Why GMC regulation of Physician Associates is imperative to tackling the child health backlog
By Sinead Phelan, Communications Officer at RCPCH
Month by month, there are more children on a waiting list within the NHS, 100,000 more than there were a year ago. This might be an infant seeking help with a developmental delay, a young adult waiting for counselling or perhaps a 12-year-old seeking a consultation for their asthma. All these individual children add up more than 350,000 in total, the highest ever on record in paediatric care, a terrifying number that doesn’t even include the ‘hidden’ waitlists in community services.
What kind of affect does that have on the health and wellbeing of children and young people? Delays accessing these essential services can impact social development, school readiness and ultimately educational outcomes, and further drive health inequalities across the country. But also — and equally important — what effect does this have on the paediatric and child health workforce? Is enough being done to support, train and resource health care staff? What types of solutions are there?
What is the problem?
The UK child health workforce suffers from the same planning problems, underfunding and staffing issues as the rest of the health workforce. Paediatricians work tirelessly, providing the best care for children and young people across the four nations. The recent Health and Social Care Committee Workforce report detailed barriers to recruiting and supporting international medical graduates, eye-watering locum and agency spend and a recurring theme of poor facilities for staff across the whole NHS. There are widespread workforce shortages, burnout, extreme stress and unsustainable workloads for paediatricians. The lack of a clear direction from Government has not helped matters and there is an urgent need for the long-delayed workforce plan to be published. In the meantime, there are actions that can bolster the child health workforce, one of which is regulating Physician Associates or PAs.
Who are PAs?
PAs are medically trained, generalist healthcare professionals, who work alongside doctors and provide medical care as an integral part of the multidisciplinary team. PAs bring additional people into the health and care system. The majority come from science and research backgrounds and others from different fields entirely. They work with a dedicated medical supervisor, but are able to work autonomously with appropriate support, carrying out duties such as taking medical histories from patients, carrying pit physical examinations, developing and delivering appropriate treatment and management plans, and providing health promotion and disease prevention advice for patients. In the paediatric workforce, a PA might do newborn baby checks and heel prick bloods on a postnatal ward, for example.
What’s really key to PA roles is that they do not rotate but instead work in the same clinic or unit, nine to five Monday to Friday. This offers a continuity of care and means PAs can really get to know patients and their families and carers. PAs help optimise teams not by replacing doctors but providing a key role in multidisciplinary teams for better efficiency; teams can see more patients, maintain patient flow and overall provide better care for the patients.
However, because PAs are currently not a regulated profession, — although they do have their own voluntary register — they are limited in some of the tasks they can undertake. For example, they cannot request x-rays or CT scans or indeed prescribe medications. The GMC has highlighted they would like the job of regulating PAs and subject to DHSC legislation, believes they should be able to become prescribers. In a survey carried out by the Faculty of Physician Associates (FPA), an overwhelming majority (92%) said not being regulated had a negative impact on their team’s ability to move through caseloads and that lack of regulation impacted how PAs felt in their roles. Moreover, patients do need help in understand the different types of healthcare professional to give them even more confidence in PAs. With GMC regulation, PAs can go further in being a key member of the multidisciplinary team for more efficient care.
Why hasn’t this happened already?
Regulation of PAs is on its way after years of campaigning. While initially estimated to take place in 2021/2022 the new timetable is for PAs to be regulated by the latter half of 2024. Later than expected, it is crucial for the paediatric workforce — and the wider NHS — that this timeframe is not pushed out even further. As workforce is the limiting factor in both bringing down waiting lists and delivering healthcare safely, PAs can play a key innovative part in overcoming the current issue of a high demand for care and not enough people to provide it, but they continue to be held back by lack of regulation. This is why the College supports the FPA campaign to #RegulatePAsNow.
The contribution of all professionals within multidisciplinary teams has to be optimised within the NHS and in paediatrics given the added value from colleagues in nursing, pharmacy, Advanced Clinical Practitioners, PAs, and other allied health professionals. The regulation and recruitment of PAs must be accelerated.
