GPs are ‘not accountable’ for the decisions and actions of physician associates (PAs) they supervise, the GMC has said.
In a letter to system leaders, the regulator said that its guidance for doctors is ‘clear’ that doctors – including GPs – are not accountable for the decisions and actions of PAs and anaesthesia associates (AAs) as long as GMC standards and guidance are followed.
The GMC also stressed that it is ‘listening and responding’ to views and concerns regarding the regulation of the roles, acknowledging that the lead-up to regulation is a ‘challenging period’.
The letter, signed by GMC chief executive Charlie Massey, said: ‘Our guidance for doctors is clear that, as with other professionals that they supervise and work alongside, doctors are not accountable for the decisions and actions of PAs and AAs, provided they have delegated responsibility to them in line with the standards and guidance in Good medical practice, Leadership and management for all doctors, and Delegation and referral.
‘When it comes to good supervision, there isn’t a one-size fits all approach because individuals who are being supervised develop their skills, competence, and experience over time.’
The GMC added that it is ‘aware’ that ‘issues’ related to the responsibility and accountability of doctors when supervising PAs and AAs have ‘come to the fore in recent weeks’, due to ‘online discussions’ about a Medical Practitioners Tribunal determination from a case in 2017.
The case of Dr Steven Zaw, a secondary care doctor who was suspended for ‘inadequately supervising’ the PA under his authority, was highlighted in Pulse by DAUK in a series called GMC case in focus, which looks at GMC cases that have implications for the profession and that are either topical or from recent history.
The GMC argued that the case ‘has been misrepresented as setting a precedent or policy position’ and added that one tribunal determination ‘sets no legally binding precedent on future tribunals’.
It added: ‘The case involved significant concerns and allegations about the doctor over a period of time. The primary failure was the doctor’s responsibility to urgently and personally review a patient upon admission because of how they presented, which he did not do.
‘While the tribunal found that the doctor failed to adequately supervise a PA’s review of that patient, other serious allegations were also found proven which were of an entirely separate nature.’
The regulator also defended its decision to not ‘set a defined post-qualification scope of practice’ that determines what tasks PAs can safely carry out, as ‘this depends on their individual skills and competence which develop over time’.
It recommended that organisations identify an individual at board level ‘who is responsible for PAs and AA’s, and that local processes are established governing ‘how they are deployed and supervised’.
The GMC’s outreach teams across the UK will ‘continue to engage’ with employers about the importance of having ‘effective and appropriate’ clinical governance systems in place.
Once regulation begins, if the GMC has ‘concerns’ about local systems, they will escalate them for action.
The letter also added that PAs and AAs ‘don’t have the same knowledge, skills and expertise as doctors’.
‘They are not doctors, and they can’t replace them,’ the regulator added.
‘It’s clear that they can, and do, play important roles within multidisciplinary teams when appropriate and effective clinical governance and supervision are in place.’
Earlier this week, a group representing anaesthetists of all grades announced it is taking legal action against the GMC as it wants to achieve ‘clear and enforceable guidance’ on the ‘privileges of members’ admitted to associate practice, ‘defining what they can and cannot do’.
Last month, local GP leaders said that the GMC is ‘complicit’ in the Government’s ‘agenda’ to create ‘a cheaper model of primary care’ by supporting the use of physician associates (PAs) in place of GPs.
And last week, the use of PAs in the NHS has been opposed by firefighters and other workers within fire and rescue services across the UK.
Taken with a large spoon of salt …
As clear as mud, Charlie. You’re one step away from telling us that that tribunal didn’t happen in 2017. Dr Zaw was ‘clearly’ punished for vicarious liability for the PA’s shortcomings. Which part of this agrees with what your current position statement is?
Also, which planet do you think the rest of us are living on when you say they aren’t replacing doctors, when NHSE and ICBs across the country advertise and officially endorse these people working alongside us seeing undifferentiated patients? Or is that bit outside of your ‘scope of practice’ because you just lay down the law as it should be in your universe but can’t be bovvered to know exactly how it is implemented in ours?
Aye………… Right
Pulse, can you ask who asked for this letter to be written? That’s where the true story lies.
MDU / MPS opinion on this position would be good. GPs (particularly Partners) are very likely to be held medicolegally responsible for actions of any employee. They can always be accused (rightly or wrongly) of inadequate supervision, training or triage. They might not be struck of by the GMC but that’s little comfort.
