The GMC raised concerns about royal colleges ‘dissuading’ GP practices from employing physician associates (PAs) with their ‘restrictive’ scopes of practice.
In response to draft RCGP guidance, which in its final version severely limited the tasks PAs can safely carry out, the GMC warned that it could ‘diminish the attractiveness of employing PAs in GP practices’.
The regulator – which officially took on the regulation of PAs last month – also urged the RCGP to consider any ‘significant conflicts’ with other pieces of guidance, citing documents from NHS England, the CQC, the Royal College of Physicians (RCP), and the BMA.
Chief executive Charlie Massey said ‘GPs practices will find it difficult to negotiate their way around such a range of guidance’ when employing and supervising PAs.
However, the GMC has been clear that it will not itself set out a scope of practice, and will ‘have reference’ to guidance produced by royal colleges in its fitness-to-practise proceedings.
It also clarified today that it is an employer’s responsibility to determine which activities or specific tasks an individual can carry out and what level of supervision is required.
In November, the BMA demanded ‘full transparency’ from the GMC regarding its position on PA scopes of practice, claiming the regulator had refused to share its submission to the RCGP’s consultation on the issue.
Now, the BMA said that ‘after refusing to release these opinions for months, [the GMC] tried to do so quietly just before Christmas’, and the union accused the GMC of ‘pressuring royal colleges to set laxer standards for PAs in order to make them easier to hire’.
The GMC’s letter to the RCGP regarding its draft guidance, dated 6 August, was published on the regulator’s website on 17 December, over two months after the college published its final guidance.
However, the GMC clarified to Pulse that it published its responses to royal college consultations on PA scopes once the relevant colleges had all published their final guidance, which was on 17 December when the RCP set out its rules for PAs working in hospitals. The aim was to give colleges time to consider feedback without prejudice or undue influence.
There is also a letter to the RCP which raises very similar concerns about its ‘restrictive’ scope which could deter employers, as well as the potential conflicts with guidance from other bodies.
Mr Massey told the RCGP in August: ‘Overall, we think the draft guidance will be helpful to PAs, GPs and GP practices and will also provide a level of reassurance to patients and the public.
‘However, we are concerned that the draft guidance on PA supervision and scope of practice appear in places to be somewhat burdensome and restrictive, to the extent that, if adopted as drafted, it could have the effect of dissuading GP practices from employing PAs.’
He also said the RCGP might ‘want to ensure that this scope of practice guidance is not more restrictive than the qualification outcomes set out in the PA curriculum’, but the college told Pulse that it did not think the curriculum necessarily guarantees that PAs have ‘adequate clinical skills’ in general practice.
Mr Massey encouraged the college to reflect on how the draft guidance ‘deviates from current practice’, and to ‘take account of areas of good practice’ in those GP surgeries where PAs have been ‘safely incorporated’ into teams.
On NHS England’s own guidance for PAs in GP practices, the GMC suggested there could be ‘conflicts’ between this and the RCGP’s draft scope.
‘It would be difficult for GPs who employ PAs in England to reconcile any such conflicts in guidance at local level and this may be further exacerbated by the range of further guidance around PAs that has been or is currently being produced by a range of other organisations,’ he told the college.
The GMC chief executive also pointed to a ‘potential conflict’ with the Network DES contract, which covers the requirements for employment of Additional Roles Reimbursement Scheme (ARRS) roles.
For PAs, the DES for 2024/25 said that ‘where their named GP supervisor is satisfied that adequate supervision, supporting governance and systems are in place, [PAs can] provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems’.
However, the RCGP’s final guidance stipulated that PAs must not see patients who have not been triaged by a GP.
In a recent bulletin to GPs, the BMA emphasised that ‘it is for individual practices to decide’ whether to follow RCGP or BMA guidance on physician associates, but noted that doing so could lead to a ‘restructure’ of how services are delivered.
‘If such a restructure results in duties being removed from one or more PAs in the practice, this could result in a redundancy situation arising, ie where there is a reduced requirement for physician associates to carry out work of a particular kind,’ the BMA told GPs.
The union advised practices considering PA redundancy to contact its employer advisory service.
Earlier this month, a PA trade union revealed that it was planning to take forward 184 individual employment claims against GP practices who were implementing ‘discriminatory’ scope guidance.
In November, health secretary Wes Streeting launched an independent review into the safety of physician associates, which is being chaired by Professor Gillian Leng.
