GMC chair Professor Dame Carrie McEwen has called on doctors to show ‘multi-disciplinary respect’ towards healthcare professional colleagues who are not doctors.
In an opening speech to the GMC Symposium this week, Professor McEwen noted that ‘the current environment for medical associate professionals is clearly very challenging’.
Recently, doctors have criticised plans under which physician associates would be regulated by the GMC and receive a GMC number, arguing this could confuse patients into thinking they were being treated by a doctor.
Patient safety concerns also prompted the BMA and its GP Committee to call for a pause on recruitment of physician associates in recent weeks.
The use of non-doctors to relieve NHS pressures have also been questioned in mainstream and social media.
Last month 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 in her speech, Professor McEwen said: ‘As our workforce continues to diversify inclusion becomes more and more important. And it’s critical that we stretch our thinking and recognise that diversity comes in many forms, including professional diversity.’
Also addressing SAS doctors, whose entry into the general practice workforce the GMC has propagated, Professor McEwen added: ‘Multi-disciplinary respect and courtesy is fundamental within our professional standards but there are going to be situations and times when that is challenging to deliver.
‘Leaders have a significant responsibility to establish a culture where this is expected, even in the face of a tough external environment, and where all doctors hold each other to high standards on inclusivity.’
She concluded that there is now ‘a small window of opportunity to demonstrate compassionate leadership, and to highlight inclusive organisational values’.
‘This is the time to outline expectations around team working, including multidisciplinary approaches, respect, empathy, mutual support and compassion.’
Meanwhile, yesterday at the conference of England’s local medical committees, delegates voted on a motion relating to the skills of non-doctor GP practice staff hired via the additional roles reimbursement scheme (ARRS).
In a debate on the subject, Dr Lizzie Toberty from Newcastle and North Tyneside LMC said: ’The job of seeing, assessing and treated undifferentiated illness in the community is hard. It requires a very specific set of skills that are unique to primary care.
‘It has both baffled and concerned me to observe huge numbers of ARRS staff being used to see an undifferentiated and sometimes acutely unwell patients with no nationally funded or mandated training.
‘We must implement funded training and supervision for new ARRS staff and pause any expansion on access until this is in place.’
The conference voted in favour of asking NHS England to ‘restructure’ the ARRS staffing model before ‘pushing’ any further access requirement on general practice.
It also passed, as a reference, motions to improve training of ARRS staff.
’The reality is right now as we sit in this room ARRS staff are seeing undifferentiated patients. This is about patient safety right now because they are not getting the supervision and I am not convinced some of them understand the basics. This is about having a pragmatic view and slowing things down. We need to slow down and train people properly,’ Dr Toberty said.
Dr Benjamin Eliad, from Hertfordshire LMC, also speaking in favour of the motion, said: ‘ARRS staff have been introduced into general practice over the last few years with no structured training and no funded supervision.
‘I’m lucky to be working in a training practice with a clear philosophy and support from partners but how would those ARRS staff be supported without that umbrella of support. We demand this for our GP trainees and we must demand this for our ARRS too and to improve the safety of our patients.’
Dr Elliott Philips, from the GP registrars committee, said: ’Salaried and locum roles are vanishing across the UK, those roles replaced by those funded by ARRS schemes. What will those of us who are left be managing.
‘Registrars fear the future is a growing burden of supervision, taking clinical responsibility for patients we have not seen because we do not have the time and being taken to the GMC. These roles should exist to support us not replace us.
But Dr Chris Morris, also from the GP registrars committee, argued the motion did ‘not go far enough’.
‘We’re hearing from colleagues that they’re increasingly struggling to find work after the CCT. We’re devaluing our roles as specialist generalists. As a future GP I want to be seeing patients and I don’t want to be seeing the more difficult patients again again and again,’ he said.
And Dr Malinga Ratwatte, from the same committee, said he agreed with the sentiment but the motion ‘doesn’t get to the crux’.
‘Only doctors are qualified to see undifferentiated patients presentations. It is our raison d’etre. It is a high risk process that we train for years and years to be able to do. This issue poses an existential threat to our profession.’
Legislation on the regulation of PAs and AAs is due to be laid before Parliament by the end of this year, with GMC regulation expected to begin by the end of 2024.
This week, the RCGP has allayed concerns that PAs and other professionals could be offered college fellowship by admitting there was an ‘error’ in its recent council papers.
LMC conference motion in full
That conference believes that Additional Roles Reimbursement Scheme (ARRS) staff have not been nationally supported to develop adequate competence within primary care and:
(i) all ARRS staff should be supervised similarly to GP registrars for three years from commencing their role – PASSED as a reference
(ii) GPC England needs to insist that, as per GMC guidance, levels of supervision should be guided by the needs of the individual rather than a blanket approach – PASSED as a reference
(iii) all ARRS roles and associated supervisors need to have funded and protected time for supervision and learning – PASSED
(iv) no further push for advanced access whilst the inefficiencies of this model are restructured. – PASSED
So to do our job we have worked hard to get top A-levels then 5 years of medical school followed by horrific years of long hours as a Junior Doctor whilst studying for post graduate exams that we pay for out of our income. Then you are suggesting someone with a 2 year degree can do what we do and we should respect them. They merrily remove Dr from name badges and label everyone a consultant to confuse and deceive patients and it is us who need to show some respect. I will respect someone who reciprocates. Currently not feeling respected so not going to hand any out myself.
Agreed DJ,like the GMC shows respect/courtesy to Drs like they have over the past decades.We are not respected, we are abused hence the exodus down which ever exit we can go.
