Medical associate professions (MAPs) employer guidance

Over the past six months NHS Employers has convened discussions on the role of medical associate professions (MAPs) (including physician associates). The discussions brought together a wide range of key stakeholders from the wider NHS, including professional bodies, representatives of patients and those expressing concern around the expansion of these new professions. While those discussions were constructive and collaborative it was not possible to produce clear recommendations for employers from this group that all parties were comfortable with, not least because of the rapidly changing situation regarding MAPs in the UK.

The organisations NHS Employers represent have asked for clarity and guidance around these new roles and as such this is our current position on several key issues.

Identity and status of MAPs

The NHS workforce is developing rapidly with new roles that are poorly understood by the public and many stakeholders. This expansion is particularly noticeable in primary care and ensuring these newer roles are easily identifiable is essential, especially for the public.

The title ‘physician associate’ (PA) is established by law and will be protected. No PA or anaesthesia associates (AA) should be appointed in place of a doctor, as confirmed by NHS England.

It is imperative that all NHS professionals introduce themselves, their roles and their relationship to supervising clinicians to their patients. The Faculty of Physician Associates (FPA) has published guidance in this area, and this should be adhered to. 

For PAs this ideally should be: ”Hello, my name is XX and I am a physician associate working for YY. I work alongside doctors, but I am not a doctor.” 

PAs work under the supervision of a named senior doctor. 

The language used to describe the PA role in job adverts and in other promotional materials needs to accurately reflect what a PA is and not blur the lines between PAs and doctors.

Actions for employers

• Restate guidance to all staff groups regarding good practice in communicating with the public and introducing oneself to the public, as well as other clinical colleagues.
• Review adverts and job descriptions for MAPs roles to ensure that there is clarity.

Scope of practice for MAPs 

Clearly defined scope of practice for PAs and close supervision to ensure this is followed is critical for patient safety. Currently there is no single widely agreed scope of practice although several organisations have worked or are working on scope. 

There are minimum standards that have been long established by the FPA and accepted by the GMC, which will be enforced by law when regulation is in place. 

The BMA have recently produced a national scope of practice. However, some of the scope standards in the BMA guidance diverge from those approved by the GMC for registration and a significant number of PAs working in secondary or tertiary care have been working safely above the level set out in the BMA document for many years. 

The Royal College of Physicians (RCP) is at final stages of wide internal and external consultation on new guidance - Physician Associates: Guidance for Safe and effective Practice. This guidance will also include how supervision should be implemented.

MAPs cannot substitute for doctors on rotas and if involved in specific rotas should only work within their scope of practice with supervision. 

Actions for employers

• Assurance that systems of supervision of practice for MAPs are in place and that key clinical policies are properly understood and applied. This should include briefing in induction for new members of clinical teams where MAPs are deployed.

Training MAPs

Medical colleagues report that there has been a significant impact of expansion of the PA profession on their training opportunities.

The specific impact that PAs working and training has on medical education and training needs to be further explored and tackled at a national as well as local level. Locally, it is the responsibility of the employer (including those that do not employ PAs), working with educational bodies, to ensure training and development opportunities are equitable and accessible for all their employees, including both those in training and those in non-training posts.

Action for employers

• Organisations to review with the director of medical education all feedback regarding missed educational opportunities and to share feedback with clinical leads/directors, educators as well as the local negotiating committee (LNC) and the resident/locally employed workforce.

Patient safety and governance for MAPs

Where there are concerns about practice, organisational policies, safety or educational opportunities, then employers and regulators must ensure that the processes for raising concerns are understood, including access to independent mechanisms. Such concerns are the responsibility of the relevant organisation (trust or primary care organisation) to address and must be done so in line with the principles of civility and fairness. 

Action for employers

• All colleagues should be reminded of the clinical governance and incident reporting processes, including the principle that they are applied fairly and consistently.

Supervision of MAPs

Supervising other colleagues (medical and non-medical) is an essential aspect of the unique accountability that doctors take for patient care in healthcare settings. Doctors work in and lead multidisciplinary teams, which include professionals from various health and social care disciplines. Effective communication within and between teams is vital. When supervising colleagues (including MAPs), doctors must take steps to ensure that the staff they supervise have the necessary knowledge, skills and training. Tasks and responsibilities can be delegated, but with this understanding of a colleague’s competence, and that this will vary over time and by their role. 

Enhanced supervision will be necessary for MAPs who are at the early stages of their career. 

Action for employers

• Medical directors should ensure that appraisal policies reflect consideration of supervision of non-medical clinicians including MAPs.