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Month: April 2024

“For the Workers not the Wokers”

The Rise of the Anti-PC Left


03/04/2024

In a tweet in early February, George Galloway claimed he stands ‘for the workers, not the wokers’. He was recently elected as MP for Rochdale in Northern England, as a representative of the Workers Party of Britain; a hard-left party, founded by Galloway himself, that strongly opposes the ‘woke left’, and promises to combat ‘increasingly unhinged identity politics’.

The word woke, once used within Black communities to draw attention to inequalities and racially motivated threats, has been weaponized by the right wing around the world. It is used pejoratively to refer to a wide range of ‘liberal’ ideals; ranging from the serious to the deeply trivial. The word’s original meaning has been essentially erased, coming to stand for anything vaguely left-leaning or politically correct, especially when it comes to identity politics. 

The debate surrounding ‘woke’ culture has escalated so massively that many on the left are tired of its constant discussion, or also feel that things have gone too far, and politicians like Galloway are jumping on the woke-bashing bandwagon to win over these voters.

Yet, who exactly are the ‘wokers’ Galloway scorns? They are reminiscent of the populist enemy number one, the Metropolitan Elite. This mystical group of globalised, flat-white-drinking city slickers have long been the target of right-wing politicians, as they supposedly attack institutions like the traditional family, the dairy industry, and the very concepts of nationality and gender. 

In a YouTube video titled ‘Sick of the woke left’, Galloway condemns the ‘woke madness’ in Scotland that he believes has been imported from the US, and is met with hundreds of comments of support. But does he actually believe that the ‘wokers’ are Britain’s biggest issue? It is thought that Galloway won the (formerly Labour) seat in Rochdale primarily due to his strong pro-Palestinian stance, so it’s hard to determine how much his party, or his constituents, care about this fight against the ‘woke’.

Galloway has long been a controversial figure of British politics – be it his infamous meeting with Saddam Hussein, or his play-acting as a cat on Celebrity Big Brother. Yet, cancel culture doesn’t seem to have particularly damaged his career, and try as they might, mainstream British politics cannot seem to get rid of him.

In Germany, an equally divisive figure has attempted to mix leftist fiscal policy with populist-leaning, anti-PC rhetoric. Sahra Wagenknecht – a prominent former member of Die Linke – founded her own party (BSW) in January 2024, promising a combination of pro-Russia foreign policy, strict immigration laws, and left-leaning economics. She claims that leftist politics have become more about gender, race and ‘lifestyle’, as opposed to issues such as pensions, wages and the social state, and her party aims to combat this.

For voters in Germany who feel angered by ‘woke’ culture and the ‘elites’, Wagenknecht’s new party could offer an alternative to the far-right AfD, which is also strongly opposed to PC culture (co-chair Alice Weidel has said that political correctness belongs in the ‘dustbin of history’). If these issues are going to swing elections, then it is arguably better, from a pragmatic point of view, to choose the lesser of two evils – socially right and fiscally left vs. socially right and fiscally right. Yet, Wagenknecht’s BSW party is new, its politics are shaky, and only time will tell how successful it will be in June’s EU elections and September’s local elections in Thuringia, Saxony and Brandenburg. 

(Galloway has shown his support of Wagenknecht, responding to a video of her calling for an end to German military aid to Ukraine with a tweet saying ‘This woman is the only sane future for Germany’.)

In Westminster, ‘woke’ is no longer just an alluded-to concept, but rather unironic terminology used in Parliament. Former GB news presenter Esther McVey now serves as the Minister of State without Portfolio – yet is unofficially known as the ‘common sense tsar’, dedicated to fighting the ‘scourge of wokery’. Though this may sound like a quest from the Lord of the Rings, it shows how desperately the Tories are clinging to the battle against ‘woke’ as a last-ditch attempt to win voters before the General Election. 

Perhaps the most polarising topic under the ‘woke’ umbrella is trans rights. In February, Rishi Sunak’s joke in Parliament about trans women was strongly criticised by Keir Starmer, as the mother of murdered trans teenager Brianna Ghey was present. Through mere critique, Starmer gained a temporary moral high ground without having to do anything material to benefit trans individuals, demonstrating perfectly how these debates and arguments are often just empty words, designed to create and then soothe moral panics.

