The BMA’s GP Committee for England has called for an immediate pause on all recruitment of physician associates across general practice and PCNs.
During a meeting yesterday, the committee passed an emergency motion ‘expressing concerns over the increasing trend of PAs being used to substitute GPs’, and calling on practices and PCNs to stop PA recruitment ‘until appropriately safe regulatory processes and structures are in place’.
The motion also reminded GPs and GP registrars that they may refuse to automatically sign prescriptions or request investigations on behalf of a PA.
GPC England chair Dr Katie Bramall-Stainer said that the motion is ‘about finding ways to protect patients’ by ensuring appropriate processes and regulations are in place.
She said: ‘The BMA recognises the vital role that multidisciplinary teams play in the NHS. In general practice, patients have long benefited from having access to a wide variety of healthcare professionals that can input into their care, from physiotherapists to diabetes nurses.
‘Patients need to know and understand what each healthcare professional can and cannot do, and where their expertise is relevant.
‘This is crucial in helping patients understand the care they’re being given. Recently, we have seen some examples in the media that suggest there is a potential blurring of the line between doctors and non-medically qualified professionals, leading patients to think they’ve seen a GP or other medically-qualified team member – when they haven’t.
‘GPs are expert medical generalists with the experience and medical knowledge to diagnose, treat and manage multiple and complex conditions.
‘PAs are not doctors; they are not regulated; and they cannot prescribe. At best this is confusing – at worst, it can threaten patient safety.’
She said that this distinction must be protected, and PAs ‘cannot be used as a substitute for GPs’, or in place of a GP when supervising GPs in training.
Dr Bramall-Stainer added: ‘The GP workforce crisis is a result of the failure of Government to plan for the recruitment and retention of GPs.
‘Only by valuing and investing in the recruitment and retention of GPs will the experience and care of patients improve.
‘While PAs may help reduce general practice workload in some cases, it should not come at the expense of patient safety.’
The Department of Health and Social Care (DHSC) is currently preparing legislation for the regulation of both PAs and anaesthetic associates (AAs), after closing a long-awaited consultation which suggested PAs could get prescribing rights in order to relieve pressure on GPs.
This legislation is due to be laid before Parliament by the end of this year, with GMC regulation expected to begin by the end of 2024.
Last week, the GMC asked NHS England to address the perception that there is a ‘plan for health services to replace doctors with physician associates’, in a letter which said discussions around PAs have escalated in recent weeks.
And earlier this week, over 2,000 doctors expressed ‘grave concerns’ about the upcoming regulation of PAs in an open letter to the GMC.
The motion in full:
That GPC England fully endorses the recent statement by UEMO expressing concern over the increasing trend of “Physician Assistants/Associates” (PAs) being used to substitute GPs in English General Practice, and:
i) asserts that PAs are neither a safe nor an appropriate substitute for a GP
ii) calls for an immediate pause on all recruitment of PAs across PCNs and General Practice until appropriately safe regulatory processes and structures are in place
iii) reminds GPs and GP registrars that they may refuse to automatically sign prescriptions or request investigations including ionising radiation on behalf of a PA
iv) asserts that it is entirely inappropriate and unsafe for GP Registrars to be supervised or debriefed by PAs
v) demands that PAs be appropriately and safely regulated by a body other than the GMC
Proposer:
Dr Samuel Parker
Seconders:
Dr Matt Mayer and Dr Ian Hume
READERS' COMMENTS [10]
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As well as poor quality P.As, there are poor quality Locums, and ——dare I say it——–poor quality G.Ps
Clinical Directors/PCNs and those who employ poorly regulated roles from my contention at financial benefit to themselves purely to fulfil an untested agenda without informing an unknowing and hence in my view a non consenting public of the experience, educational background and limitations of these new ARR PA/ACP and older ANP roles which are not fully understood by the population are in my personal opinion undertaking actions of alleged gross negligence.
This situation from my personal viewpoint is a clear dereliction of duty and action is needed to protect the taxpaying public from potential serious health related harm and from NHS financial ruin as I predict cases will come to light and rise at an exponential rate and this is all in my opinion readily foreseeable.
@John Graham Munro and others with the same arguments … let me give an analogy of how one becomes a commercial pilot…
“In general, it takes a minimum of 40-60 hours of flight time to obtain a private pilot’s license, which allows you to fly small aircraft for personal use. To become a commercial pilot, which will enable you to fly for hire, you’ll need a minimum of 250 hours of flight time and more advanced training. “
Now I ask the question, would you feel safe boarding a plane where the person flying the plane has only done 20% of the flight time and no advanced training? Would you board that plane knowingly?
