Clinical director views sought on regulating physician associates

PCN clinical directors are being asked to share their views on how the GMC regulates physician associates (PAs) in a new consultation.

Around one third (1,139 FTE) of the 3,000 PAs in the UK are hired through PCNs, according to the latest workforce data.

The role was one of the first to be made available via the additional roles reimbursement scheme (ARRS) in 2019. Though PAs have been around since 2003, NHS England recently committed to increasing the workforce to 10,000 by 2036/37.

However, there have been concerns over the scope of their practice, with the BMA suggesting that the experience of doctors has become ‘more negative and patient safety concerns have dramatically increased’ due to the increased number of PAs.

The GMC is set to regulate the role by December 2024, but there have been concerns over whether the body was the right one to take this position. The RCGP changed its mind on this earlier this year, following a UK council meeting where members passed a vote saying ‘another regulatory body would be more appropriate’.

The consultation, which is open until 20 May 2024, has asked for comments on proposed rules, standards and guidance on how the body will regulate PAs.

But, the regulator said the consultation will not reopen the decision on who should regulate PAs, nor will it ask about the roles of PAs.

It said: ‘This consultation is asking for comments on the rules, guidance and standards that set out how we will implement this new legislation. It is not about whether who should regulate these professions, or whether these professions should be regulated by another organisation.’

It will cover:

• The standards for PA curricula and how the GMC will quality assure education providers;
• The requirements for inclusion on the GMC register;
• How concerns will be dealt with;
• How the GMC will handle appeals and revise decisions; 
• The process for setting PA registration fees.

‘Integral’ part of PCNs

The new PCN DES contract, out on March 28, emphasises the GP role as PA supervisor.

It states: ‘Where their named GP supervisor is satisfied that adequate supervision, supporting governance and systems are in place’, [physician associates] provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems.

It adds: ‘The GP supervisor must take into account a physician associate’s knowledge, skills and experience gained through their training and development.’

Last week, NHS England wrote a letter to PCN clinical directors on ensuring safe and effective integration of PAs into general practice teams.

The letter stated that PAs were an ‘integral’ part of the multidisciplinary practice team, and that they provide ‘valuable support’ to patients and clinicians.

It said: ‘The NHS long term workforce plan commits to growing these roles alongside recruiting and training more doctors, nurses, allied health and other professionals, and ensuring every team member can contribute their skills, experience and education.’

However, it added that these roles must be introduced ‘safely’ and in a ‘supportive environment, ensuring oversight of the supervision and tasks being carried out’. It also stated the PA role should not be seen as a ‘substitute’ for GPs, but ‘supplementary’ members of the team.

It said it was working with the GMC, royal colleges, trade unions, doctors and PA professional groups to develop a curriculum, core capability frameworks, standards for CPD, assessment and appraisal, as well as supervision guidance for PAs.

The BMA recently published its own guidance on the scope of the PA role which suggested GPs triage patients before deciding which one a PA can see.

A PCN clinical director, who wished to remain anonymous, told Pulse PCN earlier this month that most GPs would agree the regulation of the role ‘should have been agreed before recruiting’ them.

They added: ‘The issue of supervision of clinicians in primary care extends far beyond the current focus on PAs. There is a lack of recognition by the NHS system of the time and investment needed to ensure such clinical roles are successful for staff and safe for patients.

‘However, this appears to have been politicised by groups on social media and organisations such as the BMA to defend the interests of doctors at the expense of a vulnerable group of unregulated professionals such as PAs.

‘Frankly, reading the BMA MAP guidance was uncomfortable for me as a doctor as it read as heavily biased towards our profession, encroaching on an area of standard setting which seems out of the scope of a trade union.’

Another PCN clinical director from Herne Bay PCN, Dr Jeremy Carter, who does not employ PAs, told Pulse PCN recently that supervision of PAs was a barrier to employing PAs, as it costs GP time, responsibility and stress, and there was no guarantee how long they would do the role for.

He said: ‘It can be frustrating to spend a lot of resource training and supervising staff to upskill and further their career, only for them to move on.’