It can feel like contemporary Western politics is drowning in culture wars, with social issues, many of which only affect a small minority of the population, taking up enormous amounts of space – be it in the media, the Bundestag or the House of Commons. Regardless of personal opinion, it is clear that these issues are utilised as political weapons, aimed to divide and polarise, to win over voters who care more about tangible social issues than they do more abstract economic ones. 

The continued attacks against ‘wokeism’, and its constant discussion at the expense of more pressing matters, are just contributing to the noise, adding fuel to the culture war fire. Perhaps the only way to combat ‘woke’, ‘wokers’ or ‘wokery’ (take your pick) is simply to retire these phrases from political debate once and for all. 

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News from Berlin and Germany, 3rd April 2024

Weekly news round-up from Berlin and Germany


NEWS FROM BERLIN

Celebration of cannabis legalisation in Berlin

Numerous people celebrated the legalisation of cannabis in front of the Brandenburg Gate on the night of Easter Monday. The police estimated, that 1,500 people had gathered in front of the landmark. Several joints were lit at midnight. Shortly afterwards, a strong smell of cannabis wafted across the square. A metre-high cannabis leaf could be seen and some people danced to reggae music. According to the police, the event ended at around 0:40 am. There were also celebrations on the Warschauer Brücke. At midnight, activists from the Hanf Museum and the umbrella organisation of German Cannabis Social Clubs (CSCD) lit up a joint. Source: rbb

Video surveillance system for Leopoldplatz

Last week, the Greens and the CDU announced their plans to re-install a video surveillance system at Leopoldplatz, as reported by Berliner Zeitung. It will begin with a 6 month trial phase, after which an evalutaion will take place. The Left’s Jacky Sanehy, Spokesperson for Health, has criticised the decision. She argues that bringing video surveillance back to Leopoldplatz would lead to the displacement of homeless and drug-addicted individuals, simply moving the problem elsewhere and rather than solving it. Instead of surveillance, the Left is calling for increased social welfare systems, including a space for drug consumption and more social work facilities on and around Leopoldplatz. Source: the berliner

 

NEWS FROM GERMANY

Teachers against the right – a challenging assignment

Maike Finnern’s appeal sounds obvious. The GEW (the German Education Union) chairwoman has appealed to teachers to take a critical look at the AfD in the classroom because the party harbours anti-constitutional tendencies. But as simple as it first sounds, it seems somewhat challenging to actually implement. Teachers take an oath to uphold the constitution, and it would be desirable for them not to ignore the sensitive topic of the far-right in the classroom. This may be due to the fact that as recently reported, many schools were found to have a “right-wing atmosphere” contributed to by the teachers themselves. Source: nd-aktuell

Germans consume more petrol

Petrol consumption increased in Germany for the third year in a row, according to mineral oil data from the Federal Office of Economics and Export Control (Bafa). The Federal Environment Agency attributes the rise in petrol consumption primarily to an increase in mileage last year. Moreover, the Munich-based Ifo Institute sees not only an increase in traffic volume, but also a switch from diesel to petrol as a result of driving bans and the reduced financial advantage of diesel vehicles. According to the economic researchers, there are now also more heavier cars with petrol engines. Source: taz

Fans banned from buying number 44 kits over Nazi symbolism

The trade “Adidas” has prohibited football fans from ordering German football kits customised with the number 44, after media brought attention to their resemblance to the symbol used by World War Two-era Nazi SS units. “We will block personalisation of those jerseys,” an Adidas spokesman said. The symbolism issue was first raised by historian Michael König, who mentioned the kits´ design was “very questionable”. Adidas spokesman Oliver Brüggen denied that the kit’s resemblance to the Nazi symbols was intentional. “We as a company are committed to opposing xenophobia, anti-Semitism, violence and hatred in every form,” he said. Source: bbc

Dual citizenship law to become effective likely in June

President Frank-Walter Steinmeier signed off on the country’s dual citizenship law, on March 22, 2024. Once a law is signed by the German President it automatically comes into effect 14 days later. However, since the new citizenship law will require administrative bodies to adjust, the implementation will take longer. No concrete date has been set, but authorities have been given a three-month preparation period, meaning that it should come into effect around June 22, 2024. The new law will allow, among other things, non-EU citizens with a German residence to become Germans after few years in the country, without having to surrender their original citizenship. Source: iamexpat

Whatever happened to Die Linke?

