Mon. Jul 22nd, 2024

Opinion Article – By Alexander Reynolds

Recent events across the healthcare spectrum are finally taking a toll on the PA profession.   

The recent RCP EGM outcome voting to restrict the growth of the PA profession, the grossly misinformed BMA “scope of practise” and the relentless PA bashing on social media are taking its toll on PAs, their mental health and in some cases destroying careers.   

It seems that the assault on our identity as Physician Associates, our ability to practise as clinicians and the potential to have a good career is being eroded by multiple institutions and governing bodies from all sides.  

A pertinent reminder as to why we have suddenly started to feel so vulnerable as Physician Associates is showcased by the lack of involvement with Physician Associates at the recent RCP EGM.   

The EGM, as per their bye-laws, meant that only RCP fellows could attend and vote. Yet this vote was about Physician Associates and voted on by only Doctors.   

I understand that the bye-laws are there to provide a transparent and fair process when EGMs are called for on debates about issues that are focused on doctors. But where the bye-laws fall short is when it involves Physician Associates.  

PAs themselves can’t become fellows in the RCP and therefore cannot vote on matters about their own profession at RCP EGMs.   

The result? – decisions are made for the entire Physician Associate profession that do not have a single Physician Associate voice at the debate, nor do Physician Associates have the ability to represent themselves in these discussions.  

Is this a fair process? I don’t think so.  

Every other profession has the opportunity to participate in the growth and progress of their profession, but in this case, Physician Associates do not. Perhaps the RCP should have considered updating their bye-laws when deciding to help establish the FPA to allow debates pertaining to PAs at EGMs to allow PAs to join the debate.    

I have recently heard the adage being said – “PAs are often on the menu, but not at the dinner table”. In other words, we are talked about but are not part of the conversation.  

And the results of this inadvertent gagging of our profession?   

Unchecked restrictions to practice on a group of people, who have studied at university for 5+ years, sacrificed years of their time to the learning and training of caring for others, only to find out that organisations, institutions and in some cases employers being harassed and cajoled into self-censorship to impose a “voluntary restriction on practice” for the PA profession.   

Earlier this month, Dame Sara Khan, a human rights activist and the government’s Independent Adviser for Social Cohesion and Resilience, published her report on “Threats to Social Cohesion and Democratic Resilience”.    

She termed a new phrase called Freedom- Restricting Harassment – FRH for short.   

Referring to the growing concerns that there is a culture of threatening and intimidatory harassment leading to serious censorship, affecting all aspects of public life.   

She goes on to further define FRH as acts such as Doxxing (outing people on social media), inciting hatred against individuals or families and sending death or rape threats, which all lead to victims censoring themselves due to the threatening nature of events, resulting in a “chilling impact on freedom of expression and other democratic freedoms”.   

As a PA myself watching things unravel in our profession, this resonates with me.  

There are countless examples of online doxxing, and threatening behaviours (such as GMC referrals, referrals to police, threats that any PA will kill someone etc etc), which have arisen from a small group of doctors.   

Dame Sara Khan goes on to explain “By evoking such emotional responses, extremist and other malign actors capitalise on the tensions and discontent caused by these issues, in an attempt to breed further division, distrust and disillusionment. By exploiting people’s grievances and resentment towards the perceived failure of our country to deliver for them (in our case a failing NHS due to PAs…), while also promoting a narrative that rejects pluralism and our shared democratic values, they attempt to stoke further division and hostility in our society (further stoking mistrust in reputable establishments, such as the GMC, RCP and other recognised institutions for their gain).    

Why is this important for PAs?  

I see this narrative being pushed by the BMA and Doctors Vote (DV) as a worrying sign of bringing about an unstable social cohesion, painting a picture of a desperate and failing NHS service, when in fact, new ideas and new ways of working should be embraced and welcomed. The absorption of novel ways of working has a profoundly positive effect on how we deliver care in our NHS. There is a push to increase productivity in the public sector and regulating PAs & AAs allows more doctors to deliver better care. This is clearly a positive step forward.   

Do the BMA or DV see it this way? Clearly not.   

Dame Khan recommends that professional bodies and Unions should draft guidelines so that they have the right protocols and approaches in place when dealing with incidences of FRH and conduct annual surveys to understand the extent and severity of freedom-restricting harassment faced by people within their respective professions.   

Addressing FRH practices head-on helps to keep a sense of profound reason and objectivity in decision-making on key topics, whilst avoiding the narrative of bending to the will and opinions from aggressive and threatening behaviours, even if it is not the thing you believe in and hindering freedom of expression or encouraging debate.  

So, where do we go from here? Do we encourage institutions such as the RCP to enact FRH guidance, so they are aware of the BMA’s harassment of MAPs?  

Do we call on the BMA to make themselves more aware of the group of junior doctorswho have taken over the BMA? (https://www.thetimes.co.uk/article/junior-doctors-strike-how-a-reddit-rebellion-took-over-the-british-medical-association-swp23j3qg).   

Do we call for the GMC to enact these recommendations, to make them aware of the FRH some of their members might be facing from the news?  

I guess, what I am saying, is that there are green shoots of positivity in our profession to look forward to.   

We WILL be regulated by the GMC.   

There WILL be a recommended Scope of Practice published by the FPA soon (which employers will follow).  

There is SUPPORT for PAs in the GMC and beyond 

You can have a successful and happy career as a Physician Associate.  

We need to find our voice, and not be coerced into “accepting the inevitable”.   

UMAPs are growing to be a voice of reckoning for our profession and are standing up for who we are and what believe in.    

PAs around the country are slowly but surely realising that the very fabric of our profession, and our desire to care for the sick and ill, is somehow about to be stripped away. There is a desperate need for us to fight back against the unreasonable unfair discussions around our profession.   

I hope, at the upcoming FPA AGM, we see this need to stand up on our own two feet and break away from the clasps of the RCP.   

We need our own Royal College of Physician Associates, who have the ability to decide what we do, and how we do it.   

But most importantly, include your voice, the PA voice, in debates about our profession.   

Disclaimer – The views and opinions expressed in this article are solely those of the author/contributor and do not necessarily reflect the official position of our organization, The PA+PER.

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