Royal College of Physicians in Edinburgh have nicely defined the role of PAs.
Phlebotomy, performing simple procedures such as ECG recording, test ordering, and results checking.
Hopefully this will be accepted by three other Colleges too.
🧵 We have written an open letter to the GMC setting out how its approach to the regulation of AAs and PAs blurs their distinction from doctors and constitutes a failure to fulfil its legal duties .... 1/n
6 Resolutions. 6 overwhelming majorities. Thanks to all those that voted for our resolutions - a clean sweep!
We would like to extend our thanks to the College for working with us so constructively.
And lets be proud that we're Anaesthetists. Anaesthetists United.
Resolution 1 - Proposed expansion of Anaesthesia Associates.
Voting result - resolutions is passed! The Council is advised to halt the expansion of AAs.
FOR: 88.88%
AGAINST: 11.12%
#RCOAEGM
Does regulating physican and anaesthesia associates breach the
@GMCUK
charitable objectives?
We are writing to them to seek clarification. Co-sign the letter here:
🚨 BREAKING 🚨
After exceeding the 149 signatures needed to call an EGM WITHIN THE FIRST FOUR HOURS AFTER LAUNCH, we are now close to surpassing 500 signatures - that's more than 300% of the required number!
We are a group of anaesthetists, concerned about the planned expansion of Anaesthetic Associates. This will impact the quality of delivered anaesthesia, and the training of our future colleagues. Read our mission statement below ⬇️
Doctors supervising Anaesthesia Associates is ‘economically unviable’, study finds, with the suggestion that the role should be ‘terminated as economically unviable'
Blatant evidence AAs are working outside their scope, that senior leadership is aware and encourages this, only adhering to the rules whilst there is increased scrutiny for AAs.
This is what we've been warning against.
Make your voice heard. Put a stop to this.
#RCoAEGM
Now, I get lots of DMs
But this has to be in the TOP 5 WORST❗️
‘Unhappy vocal minority’ - how dare you raise concerns?
‘We need to be careful, but only while we’re under the microscope’
Storm analogy again when in fact a tsunami is coming 🫠
@SheffieldHosp
@MajorKirsten1
?
'An introduction to the AA role' from Lancaster University.
We have compiled excerpts from three talks by senior AAs. Names and other sources of identifiable information have been removed.
🔴NEW: NHS England orders hospitals to stop using physician associates to cover doctors’ shifts after
@Telegraph
investigation reveals that the practice is widespread.
Charity Commission has agreed to reopen enquiry into whether or not the GMC has breached its charitable objectives by taking on the regulation of anaesthesia and physician associates
The current working model for Anaesthesia Associates is not financially viable. To make economic sense either the level of supervision by Doctors needs to be reduced, likely to compromise patient safety, or the AA programme itself should be terminated.
£1.8m given to one College. And presumably £millions too to other Colleges; and to the GMC and Trusts, so that they will all fall into line.
How much public money is going into Associates, and when will the public finally have a say in whether they want them?
We’ve told the GMC it must cease referring to AAs and PAs as ‘members of the medical professions’, ‘medical professionals’, and in ‘medical practice’, as it does in Good medical practice 2024. These terms falsely imply being doctors, a type of doctor or equivalent to a doctor.
The decision by the Royal College of Physicians to slow the roll-out of Physician Assistants is not yet decided; voting by Fellows is still open.
Only those with FRCP can vote.
Make sure that any Fellows you work with vote for all of the
#RCPEGM
motions
The Medical Act was set up specifically so that the public could distinguish medical practitioners from those that were unqualified. Now the government is proposing to use a parliamentary loophole that completely changes what the Act delivers.
Move in Parliament to rename Anaesthesia and Physician Associates back to the correct and more appropriate title of Assistants.
Has your MP signed it yet?
In law, as in common language, there is only one medical profession: THE medical profession. “The medical professions” is a new term of the GMC’s invention: using the plural i.e. multiple medical professions implies an equivalence to THE medical profession and therefore doctors.
Of course the public are confused about the naming of Physician Associates. They were originally called "Assistants".
Whose idea was it to change the name, knowing it might confuse the public? It must have been somebody.
The government is trying to solve the NHS workforce crisis, not by recruiting and retaining more doctors, but by training cheaper replacements.
They wouldn't do this in other safety-critical industries, why in medicine?
Say NO to AA expansion.
Royal College of Physicians, unlike the RCoA who were very supportive, have been trying to oppose an EGM of their members. Presumably they have their ears wide shut.
