Developing Anaesthesia and Physician Associates key to NHS workforce challenge

The health service is living through one of the worst winters in its history. Patients are sicker, there are more of them and the ability of doctors and other health professionals to treat them is under severe strain.

At the heart of the challenge is the vexed issue of workforce – ensuring the number of available staff corresponds to the number of patients in need of their care. This is not only a question of attracting new healthcare professionals, but also of keeping hold of the ones we already have. As we’ve seen, recruitment without retention is like watching sand slip through your fingers.

There’s no switch we can flick that will magic up the number of healthcare workers we need. Developing homegrown talent in the form of extra UK medical graduates, though important, is not a quick fix. A typical medical degree lasts at least five years before the years of training required to cultivate a doctor’s skills. In recent times, we’ve relied on the supply of overseas doctors choosing to work in the UK, with the number of international medical graduates increasing by 40% in the last five years. But this source of talent is not sustainable, and we can’t assume it will, or should, endure.

In short, there is no cavalry coming over the hill, bringing with it the requisite number of health workers to meet the country’s growing need. But that doesn’t meet there aren’t solutions to be found.

The Government has just published a consultation on the regulation of anaesthesia associates (AAs) and physician associates (PAs). There are already nearly 4,000 of these skilled professionals working across the health service, with more to come as graduates enter the workforce.

In both general practice and hospital settings, AAs and PAs have huge potential to alleviate pressures by providing care to patients as part of skilled teams. But while AAs and PAs are an increasingly important part of the workforce, there are currently no mandatory standards for their education, training or professionalism. The changes the Government is proposing will enable us to take on the regulation of these roles, so we can help develop them and the contribution they make to patient care, including prescribing responsibilities. In turn, that will allow numbers to grow, helping to address the workforce challenges we face.

As well as enabling AAs and PAs to maximise their contribution to the workforce, the reforms proposed by the Government will set the blueprint for regulation that is fit for modern needs.

Our work is currently governed by the Medical Act, legislation that is now 40 years old and wildly misaligned to the needs of patients and practitioners today. The current constraints affect the whole gamut of our activities – from who we add to the medical register, to how we investigate complaints. All too often, these limitations create a mismatch between our powers and the reality of the workforce we’re regulating.

We are required to fully assess every complaint we receive, even if it doesn’t raise fitness to practise concerns and won’t meet our legal thresholds. Conversely, if a complaint is more than five years old, we can’t consider it, unless we can make a clear argument that it is in the public interest to do so.

This is perverse. It means we end up investigating complaints that don’t need investigating but can’t investigate the complaints that do. That’s not in the interests of doctors, who end up being investigated unnecessarily, and it’s certainly not in the interests of the public we’re here to protect.

Reform will allow us to devote our energies to the work of highest priority – supporting clinicians to deliver first-class care. As doctors continue to vote with their feet, the need to keep professionals in the workforce, and develop their talents, has never been greater. The Government’s consultation gives us the chance to do this, and we must grab the opportunity with both hands.


Charlie Massey is Chief Executive of the General Medical Council