PCNs and practices have been urged to halt the recruitment of physician associates (PAs) by the RCGP this week, while the BMA has launched legal action over the regulation of the profession.

The RCGP urged its members on Thursday to ‘halt’ recruitment of PAs until they are regulated later this year after ‘concerning findings’ from the RCGP’s recent consultation. This surveyed over 5,000 GPs and found that over 80% believe the use of PAs in general practices has a negative impact on patient safety.

Yesterday, the BMA then announced it was launching legal action against the GMC over the way it plans to regulate the profession.

The union said plans would mean ‘dangerous blurring of lines’ for patients between ‘highly skilled and experienced’ doctors and assistant roles.

It added that the GMC has been using the term ‘medical professionals’ in its materials to ‘describe all of its future registrants’, including both doctors and associates. The BMA is launching a judicial review claim against the GMC over its use of this term, which it said ‘should only ever be used to refer to qualified doctors’ (see box for details of the claim).

Around one third of PAs are currently hired through PCNs, according to NHS workforce data.

For those already employing PAs, the RCGP has advised practices to ensure they do not see undifferentiated patients and that daily supervision time is built into timetables.

The college is now working on guidance for GP practices, including a PA scope of practice and induction and supervision materials.

In the update, the RCGP said: ‘After consideration of the survey results […] we are recommending to our members that they review their recruitment plans and halt the recruitment and deployment of additional PAs into general practice across the UK until PAs are regulated and practices are in a position to implement the RCGP’s forthcoming guidance.’

The ‘disturbing’ survey results showed that half of responding RCGP members reported ‘being aware of specific examples of patient safety being compromised by the work of PAs’, including instances of misdiagnosis and inappropriate prescribing.

According to the college’s initial analysis, the consultation also highlighted ‘wide variability’ in the way PAs are utilised and supervised in general practice, and respondents called for ‘greater clarity’ on what activities PAs should carry out.

College chair Professor Kamila Hawthorne said the ‘fundamental issue’ around PAs is ‘patient safety’, and recognised that the survey results ‘will be of concern’ to patients, GPs and PAs themselves.

She said: ‘Our intention is not to disparage the individuals who are working as PAs in general practice or their profession, but to address and act on the concerns that more and more of our GP members have been raising.

‘It is not the case that we heard nothing positive about PAs working in general practice – there are reports from our survey of where the role has been working well. But it is clear that there is not a sufficiently robust framework for supervision and scope of role in place in GP practices, and this is having implications for patient safety.’

RCGP recommendations on PAs in full

Practices using PAs should review their induction, supervision and triage processes, as well as the type of work that PAs are undertaking, in order to assure themselves that the College’s existing red lines, as below, are not being breached:

  • PAs working in general practice must always work under the supervision of qualified GPs.
  • PAs must be considered additional members of the team, rather than substitutes for GPs.
  • PAs do not replace GPs or mitigate the need to urgently address the shortage of GPs.
  • PAs must be regulated as soon as possible.
  • Public awareness and understanding of the PA role must be improved.
  • Training, induction and supervision of PAs within general practice must be properly designed and resourced.
  • At a time of significant GP workforce challenges, funding allocations, resources and learning opportunities within general practice must be prioritised for the training and retention of GPs.
  • The significant responsibility and skills required for supervision must be recognised and resourced, with GPs able to choose whether or not they are willing to undertake supervision of PAs. PAs should not be employed unless sufficient supervision can be provided.

GP practices should also ensure that:

  • Appropriate time for supervision is included within GPs’ and PAs’ daily timetables.
  • Processes of triage, induction, and supervision are reviewed to ensure they are robust and safe for patients, and all PAs have documented annual appraisals.
  • PAs do not see patients who have not been triaged by a GP and only undertake work delegated to them by, and agreed with, their GP supervisor. This work must be in line with the agreed scope of role for that PA in the practice.
  • Transparent and accurate methods of introduction of all members of the MDT seeing patients are visible to patients, including on the practice website, on consulting room doors, on name badges and when appointments are booked.
  • Patients who have already consulted a PA for a problem, and who re-present again with the same problem which has not been diagnosed and resolved, should not re-consult a PA, but should see a GP.

Source: RCGP

Details of the legal action

  • The BMA seeks to challenge the GMC’s decision to apply its long-established central guidance for doctors – Good Medical Practice (GMP) (the most recent version of which was published on 22 August 2023 and came into effect on 30 January 2024) – equally to PAs/AAs once they are regulated by the GMC as of 13 December 2024.
  • The BMA also challenges the continued use of the term “medical professionals” by the GMC in this context as a collective description for doctors and PAs/ AAs – and, specifically, repeatedly within the GMP text – on the basis that inclusion of PAs and AAs within the term “medical professionals” is liable to confuse patients and the broader public and blur the important distinction between medical practitioners (i.e. doctors) and associate professionals which, in turn, gives rise to serious public protection concerns.
  • Both of these issues are particularly concerning against the backdrop of: a continued absence of any nationally agreed scope of practice guidance for PAs/AAs; continuing public safety concerns connected with the same; and the broad nature of the standards for education and training for PAs/ AAs drawn up by the GMC in its latest consultation launched on 26 March 2024 Regulating anaesthesia associates and physician associates – consultation on our proposed rules, standards and guidance.

Source: BMA letter to the GMC