GP practices could face legal action from physician associates (PAs), as a trade union for the profession revealed plans to take forward 184 individual employment claims.
The organisation, United Medical Associate Professionals (UMAPs), claimed there have been around 200 PA redundancies from surgeries since October as a result of ‘discriminatory’ scope guidance produced by both the BMA and the RCGP.
UMAPs, which became a trade union in December, said it has ‘empowered’ affected PA members to ‘initiate legal proceedings’ against practices that have ‘used such guidance to justify dismissals, breaches of contract, or redundancies’.
The union’s chief executive officer Stephen Nash told Pulse they are currently ‘considering advancing 184 cases’, all of which would be against GP practices.
In October, UMAPs warned GP partners that use of ‘restrictive’ scope documents could result in legal challenges, while also unveiling plans to take legal action directly against the RCGP for ‘harm’ caused by the college’s PA scope of practice.
UMAPs told Pulse that its legal approach will now be to ‘empower colleagues who are affected by this to make an employment tribunal claim against their employer, adding the RCGP and the BMA as potential second respondents where appropriate’.
Its claim of 200 PA redundancies came from a ‘snap survey’ carried out in December which had 387 PA respondents, of which 196 had been ‘affected’ – meaning they had been dismissed or their scope of work ‘materially and adversely altered’ – while 81 said they had been ‘summarily dismissed’ from GP practices.
Mr Nash told Pulse: ‘Additionally, we have begun incorporating cases we were already working on, which did not participate in the survey, into our dataset as their internal processes conclude.
‘This has pushed the total cases beyond 200, though the final count is yet to be determined.’
He also said UMAPs hopes that ‘highlighting the ongoing damage’ will have a ‘meaningful impact’ on cases currently being ‘addressed through internal processes’, which will ultimately reduce ‘the number of cases escalating to ACAS or employment tribunals’.
UMAPs has also claimed that redundancies have ‘disproportionately’ affected women and ethnic minority PAs, based on results from the snap survey.
It found that 46% of white respondents reported being affected compared to 66% of Black respondents and 56% of Asian respondents, according to UMAPs.
The organisation’s statement, posted last week, said: ‘UMAPs has empowered affected members to initiate legal proceedings against organisations that have issued and/or acted upon discriminatory policies.
‘Employers and medical institutions that have used such guidance to justify dismissals, breaches of contract, or redundancies will be named as respondents in employment tribunal cases. This includes targeting organisations producing “non-legally binding” guidance documents designed to restrict MAP roles unjustifiably.
‘UMAPs has already begun advancing cases through its legal team to ACAS, ensuring that members have a pathway to justice.’
In response to this, the BMA told Pulse that patient safety should be ‘the first thing any NHS employer thinks about in its hiring practices’.
A spokesperson continued: ‘With multiple documented cases of patient harm due to PAs being employed in unsuitable roles as well as vocal concerns across the medical profession having now led to an ongoing Government review, it is absolutely right that clear national scopes of practice are set out to prevent further unintentional harm.
‘Attempting to challenge these safety policies, as this legal action appears to be trying to do, would seem a baffling and wrong-headed approach. However, we await further details of the case.’
The RCGP said that it was aware of UMAPs’ recent statement and ‘will engage as appropriate in due course’.
A spokesperson said: ‘We wish to reiterate that the RCGP PA guidance 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 RCGP is strongly committed to equality, diversity and inclusion, and this is key to our values as an organisation,’ the college added.
Its scope document, published in October, stipulated that PAs in general practice must not see patients who have not been triaged by a GP, nor patients who present for a second time with an unresolved issue.
The college advised practices that while it cannot ‘enforce’ the guidance – as this is down to employing GPs to decide – it ‘may be taken into account’ by NHS Resolution and medical defence organisations in clinical negligence cases.
Meanwhile, the GMC, which started regulating PAs from last month, has been clear that it will not itself set out a scope of practice for these professionals, but it will ‘have reference’ to scopes set out by other bodies.
Correction: This article was updated on 3 January to remove references to UMAPs as an ‘unofficial representative body’, as the organisation became an trade union on 1 December 2024.
