Patient safety in Scotland’s hospitals is at risk as NHS bosses resort to employing hundreds of doctors on reduced pay to cover staff shortages.
Serious concerns have been raised over plans to plug gaps in the health service workforce with doctoral associates, a role that requires just two years of training.
New figures reveal that 250 medical associates are already working across the health service and it is recommended that at least 40 more be trained each year to boost the struggling workforce.
But the British Medical Association is calling for continued recruitment of medical associate professionals (MAPs), which include physician associates, anaesthetists associates, surgical care professionals and advanced critical care professionals, until serious concerns about patient safety are addressed.
Others fear that increasing reliance on PCPs will create a “two-tier” health system.
Dr Iain Kennedy, president of the British Medical Association in Scotland, said: ‘It is worrying to see suggestions that GPs are a possible alternative workforce option or solution to NHS Scotland’s problems with doctor shortages.
The BMA has expressed concern about plans to plug gaps in the health service workforce with associate doctors.
‘To be clear, the only solution to our medical staffing crisis is adequate investment in doctors.
‘Only doctors are medical professionals.
“We do not believe there should be further recruitment of MAPs until the clear concerns about scope expansion and patient safety are resolved.”
The findings appear in a landmark report by a Scottish NHS Commission on the future of PCPs.
MAPs perform a variety of tasks including minor assessments and procedures in physicians’ offices and hospitals after completing a two-year college training course.
Scottish Government-appointed experts say the expansion should go ahead despite “tension” with other staff groups.
The Commission also said they are needed to address the shortage of doctors and nurses and the growing number of patients.
Their report states: ‘To ensure the sustainability of healthcare in the future, NHS Scotland must plan how to meet the increasing demands on services from an ageing population.
‘This has been exacerbated by shortages in some professions and specialties and the disruption caused by the COVID-19 pandemic, which resulted in an unprecedented backlog of elective care.’
The Scottish Government has pledged to increase NHS staff by 1,500 to reduce waiting lists.
The report notes that this “requires innovative solutions” given staff shortages in nursing and medicine, “such as increasing the workforce” of physician assistants.
He added: “MAPs are a potential alternative workforce option that adds flexibility and resilience to teams and contributes to the increase in essential clinical capacity to meet current and identified future demand.”
Scottish Conservative health spokesman Dr Sandesh Gulhane said: ‘Under the SNP, GP numbers have fallen to dangerously low levels and they are now trying to use doctor associates to fill the gaps, despite only having completed a two-year training course.
‘Many medical experts are unclear about the role of PAs and are concerned that relying more on them could create a two-tier health care system.’
The report warns of “tensions within some professional groups and aligned protectionism.”
The role of medical associates has come under scrutiny amid long-standing complaints from the BMA.
Roles are said to be “poorly defined” and assistants could end up doing work they are not trained for. It is also said there can often be confusion among patients and their families about whether they have seen a medical assistant or a doctor.
The GP regulator, the General Medical Council, will become the regulator for physician associates (PAs) and anaesthetists (AAs) in December 2024.
But the BMA has launched legal action against the GMC over how it plans to do this in what the BMA has called “the dangerous blurring of the lines for patients between highly qualified and experienced doctors and assistant roles”.
In Scotland, MAPs are taught at the University of Aberdeen, although more universities may offer the course in the future.
Entry requirements for the two-year course are a degree in a health-related medical science subject, such as pharmacy or physiotherapy.
A Scottish Government spokesperson said: ‘Associate medical professionals are an important part of the NHS Scotland workforce and will continue to contribute to the Scottish Government’s priority of developing a sustainable system that ensures people receive the right care, at the right time and in the right place.
‘Scottish Ministers are clear that any future growth of these valuable roles must be gradual and evidence-based, informed by the work of our National Medical Associate Practitioner Programme Board.’
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