The Leng Review has made itself clear enough: Physician Associates and Anaesthetist Associates should be renamed (to Physician Assistant and Physician Assistant in Anaesthesia respectively), their roles more clearly defined, career progression more apparent and training and supervision made more robust. And yet …
Doctors for the NHS took the view that PAs and AAs should not be appointed and used to fill workforce shortages, especially if that entailed working unsupervised and diagnosing undiagnosed (ie, new) patients. That was grossly unfair both to the health professionals and patients. Least of all in a situation where many services were critically under-staffed, underfunded and over-worked. Drafting in a new group of people to address these problems in the astonishingly vague way in which it was being done was begging for avoidable harm. We were especially critical of the job title, imported from that paragon of health inequality and privatised healthcare, the USA: ‘Associate’ in itself is ambiguous and ‘Physician’ – hardly ever used to denote physicians to the general public – lent the title a superior air which could (and did on occasion) mislead the public into thinking they were being seen by someone holding a medical degree. Doubly unfair again.
So the core recommendations of the Review are welcomed. But there remains a key question: the elephant in the room, or rather, the one absent from it. Medical training. Professor Leng was unambiguous in pointing out that unless the current parlous state of postgraduate medical training is addressed nationally, having doctors in sufficient numbers who can supervise other health professionals adequately cannot be done. Resident doctors are left guessing where in the country they must dash, often at 2 weeks’ or less notice, to further their medical training and careers. In some specialties, applicants for training places outnumber the places available by 5 or more. In some cases, many more – Leng reports up to 112 applicants for each training place in general practice. At a time when GP shortages are at an historic low. How can this make sense? This cannot and must not go on.
We welcome the development of new technology, new ways of doing things, changing medical roles to suit new situations: IF, and only if, these changes are true to the NHS’s founding principles, which we uphold and campaign for. The recommendations of the Leng Review seem to offer hope for that. Now it is up to government to ensure they are realised.