer has fundamentally breached your employment contract, making it impossible for you to continue working. For example, if your employer imposes significant changes to your role without your consent and refuses to negotiate, you may have grounds for a constructive dismissal claim. However, it is a serious decision, and you should seek legal advice or contact your union before resigning.

Can my employer change my scope of practice based on guidance from a Royal College or other professional body?

No, unless your contract specifically references or incorporates the guidelines of a Royal College or professional body, these guidelines are not legally binding. Your employment contract holds more weight in legal disputes. Your employer must follow the terms of your contract and cannot use external guidelines to make significant changes to your role without your consent.

What is the difference between fair and unfair dismissal if my scope of practice changes?

  • Fair dismissal: Your employer can dismiss you for a fair reason (e.g., misconduct, capability, redundancy), but they must follow a fair process. This includes proper consultation, warnings, and providing a right to appeal.
  • Unfair dismissal: If your employer changes your role without consent and dismisses you for refusing those changes, this may be considered unfair dismissal, especially if the proper procedures were not followed. You can file a claim for unfair dismissal within 3 months less one day of your dismissal.

What are my options if I believe the changes to my role are discriminatory?

If you believe the changes to your role unfairly impact you based on a protected characteristic (e.g., gender, age, disability, race), you may have a claim under the Equality Act 2010. Discrimination claims must be filed within 3 months less one day of the discriminatory act. You should contact your union for advice on how to proceed.

What can I do if I feel forced to accept the changes to my role?

If you feel pressured to accept changes to your role that you believe are unfair, you should:

  1. Seek advice from your union or an employment lawyer.
  2. File a grievance: Use your company’s grievance process to formally challenge the changes.
  3. Consider constructive dismissal: If the situation becomes intolerable, you may consider resigning and claiming constructive dismissal, but this is a serious step, and you should get legal advice first.

How can UMAPs help me if my employer changes my scope of practice?

UMAPs can support you in several ways, including:

  • Advising you on your rights under your employment contract.
  • Assisting in negotiations with your employer to ensure any changes are fair and reasonable.
  • Supporting you through grievance procedures or helping you file a claim for unfair dismissal, constructive dismissal, or discrimination if necessary.
  • Providing legal representation if your case goes to an employment tribunal.

What is "fire and rehire," and is it legal?

“Fire and rehire” refers to the practice where an employer dismisses an employee and then offers to rehire them under new terms, often with reduced benefits or responsibilities. While this practice is legal, it is risky for employers and can lead to claims of unfair dismissal if the process is not handled fairly. If you are facing this situation, contact your union immediately for advice.

How long do I have to file a claim if I am unfairly dismissed or face discrimination?

  • For unfair dismissal: You have 3 months less one day from the date of your dismissal to file a claim at an employment tribunal.
  • For discrimination: You must file your claim within 3 months less one day of the discriminatory act.
  • If you believe you have been treated unfairly, it’s important to act quickly and seek advice from your union or an employment lawyer.

References

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