GP supervision of physician associates (PAs) must take place immediately after each patient and before they leave the surgery, according to the BMA.
In new guidance for GPs, which aims to ‘standardise’ the use of PAs in practices, the BMA has highlighted the importance of ‘contemporaneous’ and ‘co-located’ supervision.
The union has also said PAs should not undertake home visits or care home ward rounds unless accompanied by a GP supervisor.
For ‘simple procedural tasks’ GPs may be able to relax supervision arrangements, but this would require a ‘risk assessment’ to understand the PA’s competency.
The guidance suggested that GP supervisors should review the patient history and examination findings of each patient a PA has seen.
It does not go as far as stipulating this level of supervision for every patient, adding the caveat of only ‘where relevant’.
But the BMA did warn that GPs ‘are likely to be legally responsible for PAs working under their supervision/ employment’.
It therefore urged supervisors to check they are ‘appropriately indemnified’ and ‘regularly familiarise themselves’ with their GMC and MDO obligations.
According to the doctors’ union, the use of PAs in general practice and hospital settings ‘has increased whilst the supervision and oversight has, in many instances, been relaxed’.
This new guidance is intended to be ‘complementary’ to previous BMA guidance, such as the ‘safe scope of practice’ document which said PAs should never see ‘undifferentiated’ patients in a GP setting.
The BMA noted that following this, the NHS England changed the PCN DES wording to say that PAs should only see undifferentiated patients where appropriate supervision is in place.
‘We would urge GPs who choose to employ PAs to prioritise the safety of their patients, noting that although the new DES wording suggests PAs may be able to see undifferentiated patients, this now clearly places the onus upon the GP supervisor to ensure appropriate supervision is in place,’ the supervision guidance advised.
On ‘co-located’ supervision, the BMA said: ‘Supervision must take place contemporaneously (immediately after the consultation), and prior to the patient leaving the site, in order to permit GP supervisor clarification and re-examination when needed. This must happen for each patient.’
The doctors’ union also advised GP supervisors to ‘prioritise the training of doctors and medical students’, as ensuring they develop expertise is ‘essential for the development of the future medical and GP workforce’.
Other recommendations
- Within each workplace setting, PAs must at all times have access to a clearly identified, and immediately available, named on site GP supervisor.
- Salaried and locum GPs can supervise PAs ‘should they consent to do so’ but it must be part of their agreed job plan or clinic template.
- Supervising GPs must have ‘adequate time’, e.g. debrief and supervision time built into clinic templates, and also to take account of additional prescribing and admin workload from patient reviews.
- For telephone consultations conducted by a PA, it is acceptable for the PA to advise the patient they will be called back, then present to the supervising GP, and then for the GP supervisor to call the patient back.
- GPs providing supervision need to be appropriately indemnified for supervising PAs and should confirm this with their medical defence organisation (MDO).
- At all times, the GP supervisor should be clearly identified and their name and contact details readily available so that they can be contacted with any queries about delegations in place on a particular day or shift.
- Co–located same site contemporaneous supervision is required for any PA working in any general practice setting.
- GP partners employing PA should carry out ‘due diligence’ to take into account ‘the clinical and cost effectiveness of overall needs, and factoring in the costs of GP supervisors and supervision time’.
- Non-supervising GPs must treat PAs ‘civilly and with the same level of professionalism as you would any colleague’.
Source: BMA
Pulse’s recent investigation into the rise of physician associates in general practice looked at GP concerns about their clinical responsibilities, and particularly whether they are safe to see undifferentiated patients.
The CQC recently set out guidance which said GP practices should be able to show ‘how they assure themselves’ of a PA’s ‘competence’ as part of inspections.
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I can’t see how having PAs in practice is in any way helpful if we have to review every patient.
What is the point of having a PA then?
Quicker, easier and safer to do it yourself? So why emply them?
Well, maybe would work in GP Practices if you had some sort of Assistant to save you time by helping patients in and out of their clothes and the consulting room, so you have spare time to go supervise;
But how does it work in hospitals? Do Consultants also have to supervise PAs this closely, or are those ones allowed to Practice medicine unsupervised?
or maybe GPs are expected to do that too?
In other words, BMA now advising GPs to increase their workload…strange they couldn’t foresee this PAs situation developing. Maybe once PAs are trained up, helpfully, by those GPs who always clamour to be first in the queue for funds for new NHSE initiatives, they can then take over more GPs jobs.
In response to the above, that’s the whole point of the guidance, surely. To make the use of PAs so unattractive and unworkable, that the practice is stopped forthwith.
BMA colluded with GMC and govt to support PA implementation.
Hypocrisy at its best.
Thanks, but our PA has years of experience, is more competent than most newly qualified GPs, and knows when to ask for help.
Completely impractical, much as it seems are the brains of those who come up such impracticalities.
Only surprise is that its taken so long for BMA to state this unequivocally. However. some GPs seem happy to accept the medicolegal risk of allowing PAs to see and manage undifferentiated patients. Unless the GMC change their approach, it will be down to the employing GP practice to decide how their PA works.
I said a while ago, no point having them if we need to waste time scrutinising again. It is not different than supervising final year student but unpaid work. Use arrs to employ gps.