Dr Stephen Katona posits an unorthodox method of fighting GP unemployment: why can’t GPs work as physician associates?
It is no secret to any GP that we are in the midst of a severe workforce crisis. GPs cannot find work and practices cannot afford to hire them. The only sustainable long-term solution is, of course, increased investment in general practice and GPs – which the new GP contract goes some way to address. But that does not help the GPs who are currently flailing in a hapless job market, desperately wanting to work.
In the education system, teachers are allowed to work as teaching assistants. A minority of teachers do exercise this right at some point in their career, when they are struggling for work. Which begs the question: can the same be said for out-of-work doctors working as physician associates (PAs)?
Doctors are – by definition – far more qualified than PAs, so it obviously isn’t a question as to whether or not they have the skillset to do the role. Allowing unemployed GPs the opportunity to tide themselves over with PA work could help stop the ever-increasing number of GPs leaving the NHS for private practice or pastures abroad, or just retiring altogether from stress. It could also make it easier for doctors to return to work after a period of ill health or caring for a relative. Would the NHS benefit from retaining more of these doctors? Should employers have the opportunity to choose the health professionals most qualified to look after their patients?
Despite the BMA and RCGP’s positions on opposing and phasing out PAs in general practice, advertisements for PAs persist. So while these jobs do exist, I believe that preventing doctors from having the right to apply for these roles is a form of discrimination. Currently applicants for a PA post must have a PA qualification. Given the additional training doctors receive, why then is a medical degree not also deemed sufficient?
A GP could rightly request to be paid at band 8a rates due to their ability to see undifferentiated patients and receive pay of over £60,000 per year. Yes, this is considerably less than they might receive as a salaried GP, but it beats working in Tesco, and they might end up with less stressful working conditions and less unpaid overtime. Yes, it would also blur lines further between the two professions, but would patients find that acceptable if it raised the competency of those working in physician associate roles?
It would be nice to be able to ask patients their views on the matter. In fact, I have tried! I submitted a petition to the Government, arguing that doctors should have the right to work as PAs. However, it was rejected a week later. The reasoning given was that this was about a matter for which the UK Government or Parliament was not directly responsible.
Funnily enough, I remember Parliament being instrumental in the extension of GMC regulation to include PAs in the first place. Therefore, I don’t think it is entirely unreasonable to suggest that actually, the Government can influence the GMC by introducing new laws or changes to existing legislation, which the GMC must follow. NHS England is now responsible for PA workforce policy (since Health Education England merged with NHSE) and ARRS funding.
I appealed against their decision at the beginning of this year, just after GMC regulation of PAs came into force. I reasoned as above that the Government is able to exert influence over the GMC. But, the petition was rejected again. This time it said that decisions about training requirements for PAs were now a matter for the GMC even though the GMC is merely the statutory regulator for the profession. Given that the NHSE is a public body funded by the Government and overseen by DHSC, I still failed to see how this was not a viable petition request. And that was before the announcement that NHSE was to be dissolved to move control of the NHS back to central government…
There are almost as many institutions that train PAs (33 according to the NHS health careers page) as there are medical schools in the country – that would be 46. I wonder then, how is it justified to not give medical students an automatic PA qualification in addition to their medical degree? This automatic entitlement would not change the standing of either qualification, but it might help future doctors cope with career bottlenecks and burnout.
One might argue that the inclusion of GPs in ARRS funding in the new contract ought to be mentioned, as the current temporary solution. But with the slim eligibility criteria, it doesn’t solve the problem, and it wouldn’t change what at the moment is a lack of a right. I am all too aware that this opinion – further conflating doctors and PAs together – could be unpopular. However, with the unemployment crisis our profession faces, as a temporary measure it might at least aid the plight of doctors unable to find work, and patients unable to find a doctor. It would appear though that we will never have the chance to find out.
Dr Stephen Katona is an out-of-hours GP in Manchester
There might be practicalities, – which cost for medical insurance, – whether Supervisor responsibility still applies. – what GMC subscription, – the possibility of being thought too ‘uppity,’ – regular PA’s displaced. Whether pre- Woke training and accreditation applies, perhaps.
If it is really still a PA roke, with no prescribing requirements.
It risks just being asked to do a full GP job on a race to the bottom salary
Sure. Solve an employment crisis by employing GPs in a lower paid role and by default gaining GP level experience and quality care for significantly reduced cost.
Great for employers.
Atrocious for the Profession.
Utterly ridiculous idea – do we have no self respect?