Editor Jaimie Kaffash on what the RCGP’s scope of practice document says about the physician associate project
With the greatest respect to the RCGP, they can be quite skilled in saying very little in a lot of words. But credit where it is due – their physician associates scope of practice document released today says a lot in few words.
It severely limits the scope of PAs in general practice. It recommends they only see patients who have already been triaged, they should be limited to treating ‘common, minor illnesses’, they shouldn’t see cases involving mental illness and they shouldn’t see pregnant patients (though not in an Old Testament kind of way).
It also sets out what PAs can do (although this section is far shorter). For example, they can do annual health checks (though only in patients without particular complications), they can refer on behalf of GPs and they can also ‘be involved in wider practice initiatives eg, green, community engagement/outreach’ (which has a real sixth-former-on-work-experience vibe to it).
As Copperfield has pointed out, it is unclear what a scope of practice actually does for GP practices. Those who are not signed up to the scheme have no need for it; those who do want to employ PAs quite understandably don’t want to be restricted. This isn’t a criticism – I have spoken to a number of GPs who speak highly about their PA’s capabilities while criticising the whole principle behind the role.
So let’s get this straight – this guidance isn’t for practices. The college’s audience is the GMC, the NHS and health ministers. What the RCGP guidance has done brilliantly with this document is to support its council’s declaration – that PAs don’t have a role in general practice. By restricting what they feel can be done safely and adding an absurd layer of supervision, they are showing the futility of the role.
They are describing a health care support worker. I do believe that there is a role for these type of staff (though the title will no doubt be refined). But it leaves no doubt about the kind of work they can do, limited to the most simple patient presentations and admin work that requires a level of medical knowledge. Such a role would, in time, help alleviate GP workload, but to a clearly defined extent.
As I have said before, and Pulse deputy editor Sofia Lind reiterated last month, individual PAs are not to be blamed in this row. But there is a reason GPs have five years medical education followed by at least five years training. It’s to be able to assess undifferentiated patients, spot the unusual, and identify red flags. It is not a failing of individual PAs that they cannot do this. But it becomes a problem when they are given anything more than the most basic of clinical tasks.
The RCGP’s document makes this argument under the scope of providing guidance. They’ve said so much more than it seems at first glance – and they should be applauded.
Jaimie Kaffash is editor of Pulse. Follow him on X @jkaffash or email him at [email protected]
applause. I might even consider rejoining.
RCGP’s been a bit wobbly on the PA issue, but this document gives clarity.
If any PAs now find themselves made redundant and lose their jobs, I hope those GP contractors who rushed to take them up will suitably compensate them.
Well done- really? The RCGP and the BMA are scapegoating and trying to destroy a profession and real peoples lives here. Flippant comments are not appropriate when there is such distress amongst our PA colleagues. It would be good to hear from the editor of Pulse and others exactly who will care for our people instead of PAs and by association anyone not a doctor like nurse practitioners. There are now 6 doctors qualifying for every 1 when I qualified yet I believe health inequalities are worsening and our elderly queue at 8 am to have any chance of care. I hope Mr Streeting realises the RCGP and BMA do not speak for all doctors here and their edicts are destructive to future patient care.
@Shaun- There are so many issues with the implementation of PAs within GP.
Why does the funding in essence come at the expense of being able to offer actual qualified GPs jobs?
Do they actually reduce workload in General Prac? Given the supervision burden and limited scope. If determined locally, how willing are you or others to put your registration on the line for somebody who did a 2 year course with often unrelated undergrad degrees, which may only have 4 weeks of GP exposure.
Is it correct to call it a profession when they are entirely unregulated, under doctor supervision at all times, cannot prescribe and the qualifying exams are non-standardised?
When did anyone other than 100 PA’s decide it was correct to change their title from Assistants to Associate (note not associates) without consulting those responsible for training and supervising them. Evidently, this simple change of wording before anyone was aware of the role influences perception of competence (Associate is far more competent than an Assistant?)
