Following publication of the BMA’s position of the scope of practice of physician associates, today the BMA has published guidance for doctors who supervise PAs and other medical associate professionals.
In the document, the BMA state that ‘MAPs must always work under the supervision of doctors’ which has been the agreed position by the PA profession for decades. The BMA state that they are making it ‘sufficiently clear’ who is an appropriate supervisor for PAs – Consultants, GPs and autonomously practising SAS doctors are all named as suitable as supervisors – which is in alignment with the guidance from the Faculty of Physician Associates.
The BMA state that locally employed doctors, specialty doctors who do not practise autonomously, or doctors in training are not suitable to provide supervision to PAs.
The BMA further state that employers should ensure there is adequate time allocated each working day for every patient to be fully discussed with the supervising doctor and reviewed in person by the supervising doctor if necessary.
Sticking to their previously published position on the scope of practice that PAs should have, the BMA recommend to their members to follow that guidance. This is a significant curtailing of the capabilities of physician associates. The BMA does not have any statutory power to implement the changes it proposes. The British Medical Association (BMA) is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. It does not represent the interests of physician associates as members.
The BMA also say that Consultants, GPs and autonomously practising SAS doctors should notify their medical defence organisation that they are undertaking such supervision and ensure they have adequate professional cover, noting the requirement to double check patient symptoms, clinical signs and test results before agreeing to any management plan of a MAP they have agreed to supervise.
The guidance includes specific recommendations for both supervising doctors and employers, emphasising the importance of supervising doctors having allotted time for discussions with PAs and to review patients, in accordance with the BMA’s safe scope of practice.
BMA chair of council Prof Phil Banfield said: Doctors who supervise MAPs must be confident that any person they delegate to has the necessary knowledge, skills and training to carry out the task being delegated. This has been highlighted by past medical tribunal rulings that show unsafe supervision of MAPs can not only threaten the safety of patients but also the license to practice of the doctors who remain responsible for those patients. They need to be certain what the competencies and defined limits of their colleagues are, and what they should do to make sure all members of the team understand the job at hand.
“Unfortunately, doctors have been left without clear guidance on how to supervise these staff placed under their care. PAs have been asked to work above their training and competencies without direct access to their named supervisor who would be able to double check clinical findings and plans of management. Nor can that responsibility for supervision just be passed over to those unable to undertake it safely because of their own workloads or those untrained to carry the risk of responsibility for others’ actions. This is where critical patient safety incidents become more likely and catastrophic mistakes happen.
“This is the first time such clear guidance has been produced for the NHS and for doctors, and the BMA is once again filling the void left by others by providing a straightforward set of recommendations that can be implemented locally so that doctors and employers are clear about their responsibilities. It is that clarity which will give all staff and the public the confidence that patients are being treated by the right healthcare professionals at the right time.”