So the regulator is saying that they aren’t going to say what these peoples role should be because that depends on who they are and what skills they have. Any decision about what they do is up to the people who employ them, not the GMC. GPs aren’t responsible for PA errors so long as they are following other generic guidance which we developed for other nonspecific generic situations. HOWEVER if “GMC has ‘concerns’ about local systems, they will escalate them for action”. They’re just not going to tell anyone in advance what those concerns might be..other than what has already been said…elsewhere.. in other guidance. Thanks Charlie..thats super clear. I guess you read Kafka
This guy is out of his depth and should not be heading up the GMC
GMC is becoming increasingly detached and unintelligible – the income they receive from PAs will make this situation and accountability worse. I Have no confidence in this regulatory body and there should be a vote on this increasingly isolated organisation.
Once PA had a quick world with GP they will become responsible because they have agreed. You need to trust the information given If you have to verify then you might as well see the patient.
I refuse to vote for Christmas as I am a turkey.
Once PA has spoken to Gp ,, GP will become responsible.
This is wriggly and slimy and wrong. Whilst a regulated person will be responsible for their own acts and omissions, the principle of ‘respondeat superior’ will apply in law, as it has always done. Both PA and supervising GP will be legally liable (I’m not a lawyer but clearly neither is CM).
Checking the US situation – because the UK is in fact seguing into the American model – we see that US doctors do indeed ‘enjoy’ vicarious liability for PAs errors. Noting that 85% of patients in urgent care are treated by PAs or NPs, it becomes pretty damned obvious that not only are PAs intended to replace doctors, but also that the lack of formal scope of PAs in practice is an inherent danger looking for a lawsuit. It’s a really really sad and unacceptable day when the GMC becomes a laughing stock of irresponsible misdeed and the only mirror it can reflect is through the looking glass.
Yep NM, great to get our sovereignty back only to give it away to become the corporatised vassal 51st state of the US…(not)
Eric Blair
Charlie boy’s comment is both unsuitable and offensive. I’m reporting it to Pulse😊. How insufferable is this man.
Thankfully I’m practicing overseas now.
Way less patients, way more cash and way more thanks. More time for family and social life. Much better weather.
I suppose I at least owe him and the Government for spurring my move overseas on.
Just give us a straight answer! Reading between the lines, yes the supervising GP is responsible for the PA. They will punish you just like they did with Dr Zaw. Blamed for someone else’s actions. The BMA should form an alternate regulator headed by a medical professional as we have lost faith in this one.
There may be only 2000 PA’s now working in the system, but what is the number with different ARRS roles in totality.? There is no locum or salaried GP demand in Solihull and B’ham in the past year.
Massey doesn’t convince me that doctors will not be held responsible for ARRS actions on any level.
The M in GMC, stands for MEDICAL. I am sorry but PAs are NOT medically qualified and neither are any other ARRS roles. Surely they should be under the HCPC like physiotherapy, OTs, podiatrists, ODAs. The GMC has no business being involved with this.
There are 2000 PAs in the country at the moment, but what is the ARRS total with ANP and pharmacists etc taking on undifferentiated GP work? There is no GP work as a salaried or locum in Solihull and Birmingham in the past year, and latterly too it feels like a dangerous place to work with many patients seeing a PA but still come out convinced that they have seen a GP. Patients tell me this again and again and take convincing that the person they saw last week say, was a PA and not a GP.
I’m not convinced at all that GPs will not be totally responsible for actions and errors made by PAs for all the reasons stated already. The ‘M’ in GMC stands for MEDICAL, and I dont know why the GMC has taken on regulating PAs who are NOT medically qualified. Surely they should be under the HCPC that looks after, (or at least takes annual fees off), 280,000 health professionals in 15 categories of non-medical work such as physiotherapist, OTs, podiatrists and ODA’s.
I am afraid that the PA situation is building up to be another NHS treatment failure scandal in the future.
I recall the times when unqualified G.Ps gave an anaesthetic—————–scary or what?
So essentially – Although Doctors are not accountable for PAs actions, Doctors can be removed from from the medical register, if we don’t cross check everything a PA does !! And that is so reassuring!! Ha ha !!
We have a choice. We won’t employ PAs. Thank you GMC
The reality is allied non-docs/PAs/ARRS staff cannot be overseen on a case by case basis. We might as well see the patient ourselves, quicker and more accurately. Supervision totally relies on our advice being sought by a clinician who recognises when they are consulting outside their envelope. But what if they don’t know what they don’t know? I see harm after harm, every single day, nearly all systemic, as a result of our current working practices and constraints, dictated entirely by government. It’s a scandal that the CQC blindly ignore this reality as the main driver of patient harm. I guess they enjoy punching down on the little people instead. CQC do your job!