A Multiprofessional Survey on the Role and Impact of Medical Associate Professions in the NHS

Abstract

Background: With the global scarcity of the healthcare workforce, innovations in healthcare professional (HCP) roles include the model introduced in the 1960s in the USA of medical associate professionals (MAPs). Since 2003 in the UK, MAPs had a scope of practice defined by local employers. In 2024, the UK Parliament passed a resolution to bring the MAPs under regulation by the General Medical Council. However, multidisciplinary team and public awareness of MAPs have come under scrutiny, due to uncertainties around roles, unmonitored expansion of scope of practice, patient safety concerns, and competition for jobs and training with doctors.

There is a need for rigour in exploring the opinions of the whole spectrum of HCPs, especially locally employed doctors (LEDs), Specialty and Associate Specialities (SAS) and international medical graduates (IMGs) who not only make up a large cohort of doctors in the UK but work closely with MAPs and support their prescribing and ordering investigations functions.

Aim: Designed by a multi-professional working group, an online survey of HCPs was conducted to explore the role of MAPs in patient care, and how workforce plans around the roles align with the roles, responsibilities, and training of doctors.

Findings: A total of 583 responses were collected which included consultants (43%), postgraduate doctors in training, General Practitioners, LEDs, IMGs (75%), nurses, and allied health professionals.

• Role: 53% of respondents were uncertain of the specific role of MAPs within the team; 43% agreed primary roles of MAPs involved delivering specific, well-defined skill-based services, reducing workload (20%), and providing continuity (19%). 89% emphasised the importance of a clear distinction between the roles of doctors and MAPs.
• Patient Safety: 77% agreed that MAPs currently may pose a risk to patient safety. 89% recognised the risk associated with MAPs working beyond their scope. 69% agreed with the need for a competency framework for MAPs.
• Supervision: 75% expressed concerns about the increased clinical risk and burden faced by doctors in supervisory roles.
• Impact on Doctors: 69% reported reduced job prospects and 67% reduced training opportunities.
• Regulation: 74% agreed with regulation by an independent regulator, not the GMC.

Free text: The analysis of free-text comments revealed a predominantly negative sentiment regarding the role of MAPs. Concerns about patient safety, lack of proper training, additional workload implications for doctors, the potential for misrepresentation, the erosion of training opportunities for doctors, the risk of scope creep, and confusion among patients.

Conclusion:  Innovation in healthcare professional roles and functions is key to supporting the human resource shortage in health systems. The results of this survey from Multiprofessional respondents including IMGs, suggest that caution is required in how roles are positioned to the public, to avoid blurred lines of responsibility or interchange between professional roles, and to avoid confusion and consequent risk to the public. MAPs need a robust national framework of competencies, an independent regulator for licensing, and support doctors but not compete for resources, jobs, and training opportunities.