An unofficial body representing physician associates (PAs) is preparing to take legal action against the RCGP, as it claims that the college’s recent scope of practice has caused ‘harm’.
The United Medical Associate Professionals (UMAPs), which first formed a year ago, said it is taking the ‘extraordinary step’ to move towards a ‘direct legal challenge’ of the RCGP, claiming that the ‘restrictive’ scope is adversely affecting the career of PAs.
The RCGP, along with the BMA, opposes the use of PAs after a consultation with members earlier this year found that over 80% of GPs believe PAs are having a negative impact on patient safety.
As a result, the college this month released its scope of practice, which severely 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.
It suggested that a PA’s qualifications would be suitable for seeing the same seven minor illnesses covered by the Pharmacy First scheme, noting that this is a ‘good place to start’.
However, following a meeting of PA representative bodies over the weekend, UMAPs voted ‘unanimously’ for the following proposal: ‘Explore and undertake direct legal challenge against the RCGP for the harm caused by its statements within the scope of practice document.’
It is raising an initial £30,000 to support the legal challenge, and it hopes to raise up to £100,000 overall.
The PA body sent an open letter to the college today, signed by chief executive of UMAPs Stephen Nash, claiming that the RCGP’s scope for PAs ‘implies an authoritative stance that has led to significant misinterpretations’ by GP partners, as many view it as ‘binding’.
Mr Nash said: ‘To clarify, RCGP guidance does not hold statutory authority, nor is it legally enforceable. Employers and NHS bodies should not perceive this guidance as justification for disciplinary measures or terminations.’
The RCGP told Pulse that it is ‘aware of the open letter’ and ‘will continue to engage with UMAPs as appropriate to address these matters’.
The letter also requested a number of clarifications on the scope document as part of ‘immediate remedial action’ to prevent further legal proceedings (see box).
UMAPs ‘formally’ requested that the RCGP clarifies that the document is ‘advisory’ and ‘non-binding’, and also to ‘publicly amend’ statements which suggest that PAs may face indemnity issues under the NHS scheme.
The letter to the RCGP also claimed that in GP practices where PA roles have been ‘restricted’ or ‘terminated’, patients ‘now face longer wait times, potentially delayed diagnoses – including for cancer – and the re-introduction of costly locum cover’.
‘Some practices are again forced to rely on locum GPs at significant cost, up to £14,000 per month, when salaried PAs were readily filling these needs,’ Mr Nash added.
UMAPs demands of RCGP to prevent legal action
UMAPs has formally requested that the RCGP:
- Revises its guidance to clarify the advisory, non-binding nature of the document;
- Publicly amends any statements implying indemnity limitations, in line with NHS Resolution’s stance on CNSGP coverage;
- Conducts a transparent review of the conflicts of interest disclosures from the relevant votes on the RCGP Council, including affiliations with private, locum, and Doctors Vote-related interests;
- Take steps to establish a robust methodology for data collection (e.g. surveys on PA safety) that prevents manipulation and reflects a balanced representation of PAs’ contributions in primary care.
Source: UMAPs
Commenting on UMAPs’ preparations for legal action, Mr Nash said that ‘highly damaging and grossly unfounded’ statements are made about PAs ‘on a daily basis’.
He continued: ‘We hope the RCGP reflects on its actions and reaches out to resolve the current situation. If it doesn’t, we are preparing for the worst outcome. We have already seen support from partners and doctors sympathetic to our situation. An attack on PAs is the start of an attack on the entire MDT.’
While the RCGP recognised that it cannot ‘enforce’ the guidance – as this is the ‘decision’ of employing GPs – it has said the scope ‘may be taken into account’ by NHS Resolution and medical defence organisations in clinical negligence cases.
An RCGP spokesperson told Pulse: ‘We wish to reiterate that the RCGP PA guidance was published only last month and is advisory. It covers induction and preceptorship, supervision, and scope of practice and aims to support GP practices and current employers of PAs.
‘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.
‘The college’s policy position to oppose a role for PAs in general practice was adopted at our September governing Council meeting.