Call for an EGM to share with Physicianly colleagues
We note that the original video has now been deleted from
@LancasterUni
youtube account. Our compilation is still available.
We look forward to an explanation.
'An introduction to the AA role' from Lancaster University.
We have compiled excerpts from three talks by senior AAs. Names and other sources of identifiable information have been removed.
They make us rotate. Then they give away our training opportunities to permanent staff.
On call commitments are weaponised against us. We're punished for our versatility, relegated to rota fodder.
There was a time when the GMC proudly portrayed these lofty ideals on its own doorstep.
Now they want to regulate the not-quite doctors.
What a fall from grace.
Fall? Or were they pushed?
We have called for Good medical practice 2024 to be replaced with two partner sets of standards, Good medical practice (for doctors) and Good associate practice (for AAs and PAs). GAP will mirror the same high professional standards in GMP, save for those that cannot apply.
You spoke.
We listened.
Will they?
We have collected all the comments you sent us in support of our EGM - and they paint a very clear picture of how our concerns are resonating with people.
At the EGM of the Royal College of Anaesthetists in October, 89% of the 4,421 anaesthetists voted in favour of pausing the recruitment of anaesthetic associates.
Disappointing to see that
@UHNM_NHS
isn't reading the room.
.
@JeanetteRCR
claims the Royal Colleges she represents welcome the expansion of Associates. Which of the Colleges is she speaking on behalf of? Most definitely not the RCoA.
The full letter can be read on our blog here
Credit and thanks to
@scuderia_panda
who inspired and wrote the letter with support from
@londonanaesth
and the AU team
Indeed, the GMC says “unregistered medical practice is against the law”. If it truly believes that AAs and PAs are actually in medical practice then this raises questions about its historic lack of action against AAs and PAs.
🚨
@AnaesUnited
in the Sunday Telegraph 🚨
The message is getting out there! We want to maintain high quality anaesthesia that is delivered by medically qualified anaesthetists. We are deeply concerned about the proposed expansion of AA numbers.
The GMC calls AAs and PAs ‘medical professional(s)’ but this contradicts established meaning among HCPs and most of the public, for whom a ‘medical professional’ is exclusively a doctor (as a member of the one medical profession). It also contradicts definitions in legislation.
Resolution 2 - amend GPAS and ACSA guidelines to make it clear local opt-outs from College guidance RE supervision of AAs is not allowed.
This resolution is PASSED!
🚨🚨WE ARE THROUGH TO THE NEXT ROUND🚨🚨
Over 700 of you have signed the requisition to convene an EGM. That has now been submitted to the Principal Office at the College.
We expect Notice of a EGM to be issued shortly. Most members can vote at the EGM.
Change is coming.
An overwhelming majority vote by Fellows of the RCP and a staggeringly high turnout. Hats off to those that convened
#RCPEGM
. We are truly
#doctorsunited
.
Now will NHSE start to listen? Or do they need more?
The
@RCoANews
have published their extensive and carefully-designed independently-commissioned survey on AA's.
Main findings - AAs negatively impact doctor training, and expansion is viewed negatively even by those working with them.
Our letter to the GMC enquiring about whether or not regulating AAs is breaching their charitable objects has been sent, together with 1,314 signatures.
More news when we have it.
Is the GMC undermining its own charitable objects and public confidence in the profession by integrating AAs and PAs into its register? So far 1,000 doctors and members of the public have signed our letter to find out - you can join them.
Royal College of Anaesthetists writing to clinical leaders calling for a pause in the recruitment of Anaesthesia Associates. And also implementing EGM motion restricting local opt-outs on supervision. This is big news!
The GMC must fulfil its core objective set in law to “promote and maintain public confidence in the medical profession”. To do this, the public, patients, staff and employers must always be clear who is and is not a lawful member of that profession i.e. a registered doctor.
Thank you to everyone who attended tonight’s event - we had an unprecedented 230+ attendees, and were able to engage in polite discourse, including hearing from current AA colleagues.
We will respond to the unanswered questions from the chat, and update you all soon.
As the House of Lords vaguely mumble about astronaut assistants, we can instead trust the
@RCoANews
for putting into action the changes called for at the EGM, following concerns raised by the membership relating to patient safety
In practice, this means the GMC (as multi-professional regulator) must not give the false impression that AAs or PAs are: doctors; a type of doctor going by a different name; or equivalent to a doctor.
Requiring that AAs and PAs follow ‘Good medical practice’ implies they are logically: engaged in medical practice; medical practitioners; practising medicine. But these terms are used by The Medical Act, HCPs and the public to mean exclusively medical doctors or their practice.
