In NHS Scotland, Dr Iain Kennedy said there was “confusion and inconsistency” around scopes of practice as well as misleading job titles when it came to medical associates, who undergo considerably less training than doctors.
To understand the issues more, let’s take a look at who these medical practitioners are and what action BMA Scotland wants to see.
What are medical associates?
Medical Associate Professionals (MAPs) is the umbrella term used in the UK for Physician Associates (PAs) and Anaesthesia Associates (AAs).
Physician Associates (PAs): Healthcare staff who support doctors in diagnosing and managing patients. They often take histories, perform examinations, order tests, and provide care under supervision.
Anaesthesia Associates (AAs): Work within anaesthetic teams, supporting anaesthetists during procedures, monitoring patients, and helping deliver anaesthesia care.
While PAs and AAs play a growing role in the NHS workforce, their training is much shorted and narrower than that of doctors.
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Doctors typically train for 7-10 years, while PAs and AAs generally complete about five years of study. Importantly, they are not doctors, and cannot perform tasks such as prescribing medication or working independently.
Why is BMA Scotland concerned?
The British Medical Association (BMA) Scotland has raised repeated warnings about how these roles are being introduced in NHS Scotland:
Patient Safety Risks – The BMA says inconsistent rules on what PAs and AAs can do leads to confusion and possible risks for patients.
Misleading Job Titles – The term “associate” can mislead patients into believing they are seeing a doctor, when they are not, the BMA has warned.
Lack of National Standards – At present, health boards set their own rules for PAs/AAs. The BMA argues this creates a postcode lottery of care and is unsafe.
Impact on Doctor Training – Resident doctors report PAs/AAs sometimes compete for training opportunities, or add to workloads when supervision is inadequate.
Quick Fix vs. Long-Term Solution – The BMA believes PAs/AAs are being used to plug workforce shortages instead of addressing underlying issues by training more doctors.
What happens next?
An independent review in England (the Leng Review) recently recommended changing PA and AA job titles to reduce patient confusion and restricting their ability to see patients. The UK Government has accepted these recommendations.
But in Scotland, the government has yet to formally respond — something BMA Scotland’s chair, Dr Iain Kennedy, called “an abdication of leadership at a crucial moment.”
The BMA is calling for:
A nationally defined scope of practice for PAs and AAs.
An immediate change of job titles to avoid misleading patients.
Investment in training more doctors as the safer, sustainable workforce solution.