Exclusive Physician associates will need to have individual scopes of practice as they will be working in a variety of different roles, the chair of the GMC has said.
The GMC, which will regulate PAs and anaesthesia associates (AAs) from next month, has said it will not itself set out a scope of practice but other bodies – including the BMA and RCGP – have recently published their own frameworks.
In setting out a scope severely limiting PA practice last month, the RCGP said that while unenforceable, it ‘may be taken into account’ by NHS Resolution and medical defence organisations in clinical negligence cases.
Asked by Pulse what impact these guidance documents would have on fitness-to-practise proceedings, GMC chair Dame Carrie MacEwen said PAs will need their own individual scopes of practice.
Speaking at the Pulse LIVE conference in Liverpool this week, she said: ‘No healthcare regulatory body has a scope of practice for the professions they regulate.
‘AAs and PAs will be working in different parts of the healthcare system in a variety of different roles. Therefore their scope of practice will be an individual thing that they need to develop, similar to other roles supporting doctors, such as advanced nurse practitioners.’
However, in an additional statement made to Pulse after the conference, the GMC said: ‘If a concern is raised about a PA or an AA, just as with doctors, our fitness-to-practise processes will look at each concern on its own merits, and within its own context. Our starting point will be whether, and to what extent, the PA or AA has departed from the expectations set out in Good Medical Practice.
‘We will have reference to local employer requirements and protocols, and any relevant guidance produced by royal colleges and other expert bodies. Our investigations will take into account whether the activity in question is within the individual PA or AA’s job description and whether they have been judged by a supervisor as trained and competent to undertake it and given appropriate authorisation to do so.’
The update comes as a coroner this week highlighted a death linked to actions by a physician associate, with the report containing GMC comments on scope of practice (see box).
The GMC chair was also asked by Pulse LIVE delegates when the regulator will publish a response to its consultation regarding PA regulation, to which Dame Carrie said ‘very soon’.
She said: ‘The consultation on PA regulation was incredibly technical – tedious and technical. One problem we had was that many respondents did not actually respond to the technical questions about regulation that it posed but instead opined about the role of PAs, things that have already been set out in law.
‘This meant it has taken longer but the response will be published shortly, and will also take into account some of those concerns raised.’
One Pulse LIVE delegate also asked when the GMC will ‘stop gaslighting’ doctors and take their concerns about the safety of PAs ‘seriously’, to which Dame Carrie argued that regulation should help allay concerns about safety because ‘an unregulated profession is an unsafe profession’.
She said: ‘A lot of these questions will be answered by regulation. Once regulation begins, PAs will have to practise in line with Good Medical Practice, which states you have to practise within your competency. This should embolden PAs to say no to tasks which are not within their individual scope of practice.’
She also addressed concerns that taking on a wider regulatory remit will lead to raised GMC fees for GPs.
She said: ‘We made it clear to the Government that taking on PA and AA regulation could not affect doctor fees. GPs will not be paying for the regulation of PAs and AAs.’
A new statement published by on the GMC’s website this week emphasised the importance of PA employers having ‘effective clinical governance arrangements’ in place which include ‘clear processes’ for deployment and supervision.
The GMC said PAs must ‘work within their competence’ which ‘varies by individual’ and is ‘approved’ by their employer.
‘It’s essential that PAs and AAs, like all healthcare professionals, work within their competence and don’t undertake tasks beyond what their employer has approved,’ the regulator said.
It also confirmed that the GMC’s response to the PA regulation consultation will be published next month, before regulation begins on 13 December.
GMC scope of practice comments in response to coroner’s report
In response to a coroner’s prevention of future deaths report, the GMC said royal colleges and NHS employers should ensure individual scopes and guidance are ‘aligned and consistent’ to avoid ‘confusion’.
Coroner Joanne Kearsley produced a report over the summer regarding Susan Pollitt, who ‘died as a result of an unnecessary medical procedure contributed to by neglect’.