Can’t the GMC concentrate and practicing “respect and courtesy” the doctors they regulate? Prevent deaths of these doctors under investigation? Be much more compassionate to them? After all, these are the people forced to to pay to be regulated by what can only be called a totally over the top and unfair , Guilty until you are proven innocent, no human rights regime? No. Fine teach us what you choose not to do and look after those that are nothing to do with you. You reap what you sow.
I have not seen or read the whole speech so can only comment on what has been presented in this article.
But it would seem it is necessary for someone to remind Professor Dame Carrie McEwen that the *very point* of the GMC, the very reason it was established, was to differentiate between who is qualified to practise as a doctor and who is not. That is how you fulfill your mission to protect patients. Allowing for this confusion and regulating other health care professionals is a de facto abrogation of your responsibility.
The GMC appear to be colluding in the decline of our professional rights for purely political reasons.
I have no problem with our colleagues in other allied healthcare professions, I welcome them and of course they should be treated respectfully, but there needs to be clear distinctions and different regulators in order to protect patients and preserve the profession.
GMC needs to report itself for discrimination against doctors.
More nonsense from the GMC.
Before you know it a GCSE in biology will have you seeing patients.
The patient journey is significantly lengthier and more hazardous with the increasing number of numpties they see before seeing someone who knows their job. I am thinking pharmacists, paramedics, triageurs of all disciplines…. the list goes on. These folk were trained to perform a job which most of them do well, but doctors with clinical reasoning skills and diagnostic acumen they are not.. This nonsense is as danger for thoseous seeing the patients as for the patients themselves.
Kindness, courtesy, and compassion are not the problem. Competence and clarity are the problem, and there is no sign yet that GMC is either equipped to distinguish between their roles or to work out what their roles are.
Wagging our fingers telling is to behave better s not going to cut it. In fact, it’s weak and inept.
Darren Tymens 100%
It is neither disrespectful nor discourteous to point out that an unregulated individual with minimal training should not be allowed to see diagnose and treat patients presenting de novo in General Practice. To do so without supervision is illegal and a breach of the Medical Act 1858. Perhaps Prof McEwen needs to familiarise herself with the legislation?
It’s unbelievable, how did we let it get to this? It an existential threat for our profession and our patients. GMC needs to back off.
agree with David Jarvis and ‘Anonymous’; Doctors with full medical qualifications are not getting respect from some other ‘professionals’ and that appears to include RCP, RCGP, and GMC now, as well as the usual suspects and media, politicians, etc
Was initially introduced in the guise of ‘filling in the gaps’ where there was a lack of GPs and has now subversively metastasised to cause the defenestration of primary care as we knew it.
But the GMC says we have to smile and be polite as we are replaced by cheaper, potentially dangerous (you don’t know what you don’t know) and certainly inefficient (I’m often asked to review patients or booked to ‘follow up with GP’ and see so many unnecessary investigations and referrals being sent).
This on paper may save money short term (don’t have to pay for those pesky expensive doctors) but will not bode well in the long term for the NHS or patients.
The gnc a insenstive, out of touch, organisation and look at your racist cases . Yiu are fit for purpose … stop paying gmc .govt should fund it .
The piece reflects a critical perspective on the GMC’s approach to integrating non-doctor healthcare professionals, such as physician associates, into the healthcare system. The GMC’s stance, as articulated by Professor Dame Carrie McEwen, emphasises multi-disciplinary respect and the importance of a diverse workforce, including professional diversity. However, this approach has raised concerns among doctors regarding patient safety, the dilution of the role of doctors, and the potential confusion for patients.
Firstly, the GMC’s push for inclusivity and respect for non-doctor professionals, while commendable in its intent to foster a collaborative healthcare environment, seems to overlook the practical and safety concerns raised by doctors. The criticism revolves around the GMC’s perceived failure to adequately address these issues. Doctors have expressed apprehension about the use of physician associates, fearing that it could lead to patient confusion and compromise patient safety. This concern is heightened by the BMA and GP Committee’s call for a pause in the recruitment of physician associates. Additionally, the apprehension about non-doctors being used to alleviate NHS pressures indicates a deeper issue: the GMC’s policy might be perceived as a band-aid solution to the systemic problems plaguing the NHS, such as staffing shortages and overwork, rather than a sustainable, long-term strategy that maintains the high standards of patient care.
Secondly, the article highlights a broader existential crisis for the medical profession. The deployment of non-doctor staff in roles traditionally held by doctors not only raises questions about patient safety and quality of care but also reflects a shift in the perception of doctors’ roles within the healthcare system. While the GMC’s aim for a more inclusive and multidisciplinary approach is forward-thinking, it seems to have led to a perception among doctors of a devaluation of their specialist role and expertise.
I think GP training programmes should be abolished as it is perceived by government and top medics / managers there is no role for doctors in this profession. The only need for GP training programmes is to export GPs to Australia, Canada middle east.
It just shows how out of touch the GMC is. Even a plumber knows not to let you learn their trade. We are not stupid. Want to do medicine, then go to medical school and go through all hard work like we all did.
This is not the GMC not listening but focusing on a a future cash-cow to expand their corporate tax-charity operations. The GMC is not fit for purpose and is underhanded and almost deceitful as it is not other MDT members but PA and getting PA into MDTs when often not appropriate or safe overall. The 95 percent plus non-doctors at GMC have forgotten about patient safety when they see the money signs.
Clearly doctors show respect to non-doctors as long as their is no quackery. Over decades I have seen doctors be respectful to ward clerks, cooks, cleaners and so on. Most doctors are respectful to MDT members whom are professionals but PA are not medical professionals and should be regulated by the NMC with the majority of medical associates that are NA, whom are far superior to PA/AA.
This has all been brought about by PCNs in collaboration with NHSE which have led the destruction of the Primary care