Labour conference 2024: ‘Tiering apart the NHS – the SHA motion to save our health service’

Try to envisage two parallel health services, an NHS built on inequity: a divided health landscape of privilege and deprivation; inadequate health for the many, exemplary healthcare for the few. This is the future the NHS, our NHS, is headed towards: spearheaded by the proliferation of unqualified, unregulated, and unchecked roles. Namely, Physician Associates (PAs), Anaesthetic Associates (AAs), and to some extent Surgical Care Practitioners (SCPs), as part of the previous Conservative government’s calamitous NHS Long-Term Workforce “Plan”.

The Socialist Health Association (SHA), instrumental in the creation of the NHS in 1948, now has a plan, 76 years later, to save our NHS from this insidious danger: and we implore you to back our motion at the Labour Party Conference, and keep our NHS for the many, and not just the few. 

As of 2024, there are approximately 3,250 PAs and AAs working within the NHS, with the long-term workforce plan wanting to amplify this number to 10,000, with their own impact assessment showing high risk of harm to patients.

This so-called “Plan” from the previous Conservative government, is taken straight from the workbook of marketisation and privatisation: deregulation and deemphasising of the nation’s health. The Labour Party, through our motion, must scrap this for the sake of the nation’s health: to protect patients and our NHS.

‘PAs and AAs: an import from America’s corporate healthcare dystopia’

But you may be left wondering; what exactly are PAs and AAs? And why are they so dangerous to our health and our NHS? Firstly, the role of PAs and AAs was conceived by the USA’s corporate healthcare dystopia: PAs and AAs are at the peak of profit-driven-sickness whereby medical expertise is perversely shielded for those with the deepest pockets. Comparatively, the PA and AA role is relatively new in the United Kingdom and involves a two-year postgraduate course or apprenticeship, which barely scratches the surface of the depth and breadth of medical school and does not necessarily require a science-based undergraduate degree.

PAs and AAs are then unleashed in the NHS without a scope of practice or any regulation whatsoever; at times, performing complex medical procedures with minimal training and supervision – usually performed by a senior doctor, or seeing undiagnosed patients: with disastrous consequences after patients believed they were being seen by a qualified doctor. Patients undergoing surgery are at risk too, with a recent example of an SCP removing a gallbladder independently, attracting widespread condemnation and concern from surgeons across the UK. Prompting an astounding 87 percent of surveyed doctors to report AAs and PAs currently work in the NHS posing risk to patient safety.

The problem occurs when PAs don’t identify themselves to patients, who assume they are being seen by a doctor.

As was the case with Emily Chesterton.

See the debate on this case: https://t.co/fSv5Gr7iTc https://t.co/8cMyQqkVC5

— Baroness Keeley of Worsley (@KeeleyMP) November 29, 2023

In 2014, the term “Physician Assistant” was changed to the current “Physician Associate”: obfuscating their role, and misleading patients. To confuse the matter further, an Associate Physician is a senior doctor. This has attracted widespread concern.

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‘People who are sicker will be in receipt of poorer standards of care’

The fallout from this will disproportionately fall on those with the narrowest shoulders: the disadvantaged and underserved, with PAs and AAs being more prevalent in areas of high deprivation. Ultimately, populations who are sicker with more chronic conditions, will be in receipt of poorer standards of care from PAs and AAs rather than the expertise of a qualified doctor.

This phenomenon is described aptly by renowned Socialist Doctor, Julian Tudor Hart, as the Inverse Care Law: “The availability of good medical care tends to vary inversely with the need for it in the population served. This … operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced”. The UK’s health gap between the richest and the poorest will continue to grow under this two-tier NHS.

‘Privatisation doesn’t save – it shifts focus to profits over people’

Operose, a profit-hungry company infiltrating the NHS, slashed GP numbers while hiring six times more unsupervised PAs than the NHS average. This isn’t cutting costs; it’s cutting care.

Privatisation sacrifices patient health for profit, with inadequately-supervised PAs risking misdiagnoses, and tragically, death. Privatisation doesn’t save: it shifts focus to profits over people. Doctors must spend more time supervising, nullifying any savings.

A BMA survey even found workloads exponentially increase after PAs and AAs were introduced. This is the fallacy of privatisation through displacing doctors: a deregulated system, deskilled to the core, and diluted in quality for those that need healthcare the most. Is this the future of the NHS: profits soaring while patient care sinks? 

Excellent to draft the @SocialistHealth motion on the abolition of the PA/AA role – with circulating PAs/AAs to be ‘Medical Assistants’ with strict scope limitation: protecting patients and our NHS.

Exciting to present this motion to the Labour Party Conference. Please support! https://t.co/j63V0RDeDG

— Dr Jatinder Hayre (@JatinderHayre_) September 9, 2024

This reckless experiment spearheaded by successive Conservative governments must be stopped. Senior Labour MPs have voiced concern on the PA and AA project. A danger to patients and the NHS alike, this project stands as the antithesis of Aneurin Bevan’s founding principles of quality and equality.

‘Labour has the chance to right the wrongs of the past 14 years’

76 years on from the founding of the NHS, the SHA has the remedy to heal a broken, fragmenting healthcare system, which will be presented at the Labour Party Conference. The motion hinges on three core components: 

1. To call for an immediate freeze in the recruitment of physician or anaesthesia associates and surgical care practitioners and the closure of their courses
2. To urge the government to review their regulation, scope and training
3. That these three roles be phased out in the next two years and be reclassified as Medical Assistants with duties strictly limited to professional competence regulated consistently at national level, without exception

The Labour Party in government is our chance to right the wrongs of the past 14 years. To ensure we prioritise health equity and preserve our NHS on its founding principles for generations to come, we urge your support in this motion. 

Labour conference

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