The GMC also plans to display AAs and PAs on the medical register. We have called on Council to instead use our format that makes clear at a glance the medical register is preserved for doctors and is independent from the register of AAs and PAs (as required by law).
6. That was in July. Of course, by October 2023, the GMC were busy updating their Risk Log, realising that they couldn't just sweep these concerns under the carpet quite yet.
Good associate practice will include additional standards because current guidance from the GMC and FPARCP is inadequate for the unique challenge of regulating AAs and PAs. These will be drafted based around the principles shown below.
We congratulate the BMA for coming out with a clear statement. The growth of Associate roles, combined with their ever-creeping scope, has been poorly planned and implemented. It is time to take stock and assess whether it is safe to proceed
We are clear: until there is clarity and material assurances about the role of MAPs, they should not be recruited in the NHS.
Read the full press statement following a vote of our UK Council.
We have noticed a small change in the last few days in the College’s position on role enhancement for AAs.
It seems as though there is still support for scope creep under the guise of ‘local governance’.
We do not support this. See Resolution 2.
Alongside the registers search function must sit brief explanations of the registers (like the current website). This must make clear that the register of associates has its own entry and qualification requirements, and AAs and PAs are not doctors, a type of doctor or equivalent.
Alongside the registers search function must sit brief explanations of the registers (like the current website). This must make clear that the register of associates has its own entry and qualification requirements, and AAs and PAs are not doctors, a type of doctor or equivalent.
Resolution 4 - Rotational training, consider the personal cost to trainees, minimise short term placements (1 year minimum) except specialist areas.
This resolution is PASSED.
#RCoAEGM
Royal College of GPs is the latest body to issue updated red lines for PAs: supervision must be by a fully qualified willing GP and properly funded; public understanding of the role must be improved; GMC not the best regulator. We are now
#DoctorsUnited
.
“Just two years to be anything,... They can give anaesthetics, they can do operations, they look after psychiatric patients, they can be GPs, they can treat your heart. It’s not what I personally would want as a patient.”
Clear positive action on one of our
@RCoANews
EGM Motions, as College reaffirms that trainees should get priority for training opportunities and provides clear instructions for what to do if this isn't happening.
Epidural anaesthesia is a common form of pain relief in labour. While it is very safe in experienced hands, complications can occur.
Similarly, most LSCS are uneventful.
Both of these procedures have serious risks. Labour ward is not the place for AAs.
They promised no regional blocks. Now they are running the upper limb lists. They promised no neuraxials. Now they are on their curriculum.
We don't think this is right. What do you think?
Our ophthalmology colleagues have formed a group against PA introduction in their specialty.
Anger at Colleges is spreading through all specialties and doctors have had enough of being undermined, undercut, and overlooked.
We fully support
@OphthConvergent
.
Who will be next?
Calling all UK Twitter ophthalmologists: we believe the recently announced RCOphth PA "pilot" is poorly planned and without merit. But we need your help to make our voices heard. Please read this reddit post and get in touch if you're willing to help.
Do you want to be a Consultant Anaesthetist or a Consultant AA supervisor?
Say no to AA expansion.
Read our mission statement and support our call for an Extraordinary General Meeting ⬇️
Front page story in
@thetimes
today should prompt discussion, at a national level, of the proposed expansion of Anaesthesia Associates set out in the NHS Workforce Plan. The overriding priority should be training more Anaesthetists to cover the predicted shortfall of 11,000.
Did you know that on Thursday the govt is to legislate for Regulation of Anaesthesia Associates without even defining what they can and cannot do?
Did you know that they're using a parliamentary wheeze to avoid any awkward questions?
Does your MP know?
Resolutions 3 - Ratify as a professional standard that an AA could be involved in care, that AAs are not registered medical practitioners, and who responsible consultant is. This resolution is PASSED.
The Charity Commission have decided that in carrying out activities relating to non-doctors the GMC are not committing any wrongdoing.
We have appealed this decision. Our grounds for appeal are stated here.
AU in the Telegraph again! Following the revelations from the Lancaster Uni video earlier this week, the story has been picked up by a national newspaper.
Our message is getting out there - Trusts 'bending rules' for AAs is not safe!
The GMC rightly expects doctors to“put matters right, if possible” and we have urged it to do the same in the interests of patients and the public. This must be done in time for when regulation starts, before the seeds of confusion and conflation are sown.
We have seen the letter from the Association of Anaesthesia Associates, which invites recipients to oppose our motions.
