GP surgeries have begun facing legal claims of discrimination from physician associates based on their use of RCGP and BMA scopes of practice.
Law firm Shakespeare Martineau confirmed that by the end of this week it will have filed four claims on behalf of PAs who they say have lost their jobs or have been ‘treated unfairly’ by GP employers who implemented ‘restrictive’ scope guidance.
The firm told Pulse that as well as the GP employers, the RCGP has been named as a second respondent in all four cases, while the BMA has been named a third respondent in three of them.
It also said that the number of cases is expected to rise to between 12 and 14 by the end of this month, with a ‘significant’ group of similar claims to follow.
This ‘group action claim’ was initiated and backed by United Medical Professionals Associates (UMAPs), an organisation representing PAs which announced its formation as a trade union in December.
Pulse previously reported that UMAPs was preparing 184 individual employment claims on behalf of PAs who were affected by the ‘discriminatory’ scope guidance from the BMA and the RCGP.
The law firm told Pulse this week that it cannot confirm the exact number of cases it will issue, but claimed that ‘more than 100’ PAs have lost their jobs or been treated unfairly and that a total of nearly 300 PAs have been ‘potentially affected’.
Shakespeare Martineau said this issue has highlighted a ‘troubling gender disparity’, pointing to UMAPs claims that 80% of affected PAs are women.
Lawyers representing the affected PAs have filed claims of indirect discrimination under the Equality Act 2010, and they said potential compensation ranges from £50,000 to £100,000.
If 300 PAs make claims and are successful under the group action, GP practices across the country could face total combined damages of £30m, the law firm claimed.
They warned that this could be ‘even higher if employers continue with the hasty and unconsidered implementation of the RCGP and BMA guidance’.
While the claims have been issued separately, the law firm told Pulse that they will sit behind a lead case that determines the legal principles and will be applicable to all.
The BMA said it was not aware of any legal claims having been brought against the union by PAs, nor of the BMA being named as an interested party in any – however, Shakespeare Martineau highlighted that there is a time lag between the claim being issued and the claim being served by the tribunal.
Both the RCGP and BMA guidance, released last year, set strict limits on what PAs can do within general practice, advising against PAs seeing undifferentiated patients.
Neither organisation claimed that their scopes of practice were mandatory or statutory, but they advised GP supervisors to adopt the guidance in the interests of patient safety.
Shakespeare Martineau said: ‘The RCGP guidance, which is not legally enforceable, limits the current practice of PAs, stipulating that they must not see patients who have not been triaged by a GP, nor patients who present for a second time with an unresolved issue.
‘Rushed implementation of this guidance by employers has led to widespread job losses and redundancies.’
UMAPs CEO Stephen Nash said that PAs ‘provide an essential service to the public in supporting GPs’ and claimed that the implementation of restrictive scope guidance has led to a reduction in GP practice access with the public losing out on potential appointments with PAs.
He said: ‘Despite not holding statutory authority, many GP practices have interpreted the scope as binding, and therefore justification for dismissal or disciplinary.’
‘The treatment my peers have experienced is deplorable and this first claim marks the beginning of our legal fight in obtaining acknowledgement of misgivings, apology and compensation for those whose careers and livelihoods have been shattered,’ Mr Nash added.
A spokesperson for the BMA said the union had to produce guidance for PAs because of the previous Government’s ‘disastrous decision’ not to ‘provide clear national guidelines’.
They continued: ‘This has led to a situation where there are now multiple documented cases of patient harm due to PAs being employed in unsuitable roles. This plus the volume of concerns across the medical profession has now led to the Government commissioning a review into how this situation was allowed to develop.
‘We are not aware of any of the specific decisions UMAPS are seeking to challenge and clearly each will have to be considered individually – but the top priority now has to be ensuring that the serious patient safety concerns are addressed.’
The union’s submission to the Government-commissioned review this week demanded a national scope of practice for PAs, and for their title to be changed to ‘physician’s assistant’.
In response to the claims, the RCGP said it would be ‘inappropriate to comment on a legal issue’.
A college spokesperson said: ‘The College’s policy position to oppose a role for PAs in general practice was adopted at our September 2024 governing Council meeting, following a comprehensive debate, that highlighted significant concerns about patient safety.
‘However, recognising there are around 2000 PAs already working in general practice we developed guidance on induction and preceptorship, supervision, and scope of practice, aiming to support GP practices and current employers of PAs in prioritising patient safety
‘This guidance is advisory and we have always been clear that it is for employers to decide whether to follow our guidance and that it is their responsibility to ensure the appropriate treatment and handling of existing PA contracts.’
2 years of training and low entry requirements is insufficient to be practising independently like a GP. Patient safety is paramount. Even my FY2s are not independent and need a lot of supervision.
audited my PA work. level above almost any GP trainee I ever had past 10 years. Needs supervision, like all junior and middle grades.
How do they claim discrimination under the Eauality Act?
They cannot possibly be relying on anyone believing they are Equal to a Medical Professional, surely?
I think any GP surgery affected should counter-claim against the RCP for tricking them into PAs in the first place.
Surely they never expected to be considered able to Practice Medicine independently? If they did, that is fault of the people who attracted them into the training programme on false promisses, not the GPs who employed them to assist.
The UK is going mad !
