What if your “doctor” wasn’t actually a doctor at all? Beware of this new reckless experiment | Rachel Clarke

SSomething radical, intense and far-reaching is happening in the NHS. It is untried, untested and lacking in evidence, with the potential to cause significant harm to the patient. I’m talking about the Department of Health and Social Care’s project to rapidly expand so-called medical associate professions (MAPs), the largest group of which are called physician associates (PAs). None of these groups have a medical degree or postgraduate medical training. But its use in our healthcare system is being portrayed as ‘essential’ workforce planning – the only way to meet rising patient demand and a desperate shortage of trained doctors.

Last week marked a new and depressing low point for doctors, like me, who believe this project is one of the most grossly dishonest, duplicitous and downright reckless political responses to the NHS workforce crisis. We found that a major NHS body – the Bradford District and Craven Health and Care Partnership, responsible for the health and care needs of 2.4 million people – appeared to break the law by producing posters falsely portraying doctors’ staff as doctors to the patient population. “The doctor will see you now,” the posters said. But the member of staff mentioned and explicitly described as a ‘Bradford doctor’ was no such thing. Instead of a five-year medical degree, they had an abbreviated, two-year physician associate degree.

‘Physician’, like ‘doctor’, is a legally protected term. The legislation exists to protect you, the public, from the dangers of fake doctors pretending to be real doctors. In creating these posters, the NHS may have breached section 49 of the Medical Act 1983, which criminalizes misuse of the title ‘doctor’. Equally horrifying to many doctors was the organization’s poster with the slogan: “The cancer specialist will see you now.” Most doctors would not dream of calling themselves a cancer specialist unless they had passed the specialist postgraduate exams and acquired years of expertise in oncology. The term ‘specialist’ refers to a consultant oncologist. But the staff member featured on the posters was no such thing. Not only were they not an oncologist, it’s not even clear that they were a doctor, because beneath the words “cancer specialist” was the tagline: “Not everyone needs to see a doctor.”

The response from Bradford District and Craven Health and Care Partnership to the subsequent outcry was telling. The company formally apologized for its ‘mistake’, insisting that the colleagues whose roles they had misrepresented had agreed to be photographed in good faith, without any idea of ​​how their roles would be distorted to the public. On social media they thanked the doctors who had shown “care and compassion‘ when providing feedback. In doing so, it has deployed a tactic that is increasingly being used to try to silence frontline staff when we warn the public about the potential risks of tackling NHS workforce shortages by hiring highly skilled doctors or nurses. replaced by less well-trained (and cheaper) substitutes for doctors or nurses. This tactic is to use kindness as a weapon, as a means to silence critics.

Some members of the government – ​​including former Health Secretary, now House of Lords member Jim Bethell – have gone a step further in condemning doctors who criticize the PA project as not only unkind, but downright insulting. Bethell says we are bullies, similar to the bullies he experienced when dealing with drug dealers while working at the Ministry of Sound. He slams us for “selling false stories about patient safety” and insists that our concerns are really “old-fashioned professional jealousy and workplace protectionism dressed up in nice clothes.”

The parents of Emily Chesterton, who died of a pulmonary embolism in 2022, do not agree. Chesterton, a 30-year-old actor, saw a physician assistant at her doctor’s office who misdiagnosed her symptoms as a sprain, long Covid and anxiety. A coroner later said she likely would have survived if she had been referred to the emergency room. Crucially, according to her parents, she had no idea she hadn’t done that seen a GP, assuming that the junior doctor was medically qualified. Standards in medicine are important because patient safety is important. I’m obviously not suggesting that doctors never make mistakes (we do), nor that there isn’t a crisis in the NHS workforce (there is). But is the only solution really to mislead the public into thinking they have seen a doctor when they have not? I thought the intention was for the NHS duty of candor to be enshrined at all levels, including the top?

It turns out that the “mistake” of the partnership between Bradford District and Craven was not necessarily so innocent. The BMA Board Chairman, Dr. Phil Banfield, wrote to the NHS West Yorkshire integrated care boardwho addressed the Health Secretary, NHS England and the General Medical Council, to say that he had seen clear evidence that local doctors had raised concerns about the use of ‘doctor’ to refer to non-doctors as early as February 2023, but that systematically ignored.

The response from NHS England to the posters in Bradford conveniently missed the point. A spokesperson stated that physician assistants are not physicians – and cannot and should not replace physicians. But the fact is that they are. We see MAPs working on senior registrars’ on-call rosters in hospitals, assessing undifferentiated patients in general practice and even performing abdominal operations such as cholecystectomies (without passing any surgical training exam). It is not as a doctor that I am afraid of this project, but as a patient. One day I will need high quality medical care on the NHS. How do I know if I get it?