Our comments and thoughts are posted on our website
Regulation of Anaesthesia (and Physician) Associates?
This is a novel form of regulation that doesn't define what Associates can and cannot do, and doesn't even say who will determine what they can and cannot do.
Regulation without actually regulating.
Resolution 5 - Council should make enquiries relating to ANRO disaster, consider whether there is still confidence in ANRO.
This resolution is PASSED.
#RCoAEGM
Who sets the specific Scopes of Practice for dentists, dental nurses, hygienists and others?
The General Dental Council.
Who sets the Scopes of Practice for doctors and associates?
Ooh, ah, not sure really. The person that writes the rota?
Plan by
@swasFT
to introduce pre-hospital anaesthesia air-ambulance teams without a doctor on board. Is this appropriate? We want to start this discussion now.
We would like to know as a matter of urgency:
- Are AA trainees not normally supervised 1:1?
- Are anaesthetic trainees being made to supervise AAs?
- Are plans not being discussed with named consultant?
Now that the legislation has been delayed perhaps they'll look a bit more closely at what "regulation" actually means. Because at the moment it's just a list of names with no specific role nor control over what they do.
1/ We are delighted to share that the House of Lords will now hear the debate on PA/AA regulation in the main chamber, following DAUK's call for motions of regret. This crucial discussion ensures the legislation undergoes thorough scrutiny.
The evidence supporting MAP expansion must now be revisited in the light of previously-undeclared financial interests,
@RCPhysicians
member survey results and a future analysis of economic viability of PAs.
Introducing two of our core members:
@LondonAnaesth
and
@dannyjnwong
.
Our senior members have been instrumental in formulating our motions for an EGM, liaising with the
@RCoANews
along the way.
Excellent position statement from Association of Anaesthetists emphasising significant concerns about the roll-out of the Anaesthesia Associate project, and calling for close supervision, a pause in current extended roles and centralised agreement on scope of practice.
Over the past year, there have been many developments in how both Government and the profession view the role of Anaesthesia Associates.
Read our position on Anaesthesia Associates
👉
Patients and the general public, as well as their doctors, would like the reassurance that the GMC are adhering to their charitable objectives regulating medical practitioners. We encourage everyone and all to sign our letter.
Does regulating physican and anaesthesia associates breach the
@GMCUK
charitable objectives?
We are writing to them to seek clarification. Co-sign the letter here:
Is the GMC undermining its own charitable objects and public confidence in the profession by integrating AAs and PAs into its register? So far 1,000 doctors and members of the public have signed our letter to find out - you can join them.
Rotational training hinders work life balance, allows AAs to form and maintain working relationships contributing to scope creep, increases doctors cost of living, and affects doctors mental health.
Doctors are disadvantaged, this has to change.
They were proposed for carrying out simple tasks.
The original nomenclature was clearer and easier for patients to understand.
Physician's Assistants (Anaesthesia).
@RCPhysicians
seem at a loss to know how to call for a pause in the expansion of Associates.
Here is how the RCoA did it. You can copy their letter or you can write it yourselves.
But it is possible.
#RCPEGM
#motion5
It seems contradictory for
@NHS_WTE
to claim that regulation will 'clarify the scope of the role of Associates' ; the GMC think its a job for someone else to do and not them.
Must be even more confusing for those poor MPs to work out who is doing what
"I welcome the start of the legislative process to regulate physician and anaesthetist associates through the
#GMC
. This will clarify the scope of the role of physician associates and doctors so we can move forward and work together to care for patients.
This email from
@Assoc_Anaes
is greatly appreciated.
We are pleased to see that our concerns regarding AA expansion and scope are shared by the representative group for UK anaesthetists.
We eagerly await the
#RCoAEGM
next week.
🚨🚨 IMPORTANT NEWS 🚨🚨
@RCoANews
has just sent the AA survey to members. Every member should have just received this in their inboxes.
Now is your chance to tell the College exactly what you think regarding the proposed expansion of AAs. Remember this survey is anonymous!
Ensuring effective and appropriate supervision of MAPs, that MAPs are shaped within an acceptable scope of practice, and that they work within established guidelines are all very important.
Breaches of this must be reported directly to the CQC
"We must make sure we show our support and solidarity for the hundreds of thousands of doctors nurses and midwives who are being constantly undermined, undercut and replaced".
Medical associates are working beyond their competence.
Backdoor changes will further confuse the public, put patients in danger and only benefit big business and profits. Our NHS needs more actual doctors, not less.
My latest 👇🏾