The BMA/RCGP/RCP’s scoping guidance was certainly not “hasty and unconsidered”. PAs are neither qualified nor skilled to safely diagnose undifferentiated patients. Whatever Some Bloke says.
The degree of overreach by UMAPS is astounding and its claims of medical equivalence are untenable and dangerous to patients and to their care.
A massive failure in governance by DHSC, NHSE, and Trusts.
I feel for the PAs who have put their trust in this poorly conducted or evidenced experiment.
Mr Streeting can’t continue to duck this issue, which needs urgent and transparent clarification.
That is the career prospects of a lot PA’s ruined. GP practices are not going to be rushing to recruit, retain or replace them
My understanding is that the partnerships will be personally liable for this – as not clinical I don’t believe the defence unions will cover this as not clinical. Could be personal disasterous for GPs.
What a fanatic way to ensure that PAs will never be employed in the future by any Primary Care provider.
If GP surgeries have to close because of the financial implications of any legal ruling I’m sure that will create very sympathetic headlines towards PAs in the press.
Such a beautiful own goal. They have rendered themselves utterly unemployable.
“audited my PA work. level above almost any GP trainee I ever had past 10 years”. You should be delighted then – looks like there’s going to be lots available for you.
lesson to learn here- don’t teach them, don’t employ them. Let our S”’ M””’ employ all of them
Not sure how Equalities act comes in here, as PA isn’t a protected characteristic. However, fear of litigation isn’t going to encourage practices to take on new PAs at this point whatever the merits.
Chaos predictably led by ego driven, common sense absent, PCN CDs, ICB managers and leaders and NHSE – the latter now abolished but the others still remain to continue the insidious & relentless destruction of Primary Care and professional careers of colleagues across the board.
Having been previously a senior GP partner I am now a part-time semi retired sessional GP locum.
However during the past year I have been frozen out of all locum sessions and NHS are now threatening to remove my name from the GP performers list. This is not because GP practices were unhappy to continue to utilise my services. Instead it is, as the locum agencies have confirmed to me, because practices are using their own or in some cases local agency PAs for all these sessions.
These consultations, often with undifferentiated patients who may have conditions and problems which PAs are not properly qualified to deal with, can place them in situations beyond what they may have learnt about during their limited 2 years of postgraduate medical training. This is confirmed in the locum agency’s what’s app messages group in which PAs regularly ask each other what they should do next.
All this, as can also be seen from this weeks BMJ, sometimes puts patients, who think they are instead seeing a GP, at risk of harm and is due to the practices, which may not correctly monitor their PAs records and clinical activities, trying to save on expenses. This is rather than all the blame resting with PAs who are just following their practice’s instructions regarding the type of clinical work that they should undertake for them.
The inevitable consequence of bullying one group of employed staff is legal action. Employment law protects those who are unfairly treated. The comments above only confirm that PAs have every justification to seek redress. The Leng review may well show that despite anecdotal evidence PAs as a body are safer than resident doctors or nurse practitioners. In my experience PA students are more mature and motivated than medical students( I have taught both for years)- of course that is not surprising as they are already biomedical graduates and often healthcare workers before their self funded 2 year intensive masters training. Then they start their real life working training as do doctors and nurses. Why are you surprised they are responding in the only way they can when they have sought compromise for years without any response?
the ‘trick’ with the equality act is about the proportion of a staffing group which is from a protected group. The difficulty being that there may be more female PAs than male, and this might be a greater proportion than medical personnel. On the other side though there may be more medical personnel from other protected groups such as ethnic and disability groups.
Those who support PAs seem to retain their support, which is strange as they cannot argue that their own training was excessive? It would seem that there is another reason for their belief. Is it that they believe their patients do not deserve medical care? It is interesting to compare working PAs with medical students, that is a reasonable comparison. The cost of employing medical students is significantly less than the banding for PAs.
The voluntary registration offered by the GMC to PAs has not been taken up by all of them yet, including leaders of particular organisations.
Lack of equality exists across the NHS and is endemic. The PA debate is useful in illustrating the dire state of leadership or more accurately mismanagement within PCNs, ICBs and NHSE and the abuse of this PA role including by NHSE and the government as a single example amongst many, causing untold harm at multiple levels . The dangling of the PCN funds carrot (as continues), before the eyes of some GP partners influenced these groups.. Partners saving costs as a motivating factor and as was strategically intended by NHSE to save costs and with the potential profiteering, without appropriate due diligence prior to enrolling any group of new ARR roles was perhaps the only driving factor. Trainers of these new roles, also benefiting, potentially seeing a new opportunity for themselves via rewarding training income, cost savings and a career prospect for these doctors from their own perspective are now also needing to protect their own roles. In my opinion, it is questionable as to the actual motivation of all of these groups, regardless of what they purport to say. Did any have any real consideration for PAs , newly qualified GPs or any other group but simply monetary or career gain. Conceivably, in my view these PAs should also consider the role of trainers of not warning them of potential future career and other risks. Furthermore, newly qualified, or other GPs frozen out may perhaps also have a case and should contemplate joining the PAs action ? Now that would be an alliance!
General Practice is obviously an employment environment that needs to be very flexible to adapt to changes in LES/DESes, QOF, etc, changes in population and other ‘local’ services at Trusts.
Presumably the (quite expensive) HR advisory companies that provide guidance to the Practices, will stick by their clients and support them through this, even though I am not enamoured of some of the advice they give.