The Scottish government is willing to consider a UK-wide approach to changes in physician and anaesthesia associate professions, which are to be put into place in NHS England following an independent review of the safety and effectiveness of the roles.

It comes as doctors in Scotland are urging the government to take heed of the findings, which include renaming the positions and setting a clearer scope of the roles.

In response to heightened controversy about the expansion of physician associates (PAs) and anaesthesia associates (AAs), the UK government commissioned an independent review to determine their safety and effectiveness

That review, led by Professor Gillian Leng, has now made a series of recommendations to better distinguish them from doctors, strengthen their career development and position them as complementary members of the medical team.

Among these are renaming the roles to physician assistant and physician assistant in anaesthesia and wearing distinct uniforms and lanyards.

Other proposals include new practice boundaries, including PAs not being the first to see patients in clinical settings and no longer being allowed to request ionising radiation, used commonly in diagnostic imaging like X-Ray and CT scans.

Though recommendations to NHS England, the Scottish government has confirmed ministers are willing to consider a UK-wide approach to the recommendations.

A Scottish government spokesperson said:

“Given the potential impact on the roles in Scotland, the Cabinet Secretary intends to reach a formal position on the recommendations in due course.”

Concern from doctors

PAs and AAs have been working in Scotland and the rest of the UK for decades as part of multidisciplinary teams in both primary and secondary care.

According to current Scottish parliament figures, there are 128 PAs and 25 AAs working in NHS Scotland.

Their roles involve taking medical histories, performing physical examinations and diagnosing illnesses.

However, doctors have concerns that PAs have been increasingly used to fill the gaps in jobs usually carried out by them.

The review also heard that PAs making the wrong initial diagnosis risks putting patients on an inappropriate pathway, with ‘catastrophic’ consequences.

Doctor organisations BMA Scotland and Royal College of Physicians Edinburgh (RCPE) are now saying the Scottish government should implement the recommendations of the review, but that more must be done to protect patients.

Particular concerns include the role of the General Medical Council (GMC) as regulators of PAs and AAs, expectations around supervision and the lack of a set scope of practice.

BMA Scotland Chair Dr Iain Kennedy said the Scottish government should now provide greater clarity on the roles, rather than leaving it up to local employers to decide what is safe:

“A major flaw in the report is it failure to call for a nationally set scope of practice, which would end the current postcode lottery where local decision making decides what these roles can and cannot do.

“In our view that remains inherently unsafe for patients, with simply unacceptable levels of variation.”

The review states PAs should spend at least two years working in secondary care before entering primary care, allowing for greater supervision to identify any safety issues.

PAs could then be eligible for a primary care role focused on communication prevention in areas from smoking to diet.

However, it does not propose a national scope of practice, highlighting that other healthcare professionals do not follow such a list and that GMC training regulation provides a ‘clear building block’ for better defining the roles of PAs and AAs.

The RCPE welcomed the review while adding ‘much more work is now required’, particularly around supervision and the ‘scope and ceiling’ of PA roles.

It says it will continue to advise that PA roles, responsibilities and scope of practice should be defined nationally, rather than at a local level.

The future of PAs and AAs in Scotland

The Scottish government has said previously it intends to take a more evidence-based and gradual approach to increasing their numbers than in England, but c these roles will be ‘integral’ to a sustainable NHS Scotland workforce.

It has been working with NHS Education for Scotland and representatives from across the healthcare workforce to understand the potential opportunities associated with an expansion of the two professions.

BMA’s Dr Kennedy says without national standards, unacceptable variation will persist and risk patient safety, adding Scotland can “do better” for patients and doctors by providing guidance to employers on what is safe for PAs:

“The Scottish government has the opportunity to do better here and act to protect patients and doctors by not simply relying on employers to decide what is safe for these roles, and what isn’t.

“Such clarity would also help those performing those roles, giving them the confidence they are acting within their competence and training.

“At the heart of this is the crucial issue of patient safety, so the Scottish government must act now to ensure the risks associated with how these roles are finally properly mitigated.

“Without that, any use of these roles by boards across Scotland will continue to pose a major threat to the safety of patients in Scotland’s NHS.”

Read more: Government to merge two national NHS boards; NHS waits pushing patients private; Too many doctors hesitant to ask for help; Insight: Scotland’s ‘invisible’ patients and carers; Scottish health research collaboration extended; Watchdog criticises homelessness service cuts; NHS doctors unemployment crisis despite understaffing; ‘Big leaps’ needed to secure change for disabled people; Innovation key to improving NHS Scotland, say staff

Sign up to our bulletin for key health & social care updates straight to your inbox.