The party was born at the height of the anti-capitalist movement. Since then, elections have become more important than social movements


02/04/2024

It has been 17 years since Die Linke was formed at the height of the anti-capitalist movement. In 2009, the party won 12% of the vote (and 76 MPs), becoming the envy of the international Left. Just seven years ago, the party still had 69 MPs.

In the last general election, Die Linke failed to reach the “5% hurdle” traditionally needed to enter parliament, and got in only on a technicality. More recently, when 10 MPs left the party to join the Bündnis Sahra Wagenknecht (Sahra Wagenknecht Alliance), Die Linke lost its status as a parliamentary fraction and much of the money associated with it.

More importantly, the party, which was once a motor of social movements, has become largely invisible on the ground. In the face of significant demonstrations in support of Palestine, it has remained mostly silent. Recently, left-winger Christine Buchholz refused to take on the post of MP, saying it would put her into a permanent conflict with the party line on Palestine, war and other topics.

How could a party which still has tens of thousands of members experience such crises so quickly? Phil Butland, joint speaker of the LINKE Berlin Internationals group, looks at the rise and fall of Die Linke.

The last 25 Years of the European Left

The Left in Europe experienced three phases in the last 25 years, each lasting for roughly a decade. The first was from 1999 to 2007, starting with the WTO protests in Seattle until the G8 summit in Heiligendamm in Eastern Germany. This was a time of international mass demonstrations and social forums where the Western Left came together to discuss strategies and plan joint actions.

The most important two actions of this period both started in Italy. In July 2001, the G8 summit took place in Genoa. On the day before the planned large demonstration, cops murdered 23-year old activist Carlo Guiliani. The movement quickly mobilised and 300,000 demonstrated on the following day in Italy.

One year later, in December 2002, the first European Social Forum (ESF) took place in Florence. At the forum, a couple hundred activists attended an unofficial meeting to discuss the threat of the upcoming Iraq war. It was there that we decided to coordinate protests for the 15th of February. On that day, 15 million demonstrated against the war, and 40 million in February and March.

Growth of Left-wing Reformist Parties

Despite the large-scale demonstrations, war ensued and hundreds of thousands of Iraqis were killed. Social forums became smaller and less political, and the 2008 world economic crisis led to austerity politics, carried out both by conservative and social democratic governments.

For many Leftists, this showed that demonstrations and forums were not enough. For most people, “politics” is what happens in parliament. This meant that socialists must also fight in this arena. But what did “fighting in the parliamentary area” actually mean? For the majority, it meant voting in better left-wing MPs who could make better politics on our behalf. As new mass parties were formed, there was little talk about the role of the State, or how realistic this strategy actually was.

A minority did not believe in short cuts, nor that there could be a parliamentary way to socialism. Nonetheless, we had just spent the best part of a decade building social movements, and did not want to abandon the people who had been building them with us. Many of us joined the large Left parties all the while arguing that such parties meant little without strong social movements.

Those heady days are now well and truly over. The different, but in some ways quite similar, experiences of SYRIZA, Podemos, Jeremy Corbyn and Bernie Sanders, showed that it was not so easy for the Left to take over the State and use it for our ends. If you want to know more about the specific experiences in each country, I highly recommend Joseph Choonara’s article Revolutionaries and Elections.

Let’s take one early example. The Italian party Rifondazione Communista was central to both the Florence forum and the protests in Genoa. On the evening following Carlo Guiliani’s murder, Rifondazione leader Faustino Bertinotti appeared on Italian television saying: “whatever you had planned to do tomorrow, now everyone must come to Genoa.” 

Three years later, Rifondazione was part of a governing coalition which voted for war credits. Now, Fascists are in power in Italy and the parliamentary Left is irrelevant. The Left in other countries has experienced similar disappointments.

