Warning of rising prices for doctors hired to plug gaping holes in NHS workforce

Patient safety in Scottish hospitals is at risk as NHS bosses hire hundreds of low-cost doctors to fill staff shortages.

Serious concerns have been raised over plans to fill gaps in the health care workforce using junior doctors, a role that requires only two years of training.

New figures show there are already 250 Physician Associates working in healthcare, with a recommendation that at least 40 more be trained each year to bolster the struggling workforce.

However, the British Medical Association is demanding that there be no further recruitment of Medical Associate Professionals (MAPs), including Physician Associates, Anaesthesia Associates, Surgical Care Practitioners and Advanced Critical Care Practitioners, until serious concerns about patient safety have been addressed.

Others fear that increasing reliance on MAPs will lead to a “two-tier” health care system.

Dr Iain Kennedy, chairman of the British Medical Association in Scotland, said: ‘It is worrying to see MAPs as a possible alternative labour market option or solution to the Scottish NHS’s doctor shortage problems.

‘To make it clear: the only solution to the health care crisis is a sound investment in doctors.

‘Only doctors are medical professionals.

“We believe that no further recruitment of MAPs is necessary until the clear concerns about scope creep and patient safety have been addressed.”

The findings come in a ground-breaking report from a Scottish NHS commission into the future of MAPs.

MAPs perform a variety of tasks, including assessments and minor procedures, in general practices and hospitals, after completing a two-year university degree.

The expansion must go ahead despite “tensions” with other staff groups, according to experts appointed by the Scottish Government.

The Commission also said they are needed to address the shortage of doctors and nurses and the growing number of patients.

The report states: ‘To ensure the sustainability of healthcare for the future, NHS Scotland must take into account the increasing demand for services from an ageing population.

‘This has been compounded by shortages in certain professions and specialties and by the disruption caused by the COVID-19 pandemic, which has led to an unprecedented backlog of elective care.’

The Scottish Government has pledged to increase the number of NHS staff by 1,500 to help reduce waiting lists.

According to the report, this requires “innovative solutions” given the staff shortages in nursing and medicine, “such as expanding the workforce” of Medical Associates.

It says: ‘MAPs are a potential alternative workforce option, increasing the flexibility and resilience of teams and contributing to the increase in clinical capacity required to meet identified current and future demand.’

Dr Sandesh Gulhane, Scottish Conservative public health spokesman, said: ‘Under the SNP, GP numbers have fallen to dangerously low levels and now they are trying to use junior doctors to fill the gaps, despite only having two years’ training.

“Many medical experts are unsure about the exact role PAs play and are concerned that relying more on them could create a divide in health care.”

The report warns of ‘tensions within some professional groups and one-sided protectionism’.

The role of physician associates has come into the spotlight due to long-standing complaints from the BMA.

It says roles are “poorly defined” and staff can end up doing work they are not trained to do. It can also often lead to confusion among patients and their families about whether they have seen a physician associate or a doctor.

The General Medical Council, the regulator for doctors, will also become the regulator for physician associates (PAs) and anaesthesia associates (AAs) in December 2024.

However, the BMA has launched legal proceedings against the GMC over the way it plans to do this, saying it ‘dangerously blurs the line for patients between highly qualified and experienced doctors and junior doctors’ roles.’

In Scotland, MAPs are trained at the University of Aberdeen, but more universities may offer the course in the future.

Admission requirements for the two-year course are a diploma in a medical-scientific field, such as pharmacy or physiotherapy.

A Scottish Government spokesperson said: ‘Health professionals are an important part of NHS Scotland’s workforce and will continue to contribute to the Scottish Government’s priority of developing a sustainable system that ensures people get the right care, at the right time and in the right place.

‘Scottish Ministers are clear that future growth in these valued roles must be gradual and evidence-based, and that this must be underpinned by the work of our national Medical Associate Professionals Programme Board.’