The Guardian’s view on doctor employees: the NHS must be in tune with the public | Editorial
TThe Conservative workforce plan for England’s NHS workforce is already under review. Given Labour’s pledge to rewire the system – emphasizing prevention and care in the community rather than in hospitals – the overall workforce mix will undoubtedly be reconfigured when the 10-year plan is launched next year. But amid these broader changes and the ongoing issues surrounding workforce shortages, a simmering row over the role of physician associates (PAs) has become too hot to ignore. Wes Streeting’s announcement this week of an inquiry, led by Prof Gillian Leng, showed ministers have accepted doctors’ views that there is a problem.
The role of Physician Associate (PA) was adopted from the US. Television viewers of a certain age may have seen one on screen for the first time: Jeanie Boulet was a main character in the Chicago-set hospital drama ER. Not long after, in 2003, the first PAs arrived working at the NS – initially with the title of physician assistant. But since 2014, they have been known as physician assistants – alongside a much smaller number of nurse anesthetists.
Currently there are about 3,500 and the plan was to roughly triple their number by 2037. But serious mistakes made in the care of two women who were treated by PAs and subsequently died have contributed to growing concerns among physicians about how PAs are being used to fill staffing gaps; and also about the lack of public understanding of their training – a two-year course not taught in medical schools.
Susan Pollitt’s husband, who died in Oudham after a drain was wrongly left in her body for too long, said earlier this month that he did not know the person treating her at the hospital was not a doctor. Complaints were also made after an NHS organization in Yorkshire was forced to apologize for posters misleadingly referring to PAs as ‘doctors’.
The findings from the first study of PAs in the NHS were largely positive. But the evidence has not developed since then and NHS England did not respond quickly enough when doctors’ concerns began to mount. It is a shame that Mr Streeting’s review will not extend to the role of nurses, which has also been rapidly expanded in response to staff shortages.
Some experts believe that PAs are unfairly blamed, when the problems surrounding patient safety are systemic. Mr Streeting acknowledged the damage when he spoke of “a toxic debate in which doctors feel ignored and PAs feel demoralised”. The hope must be that the assessment by Prof Leng, former head of the National Institute for Health and Care Excellence, will be given enough authority that the situation for current PAs improves – even if the plan to recruit more is reversed, or their The job title will, as seems possible, be changed back to assistant.
The introduction of associate professionals is not unique to healthcare. It is part of a wider pattern in the public sector – for example in schools, where teaching assistants have taken on work previously done by teachers. But health is a particularly sensitive subject for obvious reasons, and the review should be welcomed by anyone hoping to resolve the current tensions and their relationship to wider, crucial issues such as staffing and patient safety.
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