This is the issue wIth PAs and other ARR staff who are being used to substitute GPs. They DO NOT have equivalent training and are being made to work outside their scope… 2 years training CAN NEVER be comparable to 10 years training – it is basic mathematics.
They are being expected to fly a plane with 20% of the flight time essentially…
And thus this strategy IS a risk to patient safety in itself and needs addressing. Well done to the GPC for taking steps to address the elephant in the room!
This isn’t about individuals. There are excellent PAs and ARRS staff. We all acknowledge that but this is about ensuring that staff with limited qualifications are being utilised appropriately within the system and are not inadvertently working as GPs!!
No doubt there will also be poor quality GPs but the root cause of this is NOT their lack of training and qualifications. And they are regulated as well as accountable for their poor practice. Many are referred to GMC or NHSE for performance management. Some are struck off the GMC register and suspended.
I cannot say the same for PA or ARRS staff. When fault is found, the excuse is always that “they are not doctors or GPs and do not have the same level of qualifications and cannot be expected to know any better… “
then why, I ask, are they being expected to consult as if they are a GP, if they are not as culpable as a GP when things go wrong ??
Sad to say no amount of training can help. The E student is an E student. They ask the same question over and over again. Playing with patient’s lives.
One cannot really blame GP Practices / GP Principals / Contract Holders from a financial point of view: the ARRS staff come with a significant subsidy and the bottom line is struggling globally. What is wicked is HMG / NHSE using ARRS funding to force GPs to choose between maintaining standards and bread on the table. It’s not like these same wicked actors are supporting GPs to feel valued, are understanding the pressures or give a toss about long term sustainability. Who could blame the down trodden GP who thinks ‘sod it, let it all burn down, my only objective is to survive till I retire / can get out’.
The level of wasted effort within the NHS is stupendous. Largely because non medical (non doctor) staff circulate patients without a definitive decision being made. Well trained, experienced, WELL SUPPORTED GPs are the absolute backbone of any healthcare service. They act as effective triagers and traffic lights upon which everything else depends for effectiveness and rationality. Appropriate resource allocation. GPs need to be adequately paid and have fingers in every local healthcare pie. Restore GP respect. To my mind, GP Fundholding was beginning to do just that.
The UK cannot afford NOT to put GPs back in the driving seat. At all other levels in NHS, we need to re establish the clinical hierarchy. At the moment, it feels like the aircraft is on autopilot and no one knows the destination. Everyone is pretending the aircraft can continue flying on its own and no one really knows how much fuel is left in the tanks. Cross fingers and carry on.
That escalated rather quickly.
From we want PAs regulated to we don’t want any PAs employed.
Dieticians, nurses, physios, heck even pharmacists and the social prescribers – they all bring something to the table. I wouldn’t want them doing the job of the GP and seeing undifferentiated illness, but they all have useful knowledge and experience.
PA? No. Cheapo doctor replacements with less training and lower aptitude. Which patient would choose to see that? And they’re not that cheap! Rash – refer Derm. ALT 51 – refer gastro. Headache – refer Neuro.
So the GPC is advising us to cut off our noses to spite our faces. Cheers, folks, another cracker, keep ‘em coming.
Practices have been haemorrhaging GPs to early retirement or lucrative locums for many years. Faced with an existential threat as expensive adverts for replacement GPs went unanswered, we took Second Prize by employing relatively plentiful PAs.
Just like doctors, some PAs are duff, some are diamonds, and all need careful supervision, but they have kept Primary Care alive through tough times, and deserve to to be feted as heroic saviours , not demonised as incompetent fools.
Where have the GPC been in the last decade? They have impotently watched governments dismantle Primary Care, done nothing to stem the flow of GPs scrambling to the exit, and successfully dissuaded doctors from becoming future GPs.
Resourceful Practices have survived on PAs, but now the GPC want to stop them entering the profession.
So what’s Plan C, lads&lasses? Any more genius ideas? How about instead of ridding the Profession of PAs we rid ourselves of the GPC. Could work wonders.
David Banner, spot on.
‘We need more doctors”
Err there aren’t any would you like some other help?
‘No!’
I have nothing agaist PA’s. They will work well in a team enviroment like in hospitals and can take a load of the junior doctor’s job’s list. But General practise is all about independent practise. You have to see, understand and treat patient in independently and 15-20 of them back to back in 10 minute slots. This does not lend itself to someone who only has part knoledge, cannot work independently and is relying on supervision. For this reason I don’t think they should be in general practise and they are far more suited for secondary care .