The German experience

In Germany, Die Linke was initially able to combine Left reformism with anti-capitalism. The party emerged from the mass movement against the Hartz IV attacks on the unemployed. Many activists moved straight from the anti-globalisation organisation (ATTAC) to Die Linke. One of the party’s first actions was to mobilise for the G8 protests in Heiligendamm.

Shortly after that came the mobilisations by Dresden Nazifrei, which successfully blockaded and prevented the largest Nazi march in Europe. Die Linke was central to this mobilisation. It was both a reformist party and a motor of the movement.

The most important mobilisations of today are against the Israeli genocide in Gaza. Despite the occasional decent statement, Die Linke stands largely on the wrong side of the barricades. The nadir occurred in October 2023 when Die Linke joined the other electoral parties in calling a rally in solidarity with Israel.

Palestine is not an exception. The party played no relevant role in Black Lives Matter or in the movements against war and the climate catastrophe. Individual regional groups did support some actions, but a generation of activists has grown up believing that no parliamentary party supports them.

While all this has been happening, the Left of the party has been apparently on the ascendant. In June 2022, the left-wing Bewegungslinke (“movement left”), won a majority of posts on the party Executive. Despite this increased representation, the party’s practise has stayed the same. Winning leadership positions is no substitute for being an active part of social movements.

The limitations of Reformism

As social movements have receded, Die Linke has increasingly concentrated on winning elections. This was not always the case. In 2008, Die Linke in Hessen had the chance to join a governing coalition with the SPD and the Greens. They opted instead for toleration – allowing the SPD and Greens to form a government (no-one wants a CDU government), while not joining it themselves.

Deputy leader of the Linke parliamentary faction in Hessen, and key supporter of toleration, was current party leader Janine Wissler, a prominent member of the Bewegungslinke. She has since taken a much more pragmatic position. At a rally before the last general election, she argued that NATO would not prevent a coalition government with the Greens and SPD. In other words, Die Linke’s traditional opposition to Western imperial power could be negotiated away in exchange for a place in government.

This strategy did not even work in electoral terms. As Die Linke casually dropped most criticism of their potential coalition partners, voters saw no reason for voting Left when they could get exactly the same policies from larger centre left parties.

Areas of resistance

This does not mean that the Linke is a reactionary homogenous blob. The Berlin Linke Internationals, an organisation for non-German activists of which I am co-speaker, has consistently been anti-imperialist and pro-Palestine. 

Originally formed to mobilise for the 2014 EU elections, the group has played a leading role in the fight against German/EU austerity in Greece, challenging the international far right, and defending abortion rights. The Linke Internationals organise an annual Summer Camp, usually attended by around 60 people. Party funding means that participation is free. 

Yet relations with the Party are getting strained. Last year,  following some problematic statements by Party leaders on Palestine, we decided to stay in the Party and fight for our positions, while monitoring the political situation.

Our work has been increasingly detached from party activity. Our successful weekly Palestine Reading Groups have been effectively run in the name of theleftberlin – the website which we run together with other left-wing activists. The website has an independent editorial board and is not connected with the party.

“Left” Alternatives to Die Linke

The formation of the Bündnis Sahra Wagenknacht has excited some people who were disillusioned with the direction in which the party was going. Wagenknecht has made much clearer statements against German militarism and in support of Palestine than most in her former party. 

At the same time, Wagenknecht’s apparent belief that we can counter the AfD by adapting to their racist ideas is deeply problematic. She has called for more migration controls and attacked anti-racist activists as “scurrilous minorities”. I have written at length about Wagenknecht’s accommodation to racism in the past (see here and here), so won’t add much, except to say that Wagenknecht’s “anti-woke” agenda often dovetails neatly with that of the AfD.

Recently, some on the Left have become enthused about DiEM25, the latest manifestation of the Yanis Varoufakis vanity show. When DiEM25 was formed, they insisted that they would not contest elections, as they intended to be part of the social movements and nothing else. I reported on the DiEM founding conference here, and made a more recent appearance of Varoufakis in Berlin here.

DiEM25 are not programmatically significantly worse than Die Linke, although there is still time for them to degenerate. And yet they do not offer anything qualitatively different. The next election will surely see a plethora of Left organisations campaigning against each other. None of these parties will provide an adequate focus to unite social movements and build the resistance we need.

