RCGP to vote on physician associate scope of practice giving supervisors discretion

The RCGP will vote on a ‘scope of practice’ for physician associates (PAs) tomorrow which could give individual practices discretion to determine safe working for existing staff.

Earlier this year, the college urged practices to ‘halt’ recruitment of PAs following a consultation which suggested that over 80% of GPs believe PAs in practices are having a negative impact on patient safety. 

At the time, the RCGP said it was working on a PA scope of practice and induction and supervision materials which would be based on the survey results and ‘further external stakeholder and member engagement’.

UK council members will vote on these documents at a meeting tomorrow, as well as on a specific clause which allows PAs already working ‘beyond’ the scope of practice to continue working at that level. 

According to the motion, circulated on social media, the scope of practice will say that it is the ‘responsibility’ of GP clinical supervisors to ‘determine’ whether existing PAs working outside the guidance are ‘doing so safely’. 

The guidance said: ‘We have heard from our members that there are some PAs who, with good levels of supervision and training, have been working safely in general practice, as part of the MDT. 

‘If existing PAs are working outside the scope of practice described in this guidance, it is the responsibility of their GP CS and/or their employer, to determine that they are doing so safely and for this to be clearly documented in the PA’s contract and in their appraisal documentation. 

‘The GP CS and/or employer will need to carefully review their scope of practice on an individual basis, the underlying training and proof of competencies gained and then make a clinical judgement about whether they can, or should, continue to work at that level.’

Doctors on social media have expressed concern about this part of the guidance, with BMA resident doctors committee co-chair Dr Robert Laurenson – who qualified as a GP this year – saying it is ‘the pathway to the abolition of standards’.

Dr Laurenson continued: ‘Grandfathering in lay people to do what they like to patients by permission of a GP is sub-letting the enormous responsibility we are privileged to have. It is an abdication of our duty to protect patients.’

While this part of the guidance has been shared online, the RCGP will not publish the full scope of practice and accompanying guidance until its council has approved the documents.

In March, the BMA set out its own ‘scope of practice’ in what it called ‘first of its kind’ guidance, which declared that PAs should never see ‘undifferentiated’ patients in a GP setting.

But some critics suggested that the BMA does not have authority over scope of practice, with a representative body for PAs warning any GP practices implementing the guidance of potential legal consequences.

The RCGP motion to be debated on Friday also asks RCGP council members to ‘reaffirm’ the college’s ‘red lines’ on PAs in general practice, which in March were updated to reflect a new stance on regulation.

Council members decided that the GMC is the wrong body to take on PA regulation, which will begin at the end of this year, arguing that ‘another regulatory body would be more appropriate’.

The college’s red lines also state that PAs must never be ‘substitutes for GPs’ and that resources in general practice ‘must be prioritised’ for trainee GPs.

The RCGP declined to comment on the guidance ahead of the vote.

Earlier this month, the Royal College of Physicians (RCP) apologised to its members after admitting it had ‘failed’ them on the issue of PAs. 

An external, independent review found a ‘range of collective failures in leadership across the College’ in its handling of a debate on physician associates.