GP practices must have policies stopping PAs prescribing, says NHS England

All GP practices employing physician associates (PAs) must have a policy to restrict access to prescribing, new NHS England guidance has said. 

The national commissioner suggested practices give PAs smart cards which do ‘not permit access to prescribing activities’.

In a letter sent to practices today, which emphasised that PAs are not ‘substitutes’ for GPs or junior doctors, NHSE outlined the steps required to ensure safe implementation of the role.

Similar guidance for secondary care was issued earlier this month, stating that PAs should not be used as ‘replacements’ for doctors on rotas.

According to NHS England, these guidelines for general practice have been developed based on discussions with the royal colleges, trade unions, and the GMC. 

The letter outlined that PAs ‘must be supervised and debriefed’ by a GP, who must have ‘confidence’ in the PA’s competence.

‘We ask that practices review their processes to ensure that they have appropriate supervision, supporting governance and systems in place.’ 

It continued: ‘It is important to emphasise that PAs are not substitutes for general practitioners or doctors in training; rather, they are specifically trained to work collaboratively with doctors and others as supplementary members of a multidisciplinary team alongside nursing and other ARRS colleagues.’

Practices have also been asked to ensure all staff are ‘educated’ on the physician associate role and ‘make it clear to patients that they are seeing a PA’.

Last year, it came to light that a patient who died after seeing a PA at her GP practice had not been aware that those appointments were not with a doctor.

On prescribing, NHS England reiterated that PAs ‘are not able to prescribe’ and practice policies must reflect this. 

The guidance said: ‘Therefore, in the context of electronic patient care records, every practice should have a comprehensive policy outlining access and restriction requirements for each professional group. 

‘This policy should cover aspects such as appropriate access to prescribing, results, referrals, and patient clinical notes, and provide assurance that clinicians are not able to undertake activities falling outside of their role’s scope of practice (for example, by providing a smart card loaded with TPP or EMIS system role profiles for PAs that does not permit access to prescribing activities).’

According to NHSE, these guidelines will support practices to implement the PA role safely as the workforce grows in line with Government ambitions.

When consulting on legislation allowing for GMC regulation of PAs last year, the Government suggested that PAs and anaesthesia associates (AAs) could get prescribing rights under separate legislation in future. 

Last year, the NHS long-term workforce plan pledged to establish a PA workforce of 10,000 by 2036/37 – up from the 4,000 currently working in the NHS. 

Earlier this month, the BMA published ‘first of its kind’ guidance on the scope of practice for PAs, which said they should never see ‘undifferentiated’ patients in a GP setting. 

However, the Government has said any scope of practice is a matter for the Royal College of Physicians.

And a PA representative body warned GP practices implementing the BMA’s guidance of potential legal consequences.

The GMC is currently consulting on its proposed rules and standards for PAs, which will be implemented once they come under regulation from December this year.