‘However, there are around 2,000 PAs already working in general practice and our guidance is intended to be a practical resource for their employers and to help provide clarity on how these roles are managed.’
Last week, the BMA threatened to move towards industrial action over the lack of a nationally agreed scope of practice for physician associates.
On what basis? Hurty feelings?
Of course PAs will do this, quite rightly too. The BMA and RCGP have bullied and scapegoated a profession singling them out publicly with no evidence to do so presented. I for one am ashamed and have pleaded with them to stop. It is obvious the legal peril ahead in employment law including discrimination and bullying charges. The reparation costs will run in the millions for the loss of career earnings and training costs. BMA and RCGP members will be paying out. All doctors should be contacting their reps today to demand they treat PAs in the same way as doctors treat nurses and patients- with respect , with kindness and with the aim of helping them to do their job without intimidation.
@Michael Green, I’m no lawyer but I would have said on the basis of constructive dismissal. ACAS website states “making unreasonable changes to working patterns or place of work without agreement” as a possible claim. There’s also being bullied or discriminated against” which looks to be a strong case as well.
@shaunmeehan @anonyMouse. The scope guidance is about patient safety particularly about seeing undifferentiated patients. I believe scope limitation guidance should also apply to other Allied HCP (nurses, paramedics etc) in the same manner with respect to patient care. The currently training of all these roles does not provide enough knowledge or experience compared to a 10 year medical program which qualified GPs undertake. Use of these allied roles in managing undifferentiated illnesses which requires significant risk management is dangerous and is simply financially motivated and should not be happening. They do not know what they don’t know and that is a problem. If their training is equivalent, then we might as well not train GPs at all. That’s not to say they cannot have a role in primary care. And yes, those practices that jumped head first into employing PAs without thought of scope of practice are at risk of grievance claims and constructive dismissal and it’s something they will have to deal with.
@neo99 if this is just about patient safety then I would be interested if you could point me to the data and research papers that clearly demonstrate that PAs and other Allied Health Professionals are dangerous. As to jumping in head first I would point out that the ARRS scheme came into being in 2019 and PAs were clearly listed as clinicians who could be employed with the blessing of NHSE (and no doubt the RCGP and BMA at the time). Why has it taken over 5 years for that scope guidance to appear? Would 2019 not have been a better time? I think we all know why the guidance has suddenly appeared now and its not to do with patient safety.
A claim against the BMA or RCGP for constructive dismissal of physicians associates seems unlikely to succeed, given as the BMA and RCGP do not employ physician associates.
support for PAs by some of back stabber colleagues is astonishing. I am sitting at home today due to no job available in my area, neither locum or salaried despite in middle age with years of experience.
@anonymouse. Gathering data and research (which takes time) aimed at showing showing lesser qualified staff doing a difficult job is difficult however sometimes, you have to use common sense and pragmatism depending on the work. Would you allow a person who has used a flight simulator at home to command a Boeing 747 with passengers without the appropriate practical training,flight time and experience? No, thst would not be allowed and neither would a “trial” to see if this would be a cheaper safer option. It would be unthinkable but we are doing precisely that in general practice. As for why the delayed reponse from the BMA and the Rcgp? It’s been obvious for years. They have their own vested interests in monetising these “opportunities” by providing training, courses etc. I have also over the last 35 years found both institutions have a short term blind outlook and can’t imagine long term issues and concerns with what initiatives they promote. The PAs are the victims in this sadly and were sold a lie in terms of their role. Defining and scoping the roles of NP, paramedics, physios, pharmacist should have happened before ARRS started in 2019
‘ patients ‘now face longer wait times, potentially delayed diagnoses – including for cancer – and the re-introduction of costly locum cover’ …. think that says exactly what doctors are concerned about- PAs in positions to potentially miss cancer, or diagnoses and the dismissal of GPs from their appropriate role : cost efficiency savings vs patient safety . But many PAs are given double appointments + removing supervising doctor from seeing their own list to see patients or debrief so how is it longer wait times?