GP leaders across the UK have voted in favour of ‘phasing out’ the physician associate (PA) role in general practice.
At the BMA’s GP Committee UK meeting yesterday, members voted to stop hiring new PA roles in GP practices and to phase out existing roles.
An ‘overwhelming’ majority voted in favour of the motion, which declared that having PAs in general practice is ‘fundamentally unsafe’ and that practices should immediately suspend any sessions in which PAs see undifferentiated patients.
This is based on the belief that PAs are ‘inadequately trained’ to manage such cases.
The BMA said existing PAs who would be ‘phased out’ should be given opportunities to ‘retrain into more suitable ancillary NHS roles’.
Yesterday’s vote at the BMA follows a similar vote by the RCGP in September where its council took the stance to completely oppose the role of PAs in GP practices.
Shortly after this, the RCGP published its comprehensive scope of practice guidance for PAs, which severely restricts their current practice.
Responding to the GPC UK’s vote, chair Dr Katie Bramall-Stainer recognised that the role of PAs is a ‘challenging and politically heightened issue’ but stressed that patient safety is ‘at the heart of it’.
She said: ‘It’s no secret that we desperately need more staff in general practice, but we need be sure that staff who see patients are suitably trained and competent to see them unsupervised.
‘Workload is inextricably linked to the recruitment and retention of the workforce, so additional roles should not generate more work for already-stretched GPs.’
Dr Bramall-Stainer said PAs should be able to retrain and take up other roles, but that ‘the bottom line is getting more GPs into the workforce’.
Motion in full
This meeting believes that the role of physician associates in general practice is fundamentally unsafe and:
- there should be no new appointments of physician associates in general practice
- the role of physician associates in general practice should be phased out
- the role of a physician associate is inadequately trained to manage undifferentiated patients, and there should be an immediate moratorium on such sessions.
Passed in all parts
About time. Thank you.
Now imagine that the headline reads “Hospital Consultants vote to phase out GPs”
How do you think you might feel…..?
Rotten mentality of some readers have not changed by comparing GPs with PAs
Unbelievable attitude toward fellow health colleagues who deliver much needed care every day. So we ban PAs but allow nurse practitioners to see undifferentiated patients when they have not completed any rigorous national clinical examinations nor have clinical supervision embedded in their role? Any safety issues there? The logical conclusion is only GPs see all patients for everything. Of course GPs do not make any mistakes do they? PAs must surely have the right to sue BMA/RCGP for their lifetime learning and future earnings now- after all they agreed and supported the role previously. The intolerable mental strain they are being subjected to by those who profess to be a caring profession is appalling and legally perilous for all.
Our PA is great, significantly more effective than most recent victims of rcgp “training”, and significantly cheaper.
Take a ruining jump guys.
GPs pride themselves on autonomy. No one is compelling practices to employ and supervise PAs, unless they are subservient to their PCN in which case they need to go on an assertiveness course. If you don’t want PAs in your practice there are far less contentious roles under ARSS such as Care Coordinator and GP (administrative) Assistants to free up more core funding to use on clinicians of your choice.
Nice to see the same bleeding hearts in the comments who are the main cause of ruin for our profession. Repeat after me: PAs are not doctors and have no business in seeing undifferentiated patients in primary care. And Dave, maybe if the rcgp “victims” had the same feather touch portfolio and exam requirements as your “great” PA, theyd also be more effective at the job. But its all about the bottom line for you isnt it… forget standards and safety.
@Hussam Ali, let’s just unpack some of that shall we. If having compassion for a group of colleagues who feel as though there is a witch hunt against them makes me a “bleeding heart” then that is something I’m quite comfortable with. If PAs are ruining our profession then why aren’t ANPs, ACPs, FCPs, MH nurses and clinical pharmacists also ruining the profession ? And if GPs are going to see no more than 25 patients per day who do you propose deals with the rest of the demand, given that this capacity will only allow an average full time GP with an average list size to see each patient twice a year when real demand is in the order of 7 times a year?
We need a little bit of context here; from about 2014 onwards most partnerships found it almost impossible to recruit GPs whether that be partners or salaried doctors. An ever increasing number of GPs chose to leave their substantive posts and join the burgeoning group of locum and freelance GPs who were finding the income and work life balance better than being in a practice. As they left so practices became ever more desperate for GPs and locums found that it was a sellers market with some able to command over £1000 per day, and so low and behold the exodus into freelance working gained more momentum and practices became ever more desperate until in the end we were offered the ARRS roles via PCN working. For the first 4 years many PCNs happily employed PAs and nobody expressed any concerns, but then as practices GMS budgets were in effect cut by 20% (inflation of 10% and uplifts of 2%) then many practices felt that they needed to cut back on locum spending and use the ARRS to absorb some of the capacity. The end result of this has been over the last 12-18 months a fair few GPs have found that the locum work has dried up. I can understand why this would concern me if locuming was my livelihood but there is not much moral high ground in trying to drive one group of clinicians out of their livelihoods in order to preserve yours. There is plenty of work to go round and the enemy here is poor funding of primary care not PAs.
