NHS England chief workforce, training and education officer and national medical director letter to chair of the British Medical Association

Sent via email: pbanfield@bma.org.uk

Dear Phil,

We are writing following your press release on 16 November calling for an immediate pause to the recruitment of physician associates and anaesthesia associates because of your concerns about regulation and supervision.

As you know, these internationally recognised roles have been in the NHS for 20 years as part of multi-disciplinary teams under appropriate supervision, mostly by doctors. They perform specific aspects of patient care and, based on case studies, clinical and professional engagement and literature reviews, are proven to increase the effectiveness of multidisciplinary teams.

This evidence tells us MAPs are safe, increase the breadth of skill, capacity and flexibility of teams, positively contribute to patient experience and flow, and reduce workload pressure on other clinicians. Any issues of patient safety identified resulting from MAPs must be addressed in the same way we would any other profession.

The NHS Long Term Workforce Plan makes clear that any suggestion these roles will somehow replace doctors is wrong: the plan calls for 12,000 more MAPs and 60,000 more doctors – a factor of 5-1 in favour of more doctors.

Like you, we are absolutely committed to ensuring regulation to further embed them into the NHS and ensure current supervisory expectations and employer duties regarding effective deployment of these roles are backed up by effective regulation. We are working closely with colleagues at DHSC and GMC to move as quickly as possible to regulation.

You will remember we set out next steps in our open letter on 17 October and subsequent correspondence with the GMC, where we outlined that we would:

1. Work with partners to develop curricula, capability and career frameworks, CPD, assessment and appraisal standards, and supervision guidance.

2. Continue to ensure expertise, infrastructure and leadership so MAPs can be effectively trained and integrated into teams, through national standards, defined scope of practice, and assessment of educational capacity.

3. Remind employers about their responsibility to ensure effective and appropriate supervision of MAPs, that MAPs are shaped within an acceptable scope of practice, and they work within established guidelines.

4. Continue work with the Academy of Medical Royal Colleges and individual professional bodies to respond to further concerns or issues.

We received your letter setting out the BMA’s concerns and position and have arranged a meeting for later this month; however, may we suggest an earlier meeting. This continuing public discourse around MAPs is impacting relations between your members and their MAP colleagues, the health and wellbeing of MAPs already working in the NHS, and potentially the confidence of patients. We are keen to work together to address these issues as soon as possible in the interests of patients.

We look forward to continuing our work with you and other partners to deliver the NHS LTWP we worked so hard to create together, including through the Medical Associate Professions Oversight Board, on which we are grateful for the BMA’s continuing involvement.

We look forward to hearing from you.

Yours sincerely,
Dr Navina Evans CBE, Chief Workforce, Training and Education Officer, NHS England
Professor Sir Stephen Powis
, National Medical Director, NHS England