We need to re-evaluate MAPs roles, says DAUK co-chair

The Doctors’ Association UK (DAUK) has today called for the re-evaluation of the roles of non-doctors in the NHS to “safeguard the integrity of our healthcare system”.

DAUK co-chair Dr Matt Kneale said it was imperative that the recruitment and integration of medical associate professionals (MAPs) – in particular physical associates (PAs) – be paused.

It came in a letter to the BMJ, responding to an opinion column by Dr David Nicholl, consultant neurologist and DAUK spokesperson, in which he argued for the recruitment of MAPs to be paused for problems around regulation, scope of practice, and supervision to be resolved.

In his letter, Dr Kneale said: “This position stems from a growing body of evidence, including our own recent survey, highlighting grave concerns about the integration, regulation, and supervision of these roles within the NHS.

“In less than 72 hours, our survey garnered responses from over 650 frontline doctors, with some truly alarming insights.

“Many reported instances where PAs, operating beyond their competence, have been implicated in significant patient harm and, tragically, in some cases, fatalities.

“These incidents, while not exclusive to PAs and acknowledged as also occurring within the medical profession, are particularly concerning given the current regulatory vacuum and the relatively limited training and experience PAs possess compared to the gold standard of fully trained doctors.”

DAUK recently wrote to the General Medical Council (GMC), supported by more than 2,800 frontline doctors, calling for the GMC to urge the Government to reopen the 2017 consultation into MAP regulation. As yet, the GMC hasn’t responded to that letter.

Dr Kneale said the 2017 consultation was “an outdated snapshot”, coming at a time when only 60 PAs were in general practice. That figure now stands at well over 1,000.

“We are further concerned about the ambition to ‘grandfather’ over registrants in good standing on the PA Managed Voluntary Register at the Royal College of Physicians (RCP), as we doubt the robustness of its safety mechanisms at present,” his letter continued.

“The RCP say that employers bear responsibility for disciplinary matters, but we believe reliance on local employers for disciplinary actions presents significant risks, as seen in cases like Emily Chesterton’s, where systemic failures contributed to her untimely death.

“These instances highlight the urgent need for a comprehensive regulatory framework, away from the medical register for doctors, that encompasses not just guidelines and supervision but also clear pathways for accountability and patient safety.

“Royal Colleges need to wake up and take on this responsibility alongside the future regulator, in whichever form it takes.”

Dr Kneale said that DAUK recognised the potential value of PAs in “augmenting provision of care” but called for their recruitment and integration to be paused.

He said: “This will allow for a thorough root cause analysis of the highlighted issues, ensuring that patient safety remains paramount.

“We propose exploring alternatives, including a possible pathway for PAs into medical practice or re-evaluating their roles entirely.

“It is only through such measures that we can safeguard the integrity of our healthcare system and prevent the MAP experiment from causing further harm.”

Read Dr Kneale’s letter in full.