The ‘Leng review’ is expected to cover PA scope of practice, and will be published in spring 2025.
Just before Christmas, the RCP issued its final scope for PAs working in hospitals which it said should ‘act as a placeholder’ while the review is still ongoing.
The GMC said its regulation of the PA profession will ‘strengthen patient safety’ as they will need to meet minimum standards and ‘can be held to account if serious concerns are raised about their practice’.
A spokesperson for the regulator continued: ‘Like other professional healthcare regulators, it is not appropriate for us to provide advice on how PAs and AAs might develop their skills and competencies over time.
‘We expect PAs and AAs to be supervised by a doctor and to work within their competence – this is consistent with the approach taken by other professional regulators such as the Nursing and Midwifery Council and the Health and Care Professions Council.’
The GMC also said it expects employers to be aware of and have regard to relevant scope guidance produced by the royal colleges and other professional bodies when they are making decisions about deployment, even if they have no regulatory force.
RCGP chair Professor Kamila Hawthorne said the college ‘consulted widely on the guidance’ but the ‘final decision’ was theirs to make.
She added: ‘In this case, the College did receive feedback from the GMC saying that the scope of practice we recommend should not be more restrictive than the qualification outcomes set out in the PA curriculum.
‘However, based on the responses to our member consultation and in view of the high level of uncertainty, complexity and risk within general practice, we concluded that the inclusion of a broad range of topics in the PA curriculum does not equate to having adequate clinical skills and experience to safely deliver care across all areas in the context of general practice.’
Professor Hawthorne also reiterated that the RCGP’s position on PAs and guidance is ‘advisory’ and that ‘decisions to employ PAs ultimately rest with employers’.
In response to the GMC’s letters to both the RCGP and the RCP, BMA chair of council Professor Phil Banfield said that ‘robust national scopes of practice are the basis of any solution to the dangers’ of how PAs currently work in the NHS.
He continued: ‘It has been worrying to see the GMC, a patient safety regulator, resist all calls to publish its take on the Royal Colleges’ attempt to set these scopes. As it begins to regulate PAs, the public deserves to know what it thinks they can and can’t do.
‘After refusing to release these opinions for months it tried to do so quietly just before Christmas. It is now clear why it wanted to hide them.
‘They have astonishingly tried to claim that national scopes of practice should not be “burdensome and restrictive” on PAs in case it might lead to employers thinking twice before hiring them.’
The BMA also said that ‘patient safety should be the only priority when defining what PAs can do, not their employment prospects’.
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GMC worried about safeguarding patients, post truth Trumpism. Probably just concentrate on core principle of persecuting Doctors then.
I think that is the general idea.
It seems to be the point most doctors are making, that 2 years of part-time learning does not equate to 5 years university plus 5 years specialty training.
NHS General Practice needs to be properly funded, not forced to rely on ‘cheaper’ staff.
Would the PM have his major surgery performed by someone with only 2 years training, and no diagnostics or aftercare skills included? – or is the plan for total discontinuity : one PA for the op, a different one to diagnose, a different one to manage fluids, a different one to manage side effects, a different one to manage post-op insomnia, etc?
Questionable decision making here by the GMC. .
If a GP partner ran an entire practice with unsupervised PAs doing everything themselves, perhaps with a poorly done risk assessment, and hudreds or thousands came to harm as a result, would the GMC consider taking action against the GP partner?
If the answer is yes (it really should be yes), they need to make the effort to set out guidance carfully. If they can’t be bothered to set out their official position, they can’t then comment that others who have made that effort are too restrictive.
It’s hilarious that the GMC finds something burdensome and restrictive!
That aside, surely the risk of being sued is reason enough not to hire PAs (as if there weren’t many other reasons?)
Suspect had PAs been regulated by the HCPC and a defined scope of practice been set then GPs would be much more comfortable recruiting 🤔
Money- the GMC is worried only about the money it will receive via these thousands of subscriptions in my opinion and absolutely nothing else – any other pronouncements it makes in its GMC time paid for by these forced subscriptions from doctors or PAs is simply a smokescreen in my personal view to justify its existence- The question it should be asking is are we still using these subscriptions to continue to pay for private medical insurance , life assurance, season ticket loans ,income protection cover etc. for GMC staff when our subscribers have to pay for their own cover and we have not asked the consent of all our forced subscribers whether they wish to pay for our (the GMC staff ) benefits as well??
