In his crusade to relieve the ever-mounting pressures on the beleaguered National Health Service, Health Secretary Wes Streeting is turning to far-flung corners of the world – this time from Rio de Janeiro’s favelas – for inspiration. His latest interest, Brazil’s Family Health Strategy, is undoubtedly intriguing and warrants further study. Yet, while the UK explores radical solutions to its healthcare crisis and workforce shortages, thousands of sorely needed healthcare professionals risk being pushed out of the system due to petty infighting and lobbying from special interest groups more concerned with preserving their status than solving the country’s health emergency.
Recent months have seen increased media scrutiny surrounding physician associates (PAs) – healthcare professionals who assist consultant doctors in diagnosing and managing patient care in GP surgeries and hospitals. Ahead of the Government’s upcoming Leng Review into the future role of PAs in the NHS, representative bodies such as the British Medical Association (BMA) and the Royal College of Physicians (RCP) have submitted evidence claiming PAs pose a risk to patients due to underqualification and misdiagnosis. These groups are lobbying for the qualification to be heavily marginalised, potentially forcing thousands of practising PAs out of the NHS and derailing Government plans to increase their numbers to 10,000 within the next decade.
To qualify as a PA in the UK, students must first complete a life sciences-based bachelor’s degree, followed by a specialised two-year master’s degree and a board exam to successfully register with the Faculty of Physician Associates, the UK’s professional membership body. The level of intellectual and academic rigour required for this role is only marginally less demanding than the standard five-year training that doctors go through and are both regulated by a professional board to ensure quality and competence. Moreover, PAs are explicitly not doctors and are restricted from carrying out certain tasks such as prescribing medication or ordering scans like X-rays. Their pay also reflects their role—PAs earn significantly less over their careers than doctors, much like nurses do in their distinct professional lane.
In terms of practical experience and patient safety, both PAs and doctors undergo extensive clinical placements alongside qualified practitioners. Standards for care and professionalism apply equally across all roles – consultants, nurses, and PAs alike. There is no question of PAs being given a ‘free pass.’
So why are groups like the RCP and the BMA up in arms about PAs working in GP surgeries and hospitals, likening them to unregulated quacks running amok in the nation’s consulting rooms and wards? The answer is simple: these organisations are lobbying to protect their members’ turf. This is a classic case of protectionist rent-seeking – an effort to suppress a more efficient labour force in order to preserve status and prestige, regardless of the real-world consequences for staffing levels and patient care.
Tellingly, the ‘evidence’ submitted to the Leng Review omits any comparison of medical errors between doctors and PAs, especially given the astounding sums paid out by the NHS due to clinical negligence. With only around 3,000 PAs in the UK compared to nearly 400,000 doctors, one might reasonably question whether these groups are interested in painting the full picture.
Critics also point to junior doctors’ low starting salaries—some earning just £28,000—compared to newly qualified PAs, who may begin at around £40,000. However, doctors’ salaries rise steeply with experience, often reaching six figures, while PAs are generally capped at around £60,000. Short-term pain has long been a challenge for junior doctors as they build towards a well-compensated career in the long run, but that should not justify scapegoating another profession. While there is certainly a case to be made for better compensation for junior doctors, spitefully ousting PAs in a schoolyard spat is hardly the answer.
Ironically, for all the supposed woes facing doctors, they seem implacably opposed to a complementary profession helping to ease their workload. The healthcare market has identified a clear opportunity to expand capacity by introducing a new cadre of professionals to treat more patients more efficiently, but all they care about is the imaginary notion of their toes being stubbed.
PAs have long been integral to various healthcare systems around the world, from New Zealand to India to the United States, where the role originated in the 1960s, where they fulfil key roles in the healthcare labour market. Yet none of these countries have witnessed the indignity and petty squabbles of doctors’ unions desperately trying to gatekeep a valuable source of healthcare professionals from treating patients. For all their talk about standing up for patients and sacrificing for the NHS, their actions say otherwise.
As the Health Secretary continues his efforts to streamline the NHS behemoth and improve patient outcomes, he must resist the pressure of vested interests. Policy must serve the public good—not the egos of professional guilds. Britain deserves a modern healthcare system that makes full use of all qualified professionals. Sidelining PAs would be a serious mistake and a disservice to the millions of patients relying on timely and effective care.
