The RCGP has changed its stance on the regulation of physician associates (PA) after a vote today which argued the GMC is the wrong body to take on the job.
Following a debate at the UK council meeting, members passed a vote which stated that ‘another regulatory body would be more appropriate’ to regulate PAs.
The council also voted to add to the RCGP’s ‘red lines’ on the role of PAs in general practice, which now explicitly state that GP training and retention should be prioritised over PAs.
Another new red line stipulated that PA supervision must be ‘recognised and resourced’, with GPs having autonomy to choose whether or not they can take on supervision roles.
The College has also announced that it will begin a consultation ‘in the coming weeks’ to develop new guidance on PAs working in GP settings, including their scope of practice and supervision arrangements.
Yesterday, the BMA laid down its own take on a physician associate scope of practice, which stated that those working in general practice should never see ‘undifferentiated patients’.
RCGP chair Professor Kamila Hawthorne said that during the debate today, there was ‘deep concern’ that PAs coming under GMC regulation will ‘create further confusion for patients over the differences between doctors and PAs’.
‘It was therefore passed by council vote that the RCGP should change its stance on this issue and that another regulatory body would be more appropriate to take this crucial work forward to regulate PAs,’ the college confirmed.
Since the legislation which brings PAs under GMC regulation has now passed through Parliament, the RCGP said it will ‘need to enter into discussion with the GMC and other stakeholders to look at how these concerns can be addressed’.
Professor Hawthorne also said that by ‘reaffirming and strengthening’ their red lines, she hopes members will have ‘more clarity’.
RCGP’s updated position on PAs working in general practice (new red lines in bold)
- 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.
The College chair also sought to emphasise that PAs ‘will never be a substitute for GPs’.
She said: ‘The College’s position comes from the recognition that PAs can fulfil a potentially supportive role in general practice by taking on specific workload areas, but this must be done in the right way.
‘I’m pleased that our upcoming consultation with members will help us set standards and produce some practical guidance on how best to incorporate these team members.
‘However, PAs are not GPs, cannot replace GPs, and must not be used to “plug the gaps” of GP shortages that have been created by years of underinvestment and poor workforce planning.’
The RCGP has come under criticism in recent months for its position on PAs, including an accusation from the BMA’s GP Committee chair of a ‘lack of transparency’.
Last month, Pulse reported that the college had withdrawn a case study detailing the work of a physician associate following backlash from doctors online.
And in November, they admitted to an ‘error’ in suggesting that PAs would be able to access college fellowship.
READERS' COMMENTS [14]
Please note, only GPs are permitted to add comments to articles
Too little too late. They must have had a lot of AOB on all their zoom meetings these last 2 years….. Reactive and lazy.
Same sluggish incompetence sleepwalked us into this mess. Promotions and OBEs here we come……. Truly embarrassing.
A bit late considering House of Lords has already passed the legislation
Too many vested interests.
The mood music amongst us “ordinary”docs is very much against these fake doctors.
The RCGP comes last in the race and doesn’t even know what has already gone before it. Why do you continue to pay for a college that doesn’t represent on the ground working GP and remains totally out of touch. Imagine what you could with years and years of membership fees?
This anti PA rhetoric is just not helpful and causing so much anxiety amongst hard working professionals. They have completed a masters degree and as a profession would only work within their scope of competency.
The only difference between PAs and nursing ACPs is the current lack of registration with a recognised body. Is anyone questioning nursing ACPs, often seeing undifferentiated conditions? No, of course not because they aren’t called a PA.
GP
This is my last ever comment in PULSE
The up coming strike/industrial action will come to nothing because G.Ps are idle and will leave any substantive activity to others
Their main concern is making money and even patients get in the way of this.
I have worked as a locum almost the whole of my post graduate career, the length and breadth of Britain—– being variously a partner –salaried partner—assistant. Amazingly G.Ps think they should have a locum for free
I’ve been around the block a bit, wouldn’t you say?——–including Australia and Canada
My father was a Scot, my mother Irish, and I was born within the sound of Bow Bells
I trained in Wales, most of my friends are Welsh —— I climbed Welsh mountains with Welsh girl friends—–one of whom taught me the language When it comes to the SIX NATIONS guess who I’m rooting for?
I wish you all well in whatever future circumstances you find yourselves , but you must stop merely complaining
I do not know what an ACP is in the context above, but I have seen an ANP mistreat conditions which our Practice SEN would have done much better with. It must be all in the professionalism of the Practitioner themselves, plu whether they ‘Know what they do not know’ and ask for help and supervision appropriately. Some of all grades do not. And some of all grades ridicule someone who does ask when they are not sure.
Spot on Aaimir Munir. The PA witch hunt will achieve nothing positive. We should welcome help from other clinicians because there are no regiments of doctors riding over the hill to save us !
@Anony Mouse and Aamir Munir
Actually there is a “regiment” of GPs and doctors who are out of work and could “ride over the hill” to save the day if the government and NHSE were providing funding to hire actual doctors!!
One issue is that there are people in our profession that don’t seem to value their own doctor colleagues or high quality patient care and so will happily accept cheap substitutes!
Would either of you accept these people replacing yourself? That you are left unemployed whilst a PA with just 2 years qualification is doing the job that you do … because the powers that be seem to think that a medical degree and postgraduate training isn’t really necessary and that GPs including yourself are overrated and overpaid…
You are right that it shouldn’t be just about PAs … there are plenty of ACPs and other non-doctors who are equally dangerous because their training does not equate to that of a doctor and they are seeing undifferentiated patients.
However, I think you are somewhat naive saying that PAs would only work within their scope when we have read on the Pulse, VERY recently, that PAs in a hospital Trust prescribed opioids and benzodiazepines to patients!! They do not have a prescribing qualification so how exactly does one “accidentally” prescribe controlled drugs??! Did they forget their scope?
And there seem to have been no repercussions for them either even though they committed a criminal offence!! The same article said prescribing by PAs was happening across 24 Trusts even though only 1 admitted it and blamed it on an IT blunder!?
So yes, Drs have a right to raise concerns and this isn’t a witch hunt because there is plenty of evidence of guilt, harm and lack of professionalism that has been demonstrated amongst this group of clinicians.
I am on the edge to get out of the country , I think this is he last push that needed . Why does it feel like I wasted good years of my life …
As it stands, I would not trust a PA with a member of my family that I’m fond of. Once the infrastructure and training are sorted out I may change my mind. Nothing personal, just a total system failure.
JMG – sadly I have to agree with you that it looks like GP principals will not take fruitful action but instead will think up creative plans to avoid any breach eg switching drugs to branded etc which will be tantamount to going “na-na-na-nana” !
Enjoyed reading your interesting bio. But take a break, and come back soon so you can say “told you so” when the BMA’s “IA” has fallen flat..
The issue with ARRs in general is a travesty – I have spent part of my weekend dealing with a more or less fully booked clinic for an ARR on over £60k – most of these are appointments that the ARR rebooks themselves or advises reception to book – most should not have been booked and are appointments rebooked 5 or 6 times for the same very simple problem, all of which would have been dealt with in under a minute by a GP- I cleared the entire half day clinic in minimal time-this cycle will be repeated and is becoming tiring to monitor as we do not need AARs other than in some limited positions and they have some value in very specific roles but as stated elsewhere I have seen this wastage of appointments and NHS finance with ARRs over and over again- this situation has been caused by incompetent self centred leadership across the board and will lead to the continued downfall of the NHS until these ineffectual leaders are replaced.
How timeous, expect a consensus statement on leeches soon.