Shaun was/is part of a limited company that employs PAs who according to the adverts do the following “The PA will provide the initial history taking and clinical assessment through to diagnosis, treatment, and evaluation of care”
As for 6 times more doctors. They are mostly in secondary care. The number of GPs has decreased by 10% in the last 25 years while the population has increased 10% and become more elderly.
GPs who have been employing PAs are in fact the cause of the chaos and distress to PAs now evolving in my view and additionally to their GP colleagues and not the solution.
Despite the protestations of these GPs and their stated care for PAs and in some cases their statements they can entirely replace GPs with PAs they have not seen fit to pay them the equivalent of their own GP salaries to these PAs if they are in fact doing the equivalent work.
This is simply a manifestation of greed.
It remains taboo, that over decades, there are a relatively small group of self-indulgent self-serving manipulative GPs who have looked only after their own personal or group interests or status, whether by joining LMCs/CCGs or ICBs now PCNs simply to gain information on contracts and other information to profit themselves via APMS or other contracts and not patient care.
It is these APMS contracts with increasing interference from detached inexperienced unaccountable CCGs/ICB managers over time in my view amongst other changes that have gradually eroded the GP profession to the benefit of the GP shameless and exploitative few.
They have bought many of these organisations into disrepute and damaged the aims of the dedicated majority who wish Primary care and the family practice to thrive.
The current devastation is led by the greed of a proportion of PCN CDs and PCNs and there is no doubt that although some of these profess to champion the cause of various ARRs, their actual aim is simply to exploit these groups and profit.
Had the greed of these said GPs been curtailed, these ARRS and PAs would now be working with support of all Primary Care and all GPs in suitable well managed and supervised roles across the NHS and not for the few who continue in my opinion to exploit this ARR group, simultaneously destroying the careers of the newly qualified , locum ,salaried and other GP colleagues while ruining the future landscape of Primary Care.
Over years, decades, I had to deal with multiple complaints about GPs and GP trainees. Not a single one about my PA.
You can pay for a degree, but can’t buy ability to think
And there in lies the problem with anecdotes or n=1 studies.
This feels extremely similar to the debates which occurred when the concept of extended scope nurses were introduced. PAs should have been regulated from the outset but notwithstanding that fact , they will be similar to other allied health professions. Some will develop additional skills and will be permitted to carry out extended scope procedures. For those that are already working in GP their employers need to check if their scope is outwith the RCGP document and either accredit them or stop them from performing those tasks . We need to rapidly move beyond the current hot political situation. We need more staff in primary care , GPs and other team members .
Sorry SM, but these roles do not provide GOOD QUALITY care. They are, at best, bums on seats. I have a lot of sympathy for PAs who were sold a dream, and GPs and hospitals who have joined the bandwagon, but it’s clear they don’t have the requisite knowledge or experience to see undifferentiated patients. I’m sure there’s some good ones and who have been trained to a reasonable standard, but that doesn’t replace the depth and breadth of experience from 5 years medical school and 5 years of medical training.
Put another way, if you or a loved one had something potentially serious (eg Shortness of Breath), would you want to see an expert generalist who can consider the wide differentials and pick up the nuanced red flags that would cause concern and trigger further investigation? Or would you be happy seeing a cheap doctor replacement that’s never learnt about these rarer differentials so has decided you have a chest infection and written out the script for amoxicillin because they know no better?
Sorry SM, but these roles do not provide GOOD QUALITY care. They are, at best, bums on seats. I have a lot of sympathy for PAs who were sold a dream, and GPs and hospitals who have joined the bandwagon, but it’s clear they don’t have the requisite knowledge or experience to see undifferentiated patients. I’m sure there’s some good ones and who have been trained to a reasonable standard, but that doesn’t replace the depth and breadth of experience from 5 years medical school and 5 years of medical training.
Put another way, if you or a loved one had something potentially serious (eg Shortness of Breath), would you want to see an expert generalist who can consider the wide differentials and pick up the nuanced red flags that would cause concern and trigger further investigation? Or would you be happy seeing a cheap doctor replacement that’s never learnt about these rarer differentials so has decided you have a chest infection and written out the script for amoxicillin because they know no better?