A revolt by doctors is likely to disrupt plans to plug NHS workforce gaps by getting non-medics to take on some of their tasks.
Physician associates and anaesthesia associates are newer types of medical role that involve significantly less training than doctors receive. Medical leaders have backed plans to increase their use in the health service and the associate roles are key to the NHS Long Term Workforce Plan.
Many doctors say, however, that they are concerned about patient safety and allege that associates are not sufficiently supervised in short-staffed and underfunded hospitals.
A group protesting against the changes has forced a meeting at the Royal College of Anaesthetists in an attempt to halt its support for anaesthesia associates.
The Times understands that similar efforts are at an early stage in other medical specialties, where physician associates are being used more often.
Anaesthesia associates undertake a two-year postgraduate course but a consultant anaesthetist will have undergone nine years of on-the-job training after their medical degree.
Associates can give anaesthesia under the supervision of a consultant, who might oversee two associates in separate operating theatres at the same time. This would allow more operations to be performed than if the consultant were directly working on a single patient. The NHS’s workforce plan, published in June, set out plans for a ten-fold increase in their use.
Physician associates fulfil a similar role with more general medical training and can see patients and diagnose conditions. The associate roles are not subject to formal regulation, although the General Medical Council is due to take up the role in the second half of next year.
In July concerns emerged about the use of physician associates in general practice, after Emily Chesterton, 30, an actress, died of a blood clot that a physician associate had misdiagnosed. Her parents have said that she had no idea that she had not seen a doctor.
Dr Richard Marks, a semi-retired anaesthetist in London, who has been both a regional director of training and vice-president of the Royal College of Anaesthetists, is one of the leaders of the group opposing the changes.
He said: “Anaesthesia associates are non-doctors that have done a two-year course that enables them to give anaesthetics. Theoretically under supervision and within a narrow scope of practice, but anecdotally both of these conditions are waived in the real world.” He said that arguments that associates were necessary, given a national shortage of anaesthetists, “do not withstand close scrutiny”.
He drew attention to a bottleneck for doctors half way through their training caused by limits on numbers set in 2021. This has led to 700 would-be consultant anaesthetists being unable to progress. “My worry is that many of those currently finding themselves stuck midway through their training will catch the first flight to Australia, where they will be actively welcomed,” he said.
Marks and colleagues have forced an extraordinary general meeting of the Royal College on October 17. It will include motions mandating the college council to ask clinical directors to pause recruitment of associates and ensure that doctors in training are given priority. The group is also pushing for patients to be clearly told when an associate would be providing their care.
Dr Fiona Donald, president of the Royal College, which is surveying its members, said: “We await the results of our member survey . . . There are enormous pressures on anaesthesia services nationwide due to a shortage of anaesthetists, unprecedented demand for our services and a lack of training positions for doctors specialising in anaesthesia.”
An NHS spokeswoman said: “Anaesthetist associates are highly trained practitioners that work under the supervision of a consultant . . . and help free up clinicians so they can spend more time with patients.”
The massive issue is that they have no governing body or licence just supervision as determined by whomever employs them. So they can’t be put in special measures or have their licence revoked.
The PA is the Emily Chesterton case just moved to a job elsewhere.
I’ve had issues with a “prescribing nurse” personally. She’s been ok sometimes, but was very rude and dismissive other times and told me stuff that blatantly wasn’t true when I researched it myself. She immediately saw an old anxiety diagnosis and used that to dismiss valid concerns.
When I spoke to the GP, she completely backed up my concerns (in this case, low Ferratin, which is an easy, cheap and low risk “fix”).
If I hadn’t pushed, if I was extra vulnerable, I’d be left having palpitations and breathlessness. All of which are concerning symptoms anyway and can’t be dismissed as anxiety due to an old diagnosis.
People have to advocate now, and if they can’t, they are screwed if it’s something serious.
3 comments
A revolt by doctors is likely to disrupt plans to plug NHS workforce gaps by getting non-medics to take on some of their tasks.
Physician associates and anaesthesia associates are newer types of medical role that involve significantly less training than doctors receive. Medical leaders have backed plans to increase their use in the health service and the associate roles are key to the NHS Long Term Workforce Plan.
Many doctors say, however, that they are concerned about patient safety and allege that associates are not sufficiently supervised in short-staffed and underfunded hospitals.
A group protesting against the changes has forced a meeting at the Royal College of Anaesthetists in an attempt to halt its support for anaesthesia associates.
The Times understands that similar efforts are at an early stage in other medical specialties, where physician associates are being used more often.
Anaesthesia associates undertake a two-year postgraduate course but a consultant anaesthetist will have undergone nine years of on-the-job training after their medical degree.
Associates can give anaesthesia under the supervision of a consultant, who might oversee two associates in separate operating theatres at the same time. This would allow more operations to be performed than if the consultant were directly working on a single patient. The NHS’s workforce plan, published in June, set out plans for a ten-fold increase in their use.
Physician associates fulfil a similar role with more general medical training and can see patients and diagnose conditions. The associate roles are not subject to formal regulation, although the General Medical Council is due to take up the role in the second half of next year.
In July concerns emerged about the use of physician associates in general practice, after Emily Chesterton, 30, an actress, died of a blood clot that a physician associate had misdiagnosed. Her parents have said that she had no idea that she had not seen a doctor.
Dr Richard Marks, a semi-retired anaesthetist in London, who has been both a regional director of training and vice-president of the Royal College of Anaesthetists, is one of the leaders of the group opposing the changes.
He said: “Anaesthesia associates are non-doctors that have done a two-year course that enables them to give anaesthetics. Theoretically under supervision and within a narrow scope of practice, but anecdotally both of these conditions are waived in the real world.” He said that arguments that associates were necessary, given a national shortage of anaesthetists, “do not withstand close scrutiny”.
He drew attention to a bottleneck for doctors half way through their training caused by limits on numbers set in 2021. This has led to 700 would-be consultant anaesthetists being unable to progress. “My worry is that many of those currently finding themselves stuck midway through their training will catch the first flight to Australia, where they will be actively welcomed,” he said.
Marks and colleagues have forced an extraordinary general meeting of the Royal College on October 17. It will include motions mandating the college council to ask clinical directors to pause recruitment of associates and ensure that doctors in training are given priority. The group is also pushing for patients to be clearly told when an associate would be providing their care.
Dr Fiona Donald, president of the Royal College, which is surveying its members, said: “We await the results of our member survey . . . There are enormous pressures on anaesthesia services nationwide due to a shortage of anaesthetists, unprecedented demand for our services and a lack of training positions for doctors specialising in anaesthesia.”
An NHS spokeswoman said: “Anaesthetist associates are highly trained practitioners that work under the supervision of a consultant . . . and help free up clinicians so they can spend more time with patients.”
The massive issue is that they have no governing body or licence just supervision as determined by whomever employs them. So they can’t be put in special measures or have their licence revoked.
The PA is the Emily Chesterton case just moved to a job elsewhere.
I’ve had issues with a “prescribing nurse” personally. She’s been ok sometimes, but was very rude and dismissive other times and told me stuff that blatantly wasn’t true when I researched it myself. She immediately saw an old anxiety diagnosis and used that to dismiss valid concerns.
When I spoke to the GP, she completely backed up my concerns (in this case, low Ferratin, which is an easy, cheap and low risk “fix”).
If I hadn’t pushed, if I was extra vulnerable, I’d be left having palpitations and breathlessness. All of which are concerning symptoms anyway and can’t be dismissed as anxiety due to an old diagnosis.
People have to advocate now, and if they can’t, they are screwed if it’s something serious.