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New PCN contract increases onus on GPs supervising PAs

New PCN contract increases onus on GPs supervising PAs

GP supervisors need to be ‘satisfied’ there is appropriate governance when physician associates (PAs) see undifferentiated patients, NHS England has said. 

In the updated PCNs Network DES for 2024/25, NHS England has added new clauses ‘clarifying role requirements’ for PAs when hired through the Additional Roles Reimbursement Scheme (ARRS).

Previous contracts stipulated that PAs must ‘provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems’.

However, doctors have expressed concern about the safety of this arrangement, and last month the BMA released a PA ‘scope of practice’ which said they should never see undifferentiated patients in a GP setting. 

The new PCN Network DES does not go as far as the BMA’s guidance, but it does specify that GP supervisors must ensure there are more safeguards in place. 

Under ‘key responsibilities’ for PAs, the contract said (added new wording in italics): ‘where their named GP supervisor is satisfied that adequate supervision, supporting governance and systems are in place, provide first point provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems by utilising history-taking, physical examinations and clinical decision-making skills to establish a working diagnosis and management plan in partnership with the patient (and their carers where applicable).’

Another new clause in the DES requires GP supervisors to ‘take into account a physician associate’s knowledge, skills and experience gained through their training and development’.

PCNs must also now ensure that GP supervision of PAs includes ‘appropriate debriefing’. 

According to NHS England, these changes have been made to reflect its ‘latest guidance’ on PAs which was published last week. 

The guidance, developed based on discussions with the royal colleges, trade unions, and the GMC, said GP practices must have a policy to restrict PA access to prescribing.

It also emphasised that PAs are not ‘substitutes’ for GPs or junior doctors.

BMA GP Committee England deputy chair Dr David Wrigley said that it is ‘encouraging’ that NHS England has taken on board some of the union’s recommendations, but warned against these changes becoming ’empty words’.

He said: ‘NHS England still believes that PAs, if supervised, are able to see undifferentiated patients, which means patients are not being seen by a doctor as a first point of contact.

‘This does not reflect the BMA’s safe scope of practice guidance which is clear that seeing undifferentiated patients must not take place. We cannot allow GPs to be undermined any further; PAs are there to work to assist and help doctors deliver care and can’t be seen as a replacement for them.’

Dr Wrigley also highlighted the ‘time and skills’ required for GPs to supervise PAs, which takes them ‘away from their patients’, and called on NHS England to ‘engage further’ with the BMA on these issues.

GP spokesperson for the Doctors’ Association Dr Steve Taylor told Pulse said the changes to the DES are ‘effectively making PAs less financially viable’ due to putting in place more supervision requirements for GPs to follow. 

He said: ‘Having actively promoted and funded ARRS at the expense of GP practice funding, it appears, by amending the contract, that NHS England have decided that they need to cover ARRS by placing the responsibility of any failure to supervise on GP supervisors. 

‘It was clear from the start that PAs seeing non-differentiated patients, a NHS England stipulation, would be unsafe in practice. By amending the contract they are effectively making PAs less financially viable due to supervision requirements.’

Dr Taylor emphasised that ‘cutting funding’ for the recruitment and retention of GPs in order to fund ARRS ‘is the issue here’.

Following the publication of the BMA’s guidance, a representative body for PAs warned GP practices implementing the scope of practice of potential legal consequences.

Along with the new Network DES documents, the Government and NHSE also published full GMS contract details for this financial year which announced an increase in the global sum from £104.73 to £107.57.

And the QOF contract revealed that the number of income-protected points will increase from 81 to 212 from this month. 

However, last week GPs overwhelmingly voted not to accept the Government’s imposed contract changes.



Please note, only GPs are permitted to add comments to articles

David Church 2 April, 2024 12:54 pm

Dr Taylor is at least right that there is a move to make GPs take the blame for the problems arising in over-hurried insertion of PAs into GP-Land. It is clearly GPs fault that we did not control the creation of this role by the RCGP! Even though it was actually not the RCGP, but the RCP, over which GPs have absolutely zero control !

Andrew Jackson 2 April, 2024 1:14 pm

a beautiful on the hoof fudge of guidance leaving GPs to
again pick up the pieces

Peter Jones 2 April, 2024 3:42 pm

So at a stroke NHS England have ensured they are not responsible for any (inevitable) mistakes made by PA’s. Any GP who employs a PA will carry the can. Brilliant.

Sal Kal 2 April, 2024 4:46 pm

One of next stokes sooner or later will be removal of ARRS funding or partial funding for surgeries. It is bound to happen that the responsibility of ARRS and PAs will legally belong to partners sooner or later. NHS England will pass the buck as criticism will only grow with complaints and legal issues. It also will make partners advis that how 2 partner were there (instead of 4 or 5) making a partner supervise other ARRS letsay 3.So really only 1 partner was working for population of 8-10k patient. Moronic

DrC H 3 April, 2024 3:51 am

This situation is staggering. I supervise GP trainees who have 5 full-time years of medical study plus another 2-3 years of full time medical experience and they are nowhere near ready to practice unsupervised. Even after full Gp qualification, 10 years of full time study later, it takes another 2 years or so before one truly feels equiped to manage whatever walks through the door. How can a PA with no medical background expect to work in undifferentiated General Practice??

John Graham Munro 3 April, 2024 6:41 am

Some one has to say it————-one can’t dump any old thing on a PA like you can on a Locum

Bernie Hunt 17 April, 2024 5:57 pm

Knownowt noctors,are the responsibility of Gp’s s.
It should be easy for the RCP to work out what they can do from their course prospecives.
Is the idea that they should recognise serious illness and send it to A&E? Might explain the huge growth in traffic.
Can’t prescribe?? It’s not what the patients believe nor the time allocated to DD.
Expensive, more than 5 th year Dr, many noctors upskilled at NHS not their own cost, like nurses and doctors. No wonder NHSE built in free GP supervision into their models.
No wonder GPS are rejecting the sows ear contract.
But let’s face it, NHSE and health leaders have no idea of what a GP actually does. They will however have to face what happens to NHS when skilled gate keepers are no longer doing home visits for vulnerable complex elderly, sending an arrs medical technician= skilled first aider paramedic, and PTS can only see a PA or ACP for undiagnosed problems.
We will get collapsed of NHS, with GP’s not the leaders/ planners blamed.
It’s corporate corruption at highest level..