You reap what you sow. Doing medicine on the cheap and unsafely….was there ever going to be any other action. RCGP back tracking already and being as supportive as ever to practices and GP. “The college advised practices that while it cannot ‘enforce’ the guidance – as this is down to employing GPs to decide ” & ‘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.’. well done rcgp. Glad I don’t pay you a penny. Nice one.
Looks like healthcare on the cheap might prove expensive for the ‘blue sky, going forward, pushing the envelope, early adopters’
“Doctor Nash”? This rather unfortunate and misleading typo exemplifies the confused status of PAs. If a medical journal cannot tell the difference, what hope do patients have? (I may have missed Nash’s PhD qualification – apologies if so)
As for Nash’s erroneous and litigious quasi-status to “empower” PAs to instigate employment tribunal proceedings against GPs, who will fund this bizarre case?
Moreover, I think that Nash’s vociferous objections to the many legitimate documented patient safety concerns is deeply worrying. He appears to reject such safety concerns whilst claiming abusive and bullying practices by senior medical colleagues and official medical representative bodies.
I think Nash’s false equivalence between doctors’ and PAs’ knowledge, skills, and competencies, borders on a narcissistic self-aggrandisement. I think that patients do need protecting from such blowhard tactics and accusatory claims. Doctors have rightly focused on patient safety issues and the many cogent problems with the shoddy development of DHSC/NHSE’s experiment on patients.
In the immortal words of Grange Hill….just say no.
Don’t train them.
Dont supervise them.
Don’t employ them.
Refuse to work with them.
I am sure his lawyers will be making a lot of money from tbis.
It wil take a very big sum of money to bring 200 separate legal cases for breach of contract, as every contract is likely to be different, and each case will need to judged on its own merit.
I wonder if Stephen Nash understands that this action will make PAs even more unemployable than before?
A GP practice would be nuts to employ one after this.
I feel for the individuals PA who have been sold down the river by NHS/DoH who have persuaded them that they have a valid paramedical career ahead of them. I have no sympathy for the GP practices who saw their employment as a cheap way of doing medicine (actually, I do feel that it’s a false economy anyway as a GP can work three times as fast and more safely).
I agree with Mr. Marvellous’s comment.
Why would any practice want to run the risk of employing a PA?
I have to comment on behalf of PAs (who are excluded from this forum). Firstly there is no mention in article I read suggesting Mr Nash is a doctor and the response comments, sickeningly familiar to all PAs, cements that PAs are absolutely right to take action legally. The BMA spokespersons ‘ multiple documented cases…’ comment is unscientific scapegoating, beneath the dignity of a doctor who works under GMC ethical guidelines. The BMA/ RCGP and RCP were in consultation and agreement in training and national examination requirements for PAs many years ago. Their u- turn is legally actionable ,in my opinion, because it is causing harm and bullying one NHS worker specifically- not nurse practitioners or other workers doing similar jobs. That is something all doctors should question the BMA about- I have and await any response- that leaves BMA / RCGP and increasingly RCP open to damages because it is their direct intervention that is cited as reason to not employ a fellow professional that has been employed (and supported by them) for 20 years now in the UK. What other options do PAs have when they face losing their hard earned careers? Perhaps the BMA etc would now like to say the same things to nurse practitioners and see what their Unions will do?
I agree with Shaun.
Some all too familiar and shameful comments.
There is the wider issue of the effect of the more heterogenous nature of Advanced Practitioners whether ACPs, ANPs ,PAs or pharmacists in general as the inherent variation in ability and background in these groups is immense and wide-ranging In my opinion. The disparity is far greater in these groups in my view than that amongst, for instance GPs or PNs who have more established clearly defined roles. Even amongst pharmacists within General Practice, there are truly excellent individuals who assist greatly and then there are those who place a maximum issue of one or two, on high proportions of their prescriptions simply shifting the responsibility and workload after 4 weeks or so to someone else to again review the patient and /or patient record and reissue hence rendering the initial pharmacist consultation almost futile!