Scotland: Job advert ‘error’ left NHS Highland backpedalling

Recruitment chiefs at NHS Highland have been left red-faced this week after a job description they insist was posted "in error" sparked an online backlash.

The controversial advert suggested that the lucky recruit – a "physician associate" – would be responsible for supervising colleagues including junior doctors and nurses, sparking accusations of a "race to the bottom" when it comes to NHS staffing.

What happened?

The row ignited on X (formerly Twitter) on Monday when a first-year foundation doctor posted an excerpt from an NHS Highland job profile issued by the health board on December 14. NHS Highland was seeking to hire a physician associate who would "participate in all aspects of the patient pathway including initial assessment and triage".

More significantly, it added that the PA – a Band 7 role with a starting salary of £46,244 – "will actively undertake clinical supervision of ward nursing staff, junior doctors, and student PAs to facilitate the development of clinical skills and practice".

"Is this a joke?," tweeted the medic, asking NHS Highland to "please explain why PAs are now supervising doctors at Raigmore hospital".

Within a few hours the post had been viewed more than 300,000 times and 'liked' nearly 500 times. Dozens of medics and nurses responded, questioning why "someone with no registration or regulation would be supervising me as a registered nurse"?

Others said it was "completely irresponsible", and a "race to the bottom – how quickly can we deteriorate the NHS quality?". One junior doctor quipped: "Imagine being supervised by someone who can't even prescribe paracetamol".

By Monday night, NHS Highland had pulled the advert and apologised, stating that the job description had been "posted in error" and would be updated. As a non-GMC registered member of staff a PA "cannot provide clinical supervision", it added.

A spokesman told the Herald: "We are reviewing all job descriptions for physicians associates to ensure they comply with appropriate specifications."

The job as advertised would 'actively undertake clinical supervision of ward nursing staff, junior doctors, and student PAs to facilitate the development of clinical skills and practice' (Image: Newsquest)

The background

If you're puzzled as to why this caused such an outcry, you need to know the context. Both the UK and Scottish Governments have recently signalled plans to grow the physician associate workforce within the NHS in what is perceived by medical trade unions as a cut-price alternative to training enough doctors.

PAs are not new and they are not unique to the UK, but for now they are rare: NHS Scotland currently has 198 (up from 44 in 2014) compared to 17,000 doctors, from foundation level through to consultant.

Physician associates are not doctors – they do not hold a degree in medicine, and they are not (currently) registered and regulated by the GMC. Mostly, they are nurses or bioscience graduates who have completed a two-year postgraduate medical course designed to train them to carry out a range of support functions, such as taking medical histories from patients, performing physical examinations, diagnosing illnesses, and analysing test results.

Read more:

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They can work in hospitals or GP surgeries but – crucially – they are supposed to be supervised by fully-qualified doctor.

Plans to expand the PA workforce has coincided with publicity around adverse events (such as the case of 30-year-old Emily Chesterton who died after her deep vein thrombosis was repeatedly missed by the physician associate at her GP surgery in London) and a furore around plans to bring PAs under GMC regulation by the end of 2024, confirmed on December 11.

On the one hand, this would make them subject to investigation and sanction in the same way as other healthcare workers responsible for patient care. On the other hand, there is unease that putting them under the umbrella of the GMC – the doctors' regulator – muddies the water between who is, and isn't, practising medicine.

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A BMA survey of 1700 doctors working in NHS Scotland, published last week, found that 80% believe the way PAs currently work "is always, or sometimes, a risk to patient safety". Concerns included patient confusion and a "clear impact on junior doctors" because "senior doctors simply do not have the time to effectively train two separate professions".

With its job post, NHS Highland poured petrol on the fire.

Caught in the middle are the PAs – trained professionals in their own right who neither deserve to become political footballs nor some of the more derogatory abuse that has come their way.

They are not, and should not be seen as, a substitute for doctors, but if we fail to train, recruit, and – crucially – retain enough doctors, that resentment will worsen.