Calls for competency framework for associate roles

The scope and role of Physician Associates needs defining to ensure high-quality care for people with diabetes, according to a growing movement of professional associations.

Last year NHS England pledged to increase Physician Associates (PA) training places to establish a workforce of more than 10,000 PAs by 2036.

This has led to concerns because the profession is not yet regulated, with the BMA this summer sending a letter signed by more than 13,000 doctors to politicians warning that patients are at risk because of the way PAs are being used in the NHS. Recently, both the Royal College of Physicians and Royal College of General Practitioners have called for a review of expansion of this workforce-as planned by NHS England.

Now there are calls in the diabetes community led by DSN Forum for a competency framework for not just PAs but also for Nursing Associates (NA). The ask is for these professions to be blended into the diabetes MDT to complement existing skills – yet with relevant competency and training.

A statement has been released on the ‘Role Substitution of Registered Healthcare Professionals in Diabetes’. Drafted by DSN Forum, it has been endorsed by Professor Partha Kar, who is the Type 1 Diabetes & Technology lead for NHS England and joint GIRFT Diabetes Lead, and organisations including DISN UK Group, The Association of UK Dietitians, UK Clinical Pharmacy Association, National Nurse Consultant Diabetes Group, Trend Diabetes, Diabetes Psychology Network and Medical Trainee Association Young Diabetologists & Endocrine Forum.

In summary, it states: “The specialised expertise, continuity of care, and person-centred approach of the Diabetes MDT is a key part of diabetes management and core to present outcomes comparing the NHS favourably to other countries.

“We ask that roles for PAs and NAs as additional members of the MDT are agreed at national level via defined competency framework; they should never be used to substitute for existing members of the MDT.

“Substitution could lead to gaps in care and subsequently increased waiting lists, a detrimental effect on physical and mental health outcomes for people with diabetes, and increased healthcare costs, compromising the quality of diabetes care in the UK.”

The statement concluded: “Any new role must be additive based on defined parameters of contribution to existing MDTs in diabetes care.”

Prof Kar said: “People living with diabetes should always have access to trained and competent professionals. This statement – supported across the spectrum of professionals engaged in diabetes care in an MDT set up shows the importance of ensuring any individual or group providing care – does so to agreed standards of competency.

“The RCP and RCGP are working on national scope for PA colleagues. I would ask national organisations such as ABCD and PCDS to work with all relevant stakeholders to help define this for Physician Associates in the world of diabetes care – so that safety and quality of care continues to be of high standards – as well as emphasise to commissioners the importance of avoiding replacement of existing professional groups within the Diabetes MDT. The aim is to have consistency, not create more variation in diabetes care.”

A comment from DSN Forum said: “DSN Forum was made aware of several trusts who were trying to replace the DSN role with associate roles, so we wanted to create a document, which shows the wealth of knowledge, skills, and training that the current MDT roles bring and why these are not replaceable. People living with diabetes deserve the best care and to know they are being cared for by registered professionals with the correct training and scope. We hope this goes some way to support nurses working in diabetes care, who are facing this in their workplace.”

An NHS England spokesperson said: “We recently published summary guidance for trusts to set out the expectations on the deployment of medical associate professionals to ensure clarity of responsibilities, and expectations around safety, accountability and transparency.

“We are working with Healthwatch and the Patients Association on producing materials for patients and the public to explain the roles of medical associate professionals and will continue to work with organisations ahead of the GMC regulation coming into effect at the end of the year.”

ABCD has completed a survey on the role of Physician Associates and the findings suggest that their role is nuanced. According to the results, so far their contribution has been useful but their place needs defining, supporting the need for a competency framework to be put in place.

A statement from ABCD said: “ABCD understands the need to gain clarity on the roles and responsibilities of PAs and others, and also that is clearly a much bigger issue that just for diabetes and endocrinology. As with several professional bodies, there are already existing competency frameworks that can determine the level of responsibility that an individual can take on. ABCD continues to work with RCP and other key stakeholders to define the role and scope of practice of physician associates.”