The RCGP has urged GP practices across the UK to ‘halt’ recruitment of physician associates (PAs) until the profession is regulated later this year.
This recommendation is based on ‘concerning findings’ from the RCGP’s recent consultation, which surveyed over 5,000 GPs and found that over 80% believe the use of PAs in general practices has a negative impact on patient safety.
For those practices already employing PAs, the RCGP has advised partners to ensure they do not see undifferentiated patients and that daily supervision time is built into timetables.
The college is now working on guidance for GP practices, including a PA scope of practice and induction and supervision materials.
In the update today, the RCGP said: ‘After consideration of the survey results […] we are recommending to our members that they review their recruitment plans and halt the recruitment and deployment of additional PAs into general practice across the UK until PAs are regulated and practices are in a position to implement the RCGP’s forthcoming guidance.’
The ‘disturbing’ survey results showed that half of responding RCGP members reported ‘being aware of specific examples of patient safety being compromised by the work of PAs’, including instances of misdiagnosis and inappropriate prescribing.
According to the college’s initial analysis, the consultation also highlighted ‘wide variability’ in the way PAs are utilised and supervised in general practice, and respondents called for ‘greater clarity’ on what activities PAs should carry out.
Other survey findings included:
- 60% of respondents with experience of working with PAs said that they act as the first point of contact for potentially serious conditions;
- Only 25% with experience of working with PAs said that they had an annual appraisal;
- 25% said no time was scheduled for regular supervision, meaning PAs could only speak to their GP supervisor in gaps between appointments;
- 24% said they are aware of cases where the college’s ‘red lines’ on PAs have been breached.
As well as following its ‘red lines’, which say that PAs must not replace GPs and must always work under GP supervision, the college also urged practices to ensure that patients do not see a PA twice if they present with the same, undiagnosed problem.
The RCGP has also called on the Government to ‘commission an urgent review of the ways in which PAs work in the NHS’, and to make progress on GMC regulation of the profession as soon as possible.
College chair Professor Kamila Hawthorne said the ‘fundamental issue’ around PAs is ‘patient safety’, and recognised that the survey results ‘will be of concern’ to patients, GPs and PAs themselves.
She said: ‘Our intention is not to disparage the individuals who are working as PAs in general practice or their profession, but to address and act on the concerns that more and more of our GP members have been raising.
‘It is not the case that we heard nothing positive about PAs working in general practice – there are reports from our survey of where the role has been working well. But it is clear that there is not a sufficiently robust framework for supervision and scope of role in place in GP practices, and this is having implications for patient safety.’
The college admitted that asking GP practices to halt PA recruitment is ‘difficult step to take’, but argued that the weight of evidence from the consultation means bringing additional PAs into general practice would not be in the interests of patients, PAs or GPs.
Professor Hawthorne added: ‘We also need to see urgent action from government and NHS leaders to grow the GP workforce and ensure that PAs are not used as a substitute for GPs, and to support general practice to implement safe ways of working for PAs in general practice, including a robust system of professional regulation and significantly increased resourcing for GPs to support PA supervision.’
RCGP recommendations on PAs in full
Practices using PAs should review their induction, supervision and triage processes, as well as the type of work that PAs are undertaking, in order to assure themselves that the College’s existing red lines, as below, are not being breached:
- PAs working in general practice must always work under the supervision of qualified GPs.
- PAs must be considered additional members of the team, rather than substitutes for GPs.
- PAs do not replace GPs or mitigate the need to urgently address the shortage of GPs.
- PAs must be regulated as soon as possible.
- Public awareness and understanding of the PA role must be improved.
- Training, induction and supervision of PAs within general practice must be properly designed and resourced.
- At a time of significant GP workforce challenges, funding allocations, resources and learning opportunities within general practice must be prioritised for the training and retention of GPs.
- The significant responsibility and skills required for supervision must be recognised and resourced, with GPs able to choose whether or not they are willing to undertake supervision of PAs. PAs should not be employed unless sufficient supervision can be provided.
GP practices should also ensure that:
- Appropriate time for supervision is included within GPs’ and PAs’ daily timetables.
- Processes of triage, induction, and supervision are reviewed to ensure they are robust and safe for patients, and all PAs have documented annual appraisals.
- PAs do not see patients who have not been triaged by a GP and only undertake work delegated to them by, and agreed with, their GP supervisor. This work must be in line with the agreed scope of role for that PA in the practice.
- Transparent and accurate methods of introduction of all members of the MDT seeing patients are visible to patients, including on the practice website, on consulting room doors, on name badges and when appointments are booked.
- Patients who have already consulted a PA for a problem, and who re-present again with the same problem which has not been diagnosed and resolved, should not re-consult a PA, but should see a GP.
Source: RCGP
Are there many professions in the world where a qualified professional would require constant supervision throughout their career ?
NHS England has directed ICBs in how the PA contracts with ARRS funding are set up.
These contracts should not direct PAs to be placed into seeing patients outside of their competence or training.
The contracts need to identify clearly a scope of practice which is within that training and competence.
Any aspect of the contract which appears to do this needs to be changed (it may not be enforceable anyway).
NHS England and ICBs must not exploit this group of employees.
Further evidence of detached, poorly responsive GP leadership across the whole of the Primary care Spectrum in my opinion.
There remains the same relatively small group of leadership GPs profiteering at severe detriment to their colleagues and patients and with notable exceptions with this group including PCN CDs, ICB board member GPs and other GP leadership roles.
This is repeatedly raised as it is a fundamental cause of the tragic decline of Primary care we are witnessing.
They profiteer thorough extraordinarily high government inducement payments as with PCN CDs (again with exceptions) or ICB board GPs often on salaries in the region of £200,000 and hence have no incentive other than to push government agendas however absurd despite the damage inflicted on their colleagues and patients.
This largely same group GPs over decades via their highly paid leadership, board positions through promotion of APMS contracts , private outsourcing etc to the detriment of patient & colleagues are responsible for this insidious decline of Primary care which up until recently has gone largely unnoticed or uncommented.
We are all aware, there are exceptions and a lesser number of leadership GP illustrate have patient interest as opposed to high leadership remuneration payments as their driver but this in my experience is the exception rather than the rule.
The government and NHSE may have directed these schemes aimed at replacing doctors using their own ingeniously induced destruction of Primary care to then introduce models of cheaper care to rescue a system they themselves have disseminated.
Look at the PCN CDs and in my view you will find many are better classified as ruthless admin / business persons rather than doctors!
well said Centreground
Anaesthetics have stopped Anaesthetic PA, they raised £50k for legal challenge as well.
When would GP colleagues would wake?
RCGP must be suffering from a serious case of delirium! Finally advice that sounds sensible. PAs cannot and should not replace doctors for the sake of “saving money”. The most shortsighted thing ever ( maybe)
to Andrew Schapira’s question – yes, there are.
The first one that comes to mind is Junior Doctors.
As my good friend John said of the RCGP ” a bunch of smug useless to**ers”.