Please try to remember that PAs are humans too; they have mortgages, rents, families to support and student loans to repay. Trying to drive them out of existence shows our profession in a very poor light.
Totally agree with Hussam Ali. Nobody is arguing some GPs cant see a problem replacing themselves with PA’s. This is bleedin’ obvious. These are the guys doing just that. The other thing thats bleedin’ obvious (to me at least) is paying too much attention to the opinions of a subgroup of GPs who chose to stick around administrating the winding down of their profession, is not wise. It’s these guys who “everyone thats left” cant work for. It’s these guys who’ve carried on signing the contracts which took us here. Surprise surprise they lecture everyone on how they run the show because they set the rota. Look around you, it’s a shit show. Carry on, the rest of us see clearly what you are doing even if you don’t.
@ anony mouse “There is plenty of work to go round” no there isn’t. GPs are unemployed. They have kids and mortgages too. PA’s were created to replace them. I feel for anyone doing that role but you’re missing the point. The only thing I can agree with in your comment is that the problem is a lack of funding. That and people, administrating it all because they “have to” because they “have no choice” and they’re just “doing their job”, a little patronising I feel.
And one more thing..(please excuse me) but you guys telling folk they’ve got it wrong and we don’t need GPs in primary care because its just too difficult. Wake up. You just lost the argument. Read the news. But depressing thing is, despite it all, I’m personally quite convinced, the battle was already as good as lost. Primary care is dead. And the current generation of partners over saw the process. Too little too late
I would not like to supervise pas and don’t want to be responsible for their action.
Re AB “…..paying too much attention to the opinions of a subgroup of GPs who chose to stick around administrating the winding down of their profession”.
Astonishing rewriting of history!
The partnership model ticked along reasonably well for decades, but then in the 2010s nobody wanted them.
As partners left/resigned/died/retired, the few remaining would fritter away thousands on unanswered adverts for non-existent replacements, with a Hobson’s choice of struggling on, unlimited liability bankruptcy, or handing back their contracts.
The system was perilously close to collapse, not helped by exorbitant Locum fees.
Employing an MDT of ANPs, CPs and yes, PAs in the absence of replacement partners/salaried GPs was second prize perhaps, but it kept grassroots surgeries alive where they nearly collapsed.
We “stuck around” due to a combination of loyalty to practice/patients and fear of financial ruin (especially the poor old Last Man Standing suckers who were left in the lurch by exiting partners).
And PCNs were thrust upon a reluctant profession without warning, where refusing to sign up would mean Goodnight Vienna financially.
The fact that surviving partners have kept General Practice afloat by sticking in and making the best of a disastrous situation should be applauded, not condemned. They stuck around to save, not “wind down” the profession
But congratulations, you won, and PAs will now disappear. But since practice funding has been slashed (it’s all gone to PCNs), we won’t be able to afford the GPs we need, even if they are now interested in taking the jobs they didn’t want before. Soon the trickle of practice closures will become a flood. Now THAT’S how you wind down a profession!
We are all cannon fodder. PAs were created because the rest of us are waking up to that fact and reacting.
David I’ll read your comment after a cup of tea. I have an image of a rabbit in the middle of the road watching a lorry approach blankly reassuring himself he’s doing the right thing. It just popped in there. Mmm
Paramedic practitioners anyone?
ANPs/ PAs etc have slowly been replacing GPs since 2000, it’s just reached the tipping point now that GPs are being actually being made redundant . Locum GP is dead. Even the GMC/ MPTS/ CCGs are trying to pass the term ‘doctor’ to PAs. Allied HPs also need to recognise they are not GPs and so do some GPs who are placing the same burdens on them.
Our PA is significantly more competent than most recently trained GPs – he has a lot of experience seeing people now, which is rather more useful than hours in front of a computer with the rcgp blended learning. And unlike a significant proportion of recent trainees he is self motivated to do better, and not a 9-5 drone.
That he is cheaper means we can provide more appointments for the same money, which benefits patients. It’s a better service in consequence.