Pepperer. Grocer. Apothecary. Surgeon apothecary. General practitioner (https://www.apothecaries.org/history/origins).1 The evolution of medical associate professionals in the UK may not enjoy quite the same narrative arc, steeped as it is in workforce practicalities, but it does echo many of the controversies accompanying the introduction of apothecaries into medical practice.
The Apothecaries Act of 1815 handed responsibility for medical training and education, previously unstandardised and based on apprenticeships, to the Society of Apothecaries (https://navigator.health.org.uk/theme/apothecaries-act-1815).2 In a lecture on the origins of general practitioners, the doctor and historian Irvine Loudon summarised the two contrarian views of the act as either “among the great reforming Acts of the 19th century” or “as a result of a degrading compromise” (https://bjgp.org/content/33/246/13.long).3
Disputes over professional training and regulation are invariably heated, sometim
Recruitment of medical associate professionals should be paused to allow time for problems around regulation, scope of practice, and supervision to be resolved, writes David Nicholl
As Partha Kar said in his recent column, the whole situation around medical associate professionals, including physician associates and anaesthetic associates, is “an unqualified mess.”1 The latest development in the debate is that the BMA has called for a pause in the recruitment of medical associate professionals to allow time to resolve the matters of scope of practice, the level of supervision, and statutory regulation.2 Expansion of medical associate professionals was a key part of the NHS Workforce Plan, which proposed introducing 10 000 physician associates in total by 2036.3 But doctors have voiced their concerns about the risks of medical associate professionals performing tasks that they haven’t been trained for, the extra workload it will put on doctors supervising them, and the lack of c
The whole situation around medical associate professionals (MAPs) is an unqualified mess. What had been dismissed as social media noise has snowballed into something much larger. Statements have been issued by NHS England and the General Medical Council; the BMA is now walking into the debate1; and the medical royal colleges are starting to show unease.
The present debate occurring at the same time as disputes about doctors’ pay has created a cohort of medical trainees asking why these MAP roles exist and why there’s no national regulatory framework or definition of scope for them. Trainees are looking at the weirdness of it all, finding themselves unable to attend training days or pick up training opportunities, while MAPs do. Cue understandable friction.
Leaving the scope of these roles vague has meant that individual NHS trusts and GP surgeries have used them as they see fit, which is questionable at best and dangerous at worst. In 2019 the Department of Health and Social Care