The GMC is ‘complicit’ in the Government’s ‘agenda’ to create ‘a cheaper model of primary care’ by supporting the use of physician associates (PAs) in place of GPs, local GP leaders said today.
UK LMC Conference delegates in Newport, Wales, stopped short of ‘condemning’ the use of physician associates in general practice ‘for anything other than administrative or simple procedural duties’, however.
Speakers against the motion said they agreed with the sentiment around PAs’ tasks, but the language of ‘condemning’ their use risked worsening an already ‘venomous’ debate.
The BMA this week published additional guidance regarding PAs working across general practice and secondary care, having previously set out its ‘scope of practice’.
Speaking in favour of the motion, Dr Paul Evans from Gateshead LMC said: ‘I’m absolutely happy for physician associates to scribe for me, to take bloods for me, to take blood pressure – no more than that. And for those things, I’ve got health care assistants.
‘For more advanced things, I’ve got nurses who can operate independently and offer a heck of a lot more to patients safely and effectively.’
On the GMC, he added: ‘The GMC have clearly been complicit. They have literally taken money to deviate from their job of regulating doctors to regulate another profession that we didn’t want them to regulate. We are paying them to do something we don’t want them to do.’
Dr Chris Morris, from the GP registrars committee, said: ‘Physician associates are a threat to health professionals, GPs and doctors. And as GP registrars, we’re constantly hearing from our colleagues that are increasingly struggling to find work after CCT compared to previous cohorts.
‘This is devaluing our worth as expert generalists. How can it be acceptable that non-medical practitioners can work in general practice and see undifferentiated and differentiated patients with just two years of training?
‘PAs working in general practice and seeing these patients make a mockery of our extensive training and CCT. This is an attack on doctors and patients, and is a short-sighted poor investment in the future. If this experiment continues, we’ll be left with a two-tier healthcare.’
Against the motion, Dr Hussain Ghandi, from Nottinghamshire LMC, said he didn’t support the use of the word ‘condemn’ in the motion.
He said: ‘Venom I’ve heard in various forums online, and the way that I hear some of our colleagues speak about these PAs, makes me worried.
‘Why are we making PAs the scapegoat for the fact that general practice has been underfunded for years?’
Dr Felicity Day, a GP in North Yorkshire, said that problems around unemployed GPs weren’t a nationwide problem.
‘In my area there continues to be a shortage of GPs, with an average deficit of one and a half GPs per practice.
‘Preventing PAs from doing any role other than administrative or simple procedural duties will not increase funding to practices. It will not solve the varied recruitment challenges across the country. