Re: There is a role for physician associates in the NHS
Dear Editor
Dr Sarah Clarke’s personal Opinion (BMJ 2024;384:q618) raises a number of concerns and red flags.
Dr Clarke neglects to mention that one of the prime reasons for holding an Extraordinary General Meeting of the Royal College of Physicians (London) is that many Fellows, myself included, have major patient safety concerns about the development of the physicians’ associate (PA) role.
In spite of Dr Clarke’s citing the Government’s promise of an extra 14,000 doctors, she fails to mention that HMG has just rowed back on its commitment to increase the number of medical school places by 15,000. It remains to be seen how these mutually contradictory promises can be reconciled. The number of higher specialist training places is also being reduced, and consultant recruitment is being cut back. These reductions seem to be the price of expanding the number of PAs.
Dr Clarke rightly states that PAs are “not doctors, and cannot and must not replace doctors”. However, she fails to condemn the multiple incidences of PAs replacing doctors on medical rotas, and the cries of trainees about missed training opportunities which are favourably allocated to PAs.
Dr Clarke laments the recent BMA guidance on the scope of PA practice. These recommendations were necessitated by the failure of the RCP, which hosts the Faculty of Physician Associates, to provide any such basic patient safety guidelines. It also somewhat misleading to regret a lack of collaboration on the part of the BMA, when the Academy of Medical Royal Colleges was given embargoed copies of the BMA document, and invited to its launch, but responded by pre-empting its issue by releasing its own document, the timing of which is particularly peculiar given the incipient EGM of the RCP and the pending outcome of several colleges’ surveys of their members.
It is insufficient to hope that “regulation (of PAs) will be in place the end of 2024” without highlighting that the GMC’s intends to register, rather than regulate, PAs. Furthermore, many Fellows and Members of the RCP believe that, in the interests of clarity and patient safety, PAs should be regulated by the Health and Care Professions Council rather than by the GMC.
I fully agree that “The RCP must be at the heart of open and honest debate”. Transparency is essential. To date, the RCP has not responded to requests that it declares its significant financial interests in the development of the PA role.
Dr Clarke is entitled to her personal views about PAs. However, these views are not consistent with those of many Fellows and Members of the RCP, and the College’s position on these matters remains to be settled at the EGM. As such, Dr Clarke’s personal slant, adorned by her RCP designation, is especially unfortunate.
Dr Clarke’s advocacy for the PA role has arguably compromised her personal neutrality and authority in advance of the EGM. I find it impossible to have confidence in her ability to chair the meeting impartially. The RCP and its officers must now publicly state all personal and institutional conflicts of interests before the EGM, and a demonstrably neutral chair must be selected.
Competing interests:
No competing interests
13 March 2024
Kevin O'Kane
Consultant Physician
FRCP
Department of Acute Internal Medicine, St Thomas' Hospital
Rapid Response:
Re: There is a role for physician associates in the NHS
Dear Editor
Dr Sarah Clarke’s personal Opinion (BMJ 2024;384:q618) raises a number of concerns and red flags.
Dr Clarke neglects to mention that one of the prime reasons for holding an Extraordinary General Meeting of the Royal College of Physicians (London) is that many Fellows, myself included, have major patient safety concerns about the development of the physicians’ associate (PA) role.
In spite of Dr Clarke’s citing the Government’s promise of an extra 14,000 doctors, she fails to mention that HMG has just rowed back on its commitment to increase the number of medical school places by 15,000. It remains to be seen how these mutually contradictory promises can be reconciled. The number of higher specialist training places is also being reduced, and consultant recruitment is being cut back. These reductions seem to be the price of expanding the number of PAs.
Dr Clarke rightly states that PAs are “not doctors, and cannot and must not replace doctors”. However, she fails to condemn the multiple incidences of PAs replacing doctors on medical rotas, and the cries of trainees about missed training opportunities which are favourably allocated to PAs.
Dr Clarke laments the recent BMA guidance on the scope of PA practice. These recommendations were necessitated by the failure of the RCP, which hosts the Faculty of Physician Associates, to provide any such basic patient safety guidelines. It also somewhat misleading to regret a lack of collaboration on the part of the BMA, when the Academy of Medical Royal Colleges was given embargoed copies of the BMA document, and invited to its launch, but responded by pre-empting its issue by releasing its own document, the timing of which is particularly peculiar given the incipient EGM of the RCP and the pending outcome of several colleges’ surveys of their members.
It is insufficient to hope that “regulation (of PAs) will be in place the end of 2024” without highlighting that the GMC’s intends to register, rather than regulate, PAs. Furthermore, many Fellows and Members of the RCP believe that, in the interests of clarity and patient safety, PAs should be regulated by the Health and Care Professions Council rather than by the GMC.
I fully agree that “The RCP must be at the heart of open and honest debate”. Transparency is essential. To date, the RCP has not responded to requests that it declares its significant financial interests in the development of the PA role.
Dr Clarke is entitled to her personal views about PAs. However, these views are not consistent with those of many Fellows and Members of the RCP, and the College’s position on these matters remains to be settled at the EGM. As such, Dr Clarke’s personal slant, adorned by her RCP designation, is especially unfortunate.
Dr Clarke’s advocacy for the PA role has arguably compromised her personal neutrality and authority in advance of the EGM. I find it impossible to have confidence in her ability to chair the meeting impartially. The RCP and its officers must now publicly state all personal and institutional conflicts of interests before the EGM, and a demonstrably neutral chair must be selected.
Competing interests: No competing interests