OOH provider tells GPs to review all patients seen by PA before discharge

Out-of-hours GPs in Doncaster will now have to review ‘all assessments’ made by a physician associate (PA) before a patient is discharged, in a bid to address safety concerns. 

Clinical leaders at FCMS, a provider of GP OOH services in Doncaster and across Lancashire, have ‘formally agreed’ the new policy following ‘concerns regarding legislation around PAs and regulation’. 

In an email sent to GPs, leaders urged them not to do anything they ‘feel uncomfortable with’, and acknowledged that the decision would increase their workload. 

To mitigate this, the clinical lead has requested that there is an additional advanced clinical practitioner (ACP) or GP on the shifts where a PA is working to ‘support with capacity’ while they ‘continue to monitor pressures’.

The email said: ‘Following recent information and concerns regarding legislation around PAs and regulation, [redacted] and I have met with our PAs and explained that until further notice, and pending regulation, all assessments must be reviewed by a GP before the patient is discharged. 

‘If you feel you need to complete a full further assessment this is of course your right, it will be supported and we do not want you to do anything you feel uncomfortable with.’

FCMS clinical leaders also acknowledged that this is a ‘very difficult decision’ for the PA staff who have ‘worked and studied very hard for their qualification’.

An OOH GP working at FCMS in Doncaster said GPs have been ‘pushing’ for this change ‘for quite a long time’, calling for assurances that PAs are ‘adequately supervised’. 

According to the GP, who preferred to remain anonymous, this decision will ‘absolutely’ go down well with GPs who will feel more secure from a medico-legal perspective. 

‘Otherwise, they’re essentially taking responsibility for things that they have no influence of – the GPs will now feel more confident when they’re working alongside a PA,’ he added.

He also said the decision was based on ‘feedback from GPs’ as well as ‘analysis of near misses’ involving PAs. 

The GP continued: ‘We haven’t had incidents, necessarily, but everybody, including the PAs, has historically had some of their work scrutinised by a governance team. And the team have raised at times questions about whether this was the right thing to do, and whether a senior clinician may have come to a different conclusion.’

He also highlighted that PAs working in GP OOH services is ‘more risky’ because they do not have the ‘historical context of the patient’. 

‘I think PAs have a place in primary care but I don’t necessarily think it’s out-of-hours. I work closely alongside PAs in the GP practice, where we have a model that works like this where we will triage the patients and the PAs will come back with the answer to the questions we’ve posed. And that does seem to work quite well.’

Doncaster LMC chief executive Dr Dean Eggitt said he thinks the proposal for GPs to review every PA is ‘ultimately a waste of everyone’s time’. 

He told Pulse: ‘That’s where we need confidence with the GMC to decide what PAs can do. Are we nationally going to move to a system where we have confidence that PAs can see patients independently without being supervised directly or not? 

‘If the GMC decides that every single patient who sees a PA needs to be reviewed by a doctor, then the PA system has failed and that needs to be finished and moved on with.’

The FCMS Clinical Leadership Team said in a statement: ‘In light of recent guidance, FCMS has reviewed our supervision arrangements in relation to Physicians Associates. We strive to ensure all our staff have a positive working environment which supports continuing professional development and upholds excellent patient care.’

Pulse’s recent analysis of the clinical risks surrounding PAs in general practice explored whether they are adequately qualified to see undifferentiated patients, as well as the lack of clear guidance on their scope of practice.

In this year’s PCN contract, NHS England stipulated that GP supervisors need to be ‘satisfied’ there is appropriate governance when PAs see undifferentiated patients. 

And the BMA recently recommended that PAs must have a named supervisor ‘immediately’ available ‘at all times’ while working in GP practices and in secondary care.

In February, Pulse reported on an OOH provider in Cambridgeshire that was ‘diversifying’ its workforce due to financial constraints, leaving GPs struggling to find shifts.