Alongside other mistakes in her care, the coroner had found that the physician associate who inserted an ascitic drain ‘was not aware’ of the hospital guidance that drains should remain in place for no longer than six hours, and Mrs Pollitt’s was left in place for 21 hours.
The coroner wrote to the GMC and the Department of Health and Social Care (DHSC) raising concerns to prevent the risk of future deaths, including the lack of a ‘national framework as to how Physician Associates should be trained, supervised and deemed competent’.
In response, the GMC said it has been ‘supporting the work’ of individual royal colleges to develop guidance on supervision and competency of PAs, citing the RCGP’s scope.
‘We are also encouraging colleges, NHS employers and others to ensure that all guidance being produced is aligned and consistent so as not to cause confusion for employers, supervisors or PAs themselves,’ the regulator added.
Source: Coroner’s report
Note: This article was updated at 20.50 on 14 November to reflect an additional statement made by GMC which said they would ‘refer’ to royal colleges’ practice scopes.
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nothing to see here…move along please…
So we remove PAs( a thousand) nurse practitioners ( thousands) and all staff other than doctors, who alone will see all patients ahead. That is impossible, unrealistic arrogance. The talk about safety being paramount ignores the greatest safety issue- that patients cannot see any staff and have no continuity of care. They queue outside practices and increasingly hospital-how many die as a result? How many more doctors qualifying will you need from the trebling in the last twenty years?. Please put some figures in writing…two doctors or three doctors on the phones in reception( to filter the undifferentiated calls as they come in to make them ‘safe’), three doctors replacing 5 nurse practitioners/ PAs or more? Please help me understand how RCGPs actions will deliver care to those that need it most as well as in leafy well-staffed RCGP land.
Its called taking a stand and fixing things Shaun. Better than the perennial approach of avoiding the problem because, on the surface, ‘it’s all too difficult’, effectively giving up on Drs in general practice and throwing in the towel..like all the Drs who’ve left. But I guess you didn’t? You evidently have stamina. Please do the profession a favour and back the idea
Thanks A for trying to answer but I still don’t see how the current war on everyone not a doctor is going to improve the NHS ahead- it needs to care for our elderly, our most vulnerable and convert from an illness service to preventive service too. As well as the thousands more doctors than qualified in my time each year surely we will need other staff who can focus on say prevention at least. Do you think our young doctors want a career in preventive medicine? They could have a career in a team that delivers acute, chronic and preventive care. Nice to start a sensible debate rather than personal attacks though isn’t it?
Genuinely sorry if people have felt attacked. The debate is about primary care not individuals. Please don’t feel this is about you if you find yourself somehow oddly obliged to defend the status quo. We are in a mess. It needs fixing. This is not “ a war on everyone who is not a Dr “. It is about fixing a broken primary care service. It IS Drs commenting here (apparently) no-one else. I am a Dr. My career has been totally taken up by the disintegration of the job I trained to do. I completed my GP reg job in 2005. It’s been down hill ever since. Pay has reduced every year. Like a metronome, the job has become more difficult as each quarter of a year passed. Now there are almost no Drs. We’re employing everyone else instead. To the people who somehow managed to “dodge the bullets” (personal and professional) and remain in post, you may find the proposed changes all too much, too painful. I think thats is a reflection of the concentration of pain inflicted across countless colleagues (many of whom now left) over many years – arriving on your doorstep all at once. It’s a wake up call and I feel sorry for all affected. Personally I think it’s all too late. General practice has already gone. PA’s are not going. The Drs will not return. You will have your new model of “care”. Like dentistry. I’m not a fan. But I’ve gone and wont be coming back. Good luck
Thanks A B for the comments and support for doctors. Any tradie will tell a person off for stealing their trade but some doctors are tricked into thinking it is good to have less qualified staff doing their job, mking them have a mentality that puts their job and patient’s lives at risk. How many more PEs do we need from PAs? If we need more doctors then fund it and hire more. Not more noctors who appears to be doing the consultation but the GP actually gave the diagnosis and the management. They just type the notes.