I foresaw all of this and hence did not hire any PAs. We have doctors who are iaided by competent pharmacists who stick to their area of expertise. Works well, patients are happy and no supervision risk,
With all due respect to the GMC, isn’t this something outside of its scope and therefore something they should not offer a public opinion on?
To offer a public opinion is to take a political stance, and it is supposed to be an non-political organisation (something which political appointee Mr Massey has never respected or perhaps understood).
GMC not fit for purpose of regulating doctors, so why would it have any idea on what the scope of PA practice should be.
It spends far too much time persecuting doctors, and without a clear scope of practice, will just start persecuting PA’s arbitarily without clear guidance and reference – as it will make it up on the spot how it wants to behave – leaving the process at risk of bias, rascism, and prejudice, which we already know about from how it handles GP investigations.
It is unacceptable that the number of GPs who have come to harm from the process of GMC investigations, when they remain innocet until found guilty, but are treated as guilty until they can prove themselves innocent of often vexatious and false charges.
PAs deserve better than the GMC as a regulator.
The RCGP guidance certainly does “diminish the attractiveness of employing PA’s in GP practices” – and a very good thing too. Why should employing PA’s be attractive? And why does the GMC care?
Agree with Centreground, it’s about money – by fragmenting and cheapening first-contact via rollout of PAs, more corporate money will soon enter primary care for shareholder profits, as per failed neoliberal thinking. And agree with DarrenT, that the GMC’s been politicised and captured, indicated by Massey’s appointment, by private sector interests. This centreleft Govt is continuing the policies of the previous Govt. Things can only get worse..
‘In response to draft RCGP guidance, which in its final version severely limited the tasks PAs can safely carry out, the GMC warned that it could ‘diminish the attractiveness of employing PAs in GP practices’.
Protecting patients, guiding doctors?
The General Medical Council (GMC), by its very mandate, is entrusted with the protection and support of physicians, particularly GPs, who are central to the delivery of patient care. However, the GMC must address a growing concern that threatens the professional outlook for GPs and, more broadly, physicians in the UK. Young GPs, who were once attracted to general practice by promises of unlimited need and opportunity, are now facing an increasingly difficult job market. Despite the rising demands on the healthcare system, they are struggling to secure stable employment as cheaper alternatives and non-clinical workforce figures emerge. This shift threatens to undermine the demand for traditional GP roles, leading to a concerning outlook for the profession.
The introduction of AI in primary care, while offering potential benefits, is exacerbating this issue. While AI is intended to support and enhance the work of clinicians, there is a growing concern that it may replace human clinicians in certain roles, particularly as cost-effectiveness becomes a growing priority for the NHS. This shift could marginalise GPs, as reliance on technology could overshadow the human element that is critical in delivering patient-centred care.
The GMC must recognise that this situation represents a professional myopia—a short-sightedness in understanding the broader implications for the GP workforce. The autonomy of GPs is at risk. AI should serve as a tool to assist GPs, not to replace them. The ability of GPs to make independent clinical decisions must remain central to their role. The increasing reliance on automated, technology-driven solutions could erode this autonomy, placing patients’ care at risk and diminishing the personalised, professional judgement that GPs provide.
In this context, the GMC’s role in safeguarding the future of general practice is more critical than ever. The GP workforce faces an uncertain future, and the GMC must act to ensure that GPs are not sidelined or displaced by cost-cutting measures, including the over-reliance on AI or other technological interventions. The GMC must prioritise measures that support the training, professional development, and autonomy of GPs, while ensuring that the integration of new technologies enhances, rather than undermines, the quality of patient care.
The GMC, tasked with protecting both patients and healthcare professionals, must urgently address this issue and ensure that physicians are not left behind in the face of technological advancements. It is essential that GPs continue to lead patient care, and the GMC must take a proactive role in defending their professional status and autonomy in a rapidly changing healthcare landscape.
The GMC are not interested in patient safety or the medical profession. Neither are politicians who direct them. Their puppet masters are the private healthcare who want access to the UK healthcare market, digital/AI/tech companies that want access to NHS data to develop their models and removing doctors especially GPs and fragmenting the service aids that aim
We are obstructing them. Anything that removes our power aids the ultimate aims I’ve identified.
Sorry Eduardo, I think you may be a little naive in your understanding of what and who owns/directs the politicians and therefore ultimately the GMC