‘Junior doctors are right to be unhappy with NHS'

Times

6 hours ago

Junior doctors are right to be unhappy about the way the NHS treats them, the head of a landmark review into physician associates has said.
Professor Gillian Leng, the president of the Royal Society of Medicine, said that there was 'resentment and hostility' felt by some younger doctors towards other healthcare staff.
Anger about NHS plans to expand the use of physician associates (PAs) has contributed to 'general unhappiness' driving the British Medical Association to call a five-day strike, she said.
Leng was asked by Wes Streeting, the health secretary, to examine the NHS rollout of PAs, amid a bitter row within the medical profession over whether they are replacing doctors.
Her review was published on Wednesday and found that PAs have been used as a 'substitute' for fully trained doctors and GPs, despite having only two years of postgraduate training, which is 'risky and confusing' for patients.
In an interview with The Times, Leng revealed she found cases including of a PAs 'acting as a GP' at a practice in London, and seeing patients inside a consulting room behind a 'door with their name on'.
Leng said: 'The GP practice had clearly tried to appoint GPs but they couldn't. So the physician associate was fulfilling the role.'
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Leng recommended changes including banning PAs from diagnosing patients, renaming them 'assistants' and ensuring they wear uniforms to distinguish them from doctors.
The debate over PAs had become 'toxic' over the past two years, with reports of bullying and harassment on wards, as opposition to PAs has been led by leaders of the BMA.
Leng said that the level of 'online hostility' meant she deleted social media while carrying out the review. 'When I started doing the review, I was told to come off social media. I think that was the right thing to do, because I would have been targeted,' she said.
PAs have been working in the NHS for two decades, but a row over their roles was ignited by plans in the 2023 NHS Long Term Workforce Plan to expand the PA workforce from 3,000 to 10,000.
While carrying out her review, Leng spoke to more than 1,000 people and visited hospitals and GPs around the country, where she was struck by the poor working conditions of young doctors and the contrast with PAs.
Doctors have to move around the country and face 'lengthy training, antisocial hours and numerous exams', with thousands finding it difficult to secure jobs in the NHS after completing their foundation training. Meanwhile, PAs have set working hours and stable jobs, meaning they can become valued members of a team. Leng said this contrast was 'undoubtedly one of the reasons why the debate has become so impassioned'.
Leng said: 'It's fair enough that doctors are unhappy about the way their training works. It's like being a widget in a factory. You don't have much control where you move around. You are put on a conveyor belt.
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'Resident doctors move around so much they don't have a chance to build that relationship [with consultants]. I've been racking my brains to think of any other careers that you might go into where you are one of the brightest members of the system and you'd be treated like that.'
Resident or junior doctors — who are launching a five day strike next week — are also furious that PAs start on a salary of £47,000 a year, while a first-year junior doctor earns £39,000.
Leng said that this resentment had contributed to the BMA's strike action. 'When you look at some of the big national strikes that we've had in this country — miners, train drivers — it's never just about pay. These issues are always pay plus general unhappiness with terms and conditions. So I don't think this is any different. You've got resident doctors unhappy with the way that their training has become a number on a conveyor belt, and they feel they don't have a team structure.'
Leng's 134-page report stressed that evidence regarding the safety and effectiveness of PAs was 'poor', and she said much of the evidence submitted by organisations including the BMA was 'anecdotal' and 'could not be verified'.
Leng, who qualified as a doctor at the University of Leeds in 1987, was formerly head of the National Institute for Health and Care Excellence, and became president of the Royal Society of Medicine last year.
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Streeting said: 'We're accepting all of the recommendations of the Leng review, which will provide clarity for the public and make sure we've got the right staff, in the right place, doing the right thing. Patients can be confident that those who treat them are qualified to do so.
'Physician assistants, as they will now be known, will continue to play an important role in the NHS. They should assist doctors, but they should never be used to replace doctors.'