A five-day strike by up to 50,000 resident doctors over pay has sparked a fresh row with physician associates (PAs).
It comes after a Government review called for PAs to be banned from diagnosing patients that haven’t seen a doctor.
The review, chaired by Professor Gillian Leng, president of the Royal Society of Medicine, recommended PAs are renamed physician assistants to avoid any confusion for patients.
A bitter row has erupted between doctors and PAs with both the British Medical Association (BMA) and Royal College of General Practitioners (RCGP) raising concerns over their role.
Health Secretary Wes Streeting has vowed to implement the full findings of the Leng review which said PAs must not diagnose patients in A&E or GP practices.
There has also been resentment among doctors about PA salaries after years of pay erosion since the financial crash of 2008 which led to austerity measures.
There are more than 3,500 PAs within an NHS England workforce of more than 1.5 million people.
PAs’ starting salaries come under the NHS Agenda for Change pay rate band 7, which means an annual pay of £47,810 for someone with two years or less experience.
Internships are paid according to band 6, which starts at £38,682.
NHS resident doctors outside Bristol Royal Infirmary (Photo: Ben Birchall/PA Wire)That can increase to around £55,000 for a PA with five or more years’ experience working a weekly shift of 37 to 42 hours.
For full-time resident doctors in England, formerly known as junior doctors, starting postgraduate foundation year 1 training the average starting basic salary is now around £38,800, up from around £29,380 in 2022/2023, according to Government figures.
The salary is for an average of 48 hours per week and rises to £44,439 in the second year.
It’s expected that the average full-time basic pay of a resident doctor will reach about £54,300 in 2025-26, the Government believes.
The top of the basic pay scale is £73,992 for best-paid resident doctors, or specialty registrars.
Stephen Nash, general secretary of the United Medical Associate Professionals which represents PAs, said it was “entirely disingenuous to point the finger at us” and said doctors’ foundation year 1 pay was “the worst case scenario if they had no uplift”.
“The BMAs failure to deal with their quality of life and remuneration over a 20-year period has nothing to do with a synergistic workforce that has worked as much as it has to facilitate patient care,” he said
Fact check: PAs starting out in the NHS can be paid more than newly qualified resident doctors, but doctors have more earning potential over the course of their career.
Why are doctors striking?
A five-day walkout by resident doctors in England started on Friday, with members of the British Medical Association (BMA) manning picket lines across the country.
The BMA has a six-month mandate to call more industrial action, but the Health Secretary argues that more strikes are not necessary as resident doctors’ pay has increased by 28.9 per cent over the last three years.
However, the BMA says resident doctors’ salaries will be 20 per cent lower in real terms than in 2008 despite the increase and says they have not had a “credible pay deal” for 2025-2026.
They are calling for a 29 per cent pay rise after receiving a 22 per cent increase last year, with another 5.4 per cent average rise from next month.
Resident doctors have taken part in 11 strikes for fairer pay and working conditions since 2023.
Speaking to The i Paper, Stephen Nash, general secretary of the United Medical Associate Professionals, said PAs had been “dragged into” the strike with “figures and facts that are easily disputable”.
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The union leader also hit out at the Government for “placating the British Medical Association by restricting our scope of practice and our ability to do our job just before strikes”.
He said: “I think it’s very difficult not to have concerns [about the strike] when the workforce that would have helped mitigate that patient safety risk has been attacked by the British Medical Association to make the strike bite harder.
“We are still being asked to staff and protect patients and work within our qualification scope of practice, and I think PAs have to do what they can live with in that situation.”
Leng review findings
Prof Leng’s review suggested a major change to the role of PAs after it acknowledged they have been used as substitutes for doctors, despite having significantly less training.
Mr Streeting ordered the Leng review into PAs and anaesthesia associates (AAs) after concerns were raised over whether they were safe and the impact on the training of junior doctors.
Six patient deaths linked to contact with PAs have been recorded by coroners in England.
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One high-profile death involved Emily Chesterton, 30, who died from a pulmonary embolism. She was misdiagnosed by a PA on two occasions and told she had anxiety.
Following the review, newly qualified PAs will also now work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts.
Physician associates should also be part of a team led by a senior doctor and wear badges, lanyards and clothing to distinguish them from doctors
Mr Streeting said: “Patients should always know who they are being treated by and should always receive appropriate care.
“Legitimate concerns about patient safety have been ignored for too long – that’s why I sought out the very best clinical advice to review physician associates and anaesthesia associates’ roles in the NHS.”
In response to the review’s findings, the United Medical Associate Professionals said it objected in particular to the recommendation that PAs only treat patients who have already received a diagnosis.
In a message to members, the union said “we DO NOT accept the recommendations of the Leng Review” which was “unable to substantiate a legitimate patient safety concern and relies on conjecture”.
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