Can Die Linke be reborn?

Some Leftists agree that Die Linke is not what it used to be, but argue that Wagenknecht’s departure means that the party can be rebuilt on left-wing principles. They point out that party membership has risen since Wagenknecht flounced out, including many pro-refugee activists who refused to engage with a party for which Wagenknecht was a prominent spokesperson and regular chat show guest.

It is certainly true that in my Linke branch, in Wedding, we have had a massive influx of new members, many of whom are well to the Left of the party leadership. We have had lively discussions on Palestine and sent delegations to solidarity demos. But none of this alters the fundamental nature of the party and its obsession with winning elections.

In February, Vashti media claimed that “the Left Party is split between the Wagenknecht group – which consistently opposes militarism but seeks to intensify deportations – and the remainder, which consistently protects migrants”. Unfortunately, this does not remotely reflect reality. 

Die Linke has been the majority party in Thüringen for 10 years. Last year, under Linke President Bodo Ramelow, Thüringen deported more than 300 people. Although Wagenknecht’s departure is no political loss, the short term effect has been to strengthen “reformers” like Ramelow whose practise is everything other that “consistently protect[ing] migrants”.

I never thought that Die Linke would be the organisation we needed. From the start, it was an integral part of the electoral process which would always ultimately side with the system. But there were always enough contradictions for it to be a meeting point for people who wanted to go further.

In some places, like my local branch in Wedding and the Internationals group, this is still the case. At the same time, it is no surprise that both Die Linke Wedding and the Internationals are questioning how long we can be part of this rightward drift. In both groups, we have said if we leave we will leave together, and that the unity which we have built is more important than any party structures.

Whatever happens, organisations outside Die Linke are increasingly necessary for carrying on the fight – be this Aufstehen gegen Rassismus for the fight against the AfD, or theleftberlin website. For my part, I still have hopes in the new socialist organisation Sozialismus von Unten, where I am working to bring together German and non-German activists, particularly those who have been radicalised by the Palestine movement.

The situation facing the German Left is grim, but we can’t give up hope. I am convinced that our international experience will be part of what lifts us out of our current malaise. I look forward to seeing more faces in demos, in reading groups, and on the streets of Berlin  – with or without Die Linke.

The English NHS plans Medical Assistants will replace expensive doctors – Are they safe?

Medical Associate Professionals are being used as a cheap cover for not enough doctors. This must be fought.


Given both an international crisis in health care staffing and a drive ro reduce costs, highly skilled workerws are being replaced by those with fewer skills and less training. How does this play out? In the UK, Physician Associates (PAs) are now widely discussed. Largely because of plans to increase their numbers, public confusion about what they are and how safe they are, doctors’ complaints against  professional bodies (Royal Colleges). The worry is that PAs are simply ‘doctors on the cheap’ and pose significant risks to patients while undermining planned increases in medical staff. We highlight some of these issues.

What are Medical Associate Professionals (MAPs)?

Since 2003, PAs are one of several MAPs, who currently work in the NHS in a avariety of roles.  By 2036/37 the government in England plans to increase the number of PAs from approximately 3,250 to 10,000 (an increase of over 300%), and MAPs from approximately 180 to 2,000 NHS Long Term Workforce Plan. MAPs complete only a two-year postgraduate course (1,600 hours of clinical experience and teaching) but the NHS deploys them instead of doctors. That includes care of patients with new and undiagnosed problems (‘undifferentiated patients’). In a recent survey by the British Medical Association (BMA)  a large majority of doctors expressed concerns that PAs and AAs risked  patient safety. The BMA has called for a halt in recruitment until their role is reconsidered.

What are PAs qualified to do?

The Royal College of Physicians (of the Royal College of Physicians) states that: ‘PAs are healthcare professionals with a generalist medical education, who work alongside doctors… . .. under their supervision ….They are complementary to GPs …..and in no way a replacement for any other member of the general practice team…(This)  does not mitigate the need to address the shortage of GPs’. The College says that PAs work within a defined scope of practice and limits of competence.

These  accord with guidelines developed by the Department of Health and Social Care (DHSC),and professional bodies. After a PA degree programme, PAs must pass a National Examination..

Seeing “undifferentiated patients” is controversial. In 2020, a PA could be the first contact for patients with undifferentiated problems. However, a later statement  in GP contract 2024/5  states: ‘#17. non-GP doctors (sic) should not see undifferentiated patients’. It is both telling and confusing that PAs seem to be referred to here as ‘non-GP doctors’ . Some GPs  question the usefulness of PAs in general practice altogether, since the supervision required is onerous, and they flag patient safety concerns.

The NHS England (NHSE)  National Medical Director Sir Steve Powis said: ‘PAs are trained to examine, diagnose and treat patients under the supervision of doctors…PAs are not doctors, and cannot and must not replace doctors’.

Representing all the colleges, the Academy of Medical Royal Colleges (AOMRC) produced a consensus statement on PAs, stating that: ‘PAs are not doctors and cannot and should not be used as a substitute for doctors’. In addition, training opportunities for junior doctors need to be prioritised and protected. The AOMRC also emphasised the importance of supervision.

The issue of professional regulation

Oversight was established by the RCP in 2015 ‘to provide clarity to the public on the different scope of practice of a doctor and a PA’. MAPs currently only have voluntary professional registration. But the government pushed the General Medical Council (GMC) to become the regulatory body for MAPs. The GMC is the independent regulator of doctors in the UK. The BMA set out three demands:

  • PAs and AAs be regulated by the Health and Care Professions Council (HCPC)
  • They should be called ‘Physician Assistants/Anaesthesia Assistants’ 
  • A moratorium on PAs/AAs until clarity about their role and scope of practice was achieved.

The debate on regulation (Draft Anaesthesia Associates and Physician Associates Order – AAPAO) took place in a parliamentary committee session, but lacked depth to assess this important issue. For example, former Health Secretary Thérèse Coffey remarked that after she had waited nine hours in one hospital, she went to a different hospital the next day and was seen more quickly – because the hospital had a PA. 

In a radio interview on PAs, Conservative peer Lord Bethell showed his lack of understanding while not endearing himself to GPs: ‘GPs don’t face huge amounts of complexity. Most interactions are incredibly straightforward. Certainly, my own experience over the last 20 years of going to my GP, it really hasn’t required 10 years of training to deal with my small problems’. In Lord Bethell’s opinion at least, PAs could easily take on work currently being performed by GPs in assessing patients presenting with new problems.

But as KONP has pointed out, people often have very complex symptoms with a many possible causes – some serious, some not. It takes 10 years to train a GP with on-going learning. GPs are expert medical generalists who can diagnose, treat, prioritise and manage multiple and complicated conditions. Their particular strength is using their communication skills and clinical knowledge to make sense of symptoms which do not fall into any algorithm.

A Conservative MP and doctor, Dan Poulter, put it this way to Parliament: ‘When the PA role was introduced, it was clearly seen as part of the solution to a shortage of doctors… By freeing up doctors from administrative tasks and minor clinical roles, it allowed them to see more complex patients… Unfortunately, physician associates and anaesthesia assistants (are) employed in the NHS in roles that stretch far beyond that original remit, and… they appear to be working well beyond their competence. That has raised serious patient safety concerns’. 

Push back against expansion of MAPs by rank and file doctors

Many doctors remain concerned that PAs are a threat to patient safety. Members of both the Royal College of Anaesthetists and of the RCP forced their college executives to call an extraordinary general meeting (EGM) to explore this. At the meeting of Anaesthetists, 89% of college members voted for a pause in recruiting anaesthesia associates until after a survey, a consultation, and an impact assessment of doctors in training.

The meeting was followed by huge recriminations after it became clear that data from a college survey had been misrepresented to suggest more support for PAs than was actually the case. Negative publicity ensued with accusations that the leadership was ‘in bed with the government’.

Are doctors right to worry they are being replaced by MAPs?

The GMC has asked NHS England (NHSE) to address whether there is a plan to replace doctors with PAs: ‘We believe governments should also consider what they can say about future training numbers to make it clear that their workforce plans envisage significant growth in doctor numbers, as well as amongst PAs and AAs’. In December 2023, there were 8,758 medical vacancies in the NHS and England needs an additional 50,000 doctors to bring it into line with European countries. NHSE points to its plan to double the number of medical school places over the next decade, to ensure an extra 60,000-74,000 doctors plus 10,000 PAs in the NHS by 2036/37. The AOMRC repeats this reassurance, implying that with rising demand there is more than enough work for both doctors and PAs.

But just how reassured should doctors be? There has already been back pedalling on the increase in numbers of new medical student places (just 350 for 2025/6), and no new capital funding for medical schools. In addition, junior doctors already see bottlenecks in training. For example, in 2021, 700 anaesthetic trainees could not continue despite 680 unfilled anaesthetic consultant posts. The government ignores retention of doctors, as many threaten to leave the NHS because of poor pay and working conditions; and only 56% of those entering core training remain at work in the NHS eight years later. The Panorama programme on Centene showed in one London general practice that PAs were effectively working as GPs without supervision. A general practice in Surrey made three of its GPs redundant due to ‘new ways of working’ including the use of non-medical staff, while other qualified GPs report difficulty finding a job. Richard Meddings, chair of NHSE (a banker by trade), argues that the medical staffing crisis could be solved not by improving retention and training more staff but by slashing the time to train a doctor.

The National Audit Office recently examined the modelling used of long-term workforce planning assumptions. There is a gap between estimated demand for GPs and number of expected GPs. NHSE anticipates moving work from fully qualified GPs to trainees (!). This seems very unlikely, and it is more plausible that PAs will be called upon to close this gap.

How to ensure that MAPs do not replace doctors

The BMA asserts that MAPs can play an important part in NHS teams. Because of their concerns the BMA has produced guidance with the aim of protecting patients and safeguarding medical training for the doctors of the future.

Key concepts in this document include that MAPs should follow, and not give medical directives; but act upon the medical decisions of a doctor and do not make independent treatment decisions; and that national standards for supervision of MAPs must be set.

We should spare more than a thought for the 3,250 MAPs currently working in the NHS as valued team members, and through no fault of their own, are caught in the middle of arguments about their future. A worried ‘union’ for PAs (United Medical Associate Professionals – UMAP) warns of GP practices implementing the BMA’s scope of practice of potential legal consequences. The union argues that it is ‘inappropriate’ for the doctors’ union to ‘unilaterally redefine and attempt to impose a scope of practice on another profession’, and highlight a lack of ‘stakeholder engagement or peer review’. MAPs currently in post should be supported, supervised and not forced to work outside their competence.

Conclusions

Some commentators have raised fundamental questions about PAs. What special skills is it that PAs bring to the multi- disciplinary team and what is their scope of practice to be? If they are ‘medical skills’ as such – what then is unique about the profession of medicine and what has been excluded from a five-year course in reducing it to a two year one for MAPs?

The BMA framework should be welcomed by all bodies since its aim it to ensure PAS do not substitute for doctors . However, the government wishes to blur boundaries between MAPs and doctors as a strategy for substituting a cheaper alternative for the latter. The long-term workforce plan looks unlikely to deliver the numbers of doctors we need. The failure to address doctor retention through improved pay and work conditions also suggests that NHSE and the AOMRC reassurances must be taken with a large pinch of salt.

It is instructive to look at the United States where PAs (called Physician Assistants) can work without medical supervision and are growing in number at a much faster rate than doctors. This has been driven by an increase in demand for health care and the push from profit-based providers to reduce labour costs. The cost savings of increasing Physician Assistants relative to physicians is substantial. However, evidence indicates that Physicians Assistants both over investigate and over treat patients compared with physicians. In other words, quality of care deteriorates.

As the editor of Pulse magazine has pointed out: in England ‘it boils down to one thing: they are being used because they are cheaper than trained doctors. This replacement of doctors with PAs is a scandal. Not because we are seeing a spike in avoidable deaths or the like (yet). It is a scandal because it is an acknowledgement that lower standards of care are a literal price worth paying for a cheaper service’.

Campaigners should tell employers that for the sake of patients (and for MAPs), the BMA scope of practice must be adopted and implemented.