The BMA has called out the “postcode lottery” in which different hospitals can decide what physician associates can and can’t do.

The British Medical Association (BMA) has called on NHS England to introduce a mandatory scope of practice for physician and anaesthesia associates (PAs and AAs), following the publication of a study in the BMJ that found little evidence to support their safety and efficacy.

In November 2023, the BMA called for a national pause in the recruitment and expansion of PAs and AAs following evidence that they are working considerably beyond their competencies, taking on tasks that are usually undertaken by doctors with a decade or more of education and training.

Nonetheless, in an open letter at the time Stephen Powis, NHS England’s national medical director and Navina Evans, NHS England’s chief workforce officer, claimed not only that “the evidence tells us” that PAs are safe, they also increase the breadth of skill, capacity and flexibility of teams, and reduce workload pressure on other clinicians.

A postcode lottery

In a new letter sent by the BMA, chair of council Phil Banfield raised continuing safety concerns about their use.

“By maintaining a postcode lottery in which different hospitals can decide what physician and anaesthesia associates can and can’t do in the absence of any agreed scope of practice, I fear that the NHS has created a patient safety scandal… It is wholly unacceptable for NHS England to continue its current course of inaction relying on evidence that cannot be provided and which this systematic review has shown does not exist,” he said.

Increasing number of coroners are now speaking out after several tragic deaths following misdiagnosis by PAs. As Healthcare Today reported in early March, Karen Henderson, assistant coroner for Surrey, has raised concerns after an elderly lady called Pamela Marking was seen by an unsupervised PA in A&E in February last year and sent home without a medical review. She subsequently died.

While Wes Streeting, the minister for health and social care has launched a review of the role, there are currently no interim safety measures to protect patients in place.