The RCGP has voted to completely oppose the role of physician associates (PAs) in GP practices.
At a vote of the college’s UK council today, 61% of members agreed to ‘oppose the role of PAs working in general practice’, with 31% disagreeing and 8% abstaining.
The college also voted on a new set of guidance limiting the scope of practice for PAs who already work in general practice.
This saw council members vote down a clause that would have allowed individual GP practices discretion to permit existing PAs to work beyond the recommended scope of practice.
This decisive opposition to the role of PAs in general practice follows advice to practices in June to ‘halt’ recruitment of new PAs until the profession is regulated by the GMC later this year.
RCGP chair Professor Kamila Hawthorne said the debate among GPs today made it ‘very clear’ that the college ‘needed to speak out in opposition to the PA role within a general practice setting’.
Despite the successful vote to oppose a role for PAs in practices, the college recognised that there are already around 2,000 professionals working in this role who require clear guidance.
After a consultation with members earlier this year, which found that over 80% of GPs believe PAs are having a negative impact on patient safety, the RCGP promised to set out clear guidance on scope of practice, induction and preceptorship, and supervision.
These documents were approved at the council meeting today, however the RCGP said ‘further work’ is needed and they will be published ‘as soon as possible’.
Yesterday, Pulse reported on a paragraph within the draft guidance, leaked on social media, which suggested that it is the responsibility of individual GP clinical supervisors to determine whether existing PAs working beyond the scope of practice are safe to do so.
Council members ‘opposed inclusion of this paragraph’ and as such it has been removed ‘to ensure it is clear that PAs must always work within the scope of practice the RCGP will set out’, according to a statement this afternoon.
Responding to the outcome today, Professor Hawthorne said: ‘The role of PAs in general practice has dominated the medical agenda for well over a year now and we understand the strength of feeling amongst our members and their concerns for the safety of their patients.
‘It became very clear at today’s Council discussion that we needed to speak out in opposition to the PA role within a general practice setting and I am pleased that our processes have enabled us to do this in a collegiate and democratic way.’
She also recognised that the college’s new policy position ‘may be unsettling’ for PAs already working in practices and for their employers.
But Professor Hawthorne said she hopes the new documents, to be published in the coming weeks, will ‘provide some clarity on how these roles could be managed where they are in place’.
The RCGP also said its ‘red lines’ on physician associates ‘still stand’, after being updated in March to reflect a new stance on regulation.
Council members had decided that the GMC is the wrong body to take on PA regulation, which will begin at the end of this year, arguing that ‘another regulatory body would be more appropriate’.
The college’s red lines also state that PAs must never be ‘substitutes for GPs’ and that resources in general practice ‘must be prioritised’ for trainee GPs.
But the NHS Confederation, which represents providers and commissioners of healthcare services, has opposed the RCGP’s stance.
Its director of primary care Ruth Rankine highlighted the ‘positive contribution’ PAs can make and said they could be ‘integral’ to primary care when ‘given adequate supervision’ and support ‘work within their scope of competency’.
‘Our members agree that PAs should be regulated and are keen for this to begin without delay. PAs in general practice must always work under the supervision of qualified GPs, must not be considered substitutes for GPs nor mitigate the need to urgently address the GP shortage,’ she added.
‘The training, induction, and supervision of PAs within general practice must also be properly designed and resourced so we look forward to working with the College on supporting guidance.’
finally . BUT the line has to be the RCGP wants nothing to do with PAs. This needs to be done by a PA regulating body.
I wonder how many of these council members who voted against PAs employ nurse practitioners?
Too little too late. Trojan noctor horse already here. Paramedic and nurse consultants getting the jobs from which they won’t get fired ever. Who are we kidding? Doctors are obsolete.
PAs are in no way.comoarablw to Nurses though ironically usually paid more. Nurse training and regulation has been systematised for years. It is currently being tightened further to include regulation of titles like nurse practitioners, advanced nurse practitioner and nurse consultant.
Oops spelling! Why no edit function, Pulse?
Pulse I need an edit function for spelling errors!
Is this a declaration of war between the RCGP and the RCP ?
I predict the next step will be a similar move from Doctors-in-Training organisations, to free-up learning opportunities for Doctors who need them.
The response needs to be a plan from RCP and Medical Schools to offer those affected the opportunity to convert through further training to become either Doctors (with suitable full training and experience only), or Nurses, or Paramedics, (likewise), or other types of workers.
The problem was that hospitals wanted to get cheap staff without the commitment to educating future staff needs (for doctors) that they previously had to. And such cheap-skate moves from NHS should be resisted BECAUSE it has been a contributor to the current staffing crisis and lack of appropriate specialists in specialties that need them, which is getting worse while we sit back and watch this debacle without acting!
The assumption of many of those who are ‘against’ PAs is that medical presentations are either ‘granny should give advice’ or ‘needs fully trained MBBS MRCGP’.
An alternative possibility is that pretreated patients can see other kinds of healthcare professionals, particularly if their training includes the ability to be aware of red flags, gaps in knowledge etc.
The PA course teaches a medical model and way of thinking from the start. If the employer is willing to supervise and develop a PA there should be no bars.
In the same way to practices training ST doctors there is a need for supervision and support, but as long as this is a practice choice and there is honesty in communication I don’t see a problem.
Typo autocorrect in paragraph 2 should be ‘pre-triaged patients’ or even ‘triaged patients’.
Its a problem that there are Drs who cant see the problem with the use of PAs in general practice. In-fact its this problem that caused the whole problem because its these people who are employing them
Baby’s and bathwater spring to mind. Have the 61% opposed to the PA role ever been forced to employ a PA? Can GPs who would like to employ a PA not be trusted to set safe limits to their responsibilities and define their role (taking into account relevant guidance)? All seems a little random, but maybe some nuance was missed in the article?
The system is ok so long as you are forced
“there should be no bars ” is that what you meant to say.
We are all constrained in some way, those with fewer bars have only earned that by carefully curated courses of education and training and certification.
Or perhaps you do mean it was all a waste of time….
Maybe these PA students are ‘special’ and don’t need any more than a kindly mentor, beneficence personified, and they will instantly see through the traps of corporate primary care with its bullying and ‘top of licence’ profit hungry mantra.