The Diabetes Specialist Nurse Forum is demanding Physician Associates and Nursing Associates should never be used to substitute for existing members of the diabetes multidisciplinary team (MDT).
A joint statement by the DSN Forum and other diabetes organisations calls for the roles of PAs and NAs as additional members of the MDT to be agreed at national level via a defined competency framework.
Diabetes is a speciality which prides itself on multi-professional working, including DSNs and general practice nurses, doctors, dietitians, podiatrists, clinical psychologists and clinical pharmacists. There is a strong body of research to demonstrate that the current MDT composition improves clinical outcomes.
These clinicians provide essential skills in diabetes care as their role extends beyond routine care to include complex insulin and glucose management, cardio-renal-metabolic risk reduction, admissions avoidance, handling acute emergencies, and integrating the latest clinical guidelines.
The ability of many members of the current MDT to prescribe is important, and without professional regulation this is not something that can currently be changed for other groups.
The NHS Long-Term Workforce Plan, published in 2023, looks at different ways of working with increasing number of other staff such as Physician Associates (PA), who have yet to have nationally defined scope or regulation or prescribing rights, thereby lacking the skill or expertise detailed above.
The DSN Forum states: ‘Substitution could lead to gaps in care and subsequently increased waiting lists, a detrimental effect on physical and mental health outcomes for people living with diabetes, and increased healthcare costs, compromising the quality of diabetes care in the UK. Any new role must be additive based on defined parameters of contribution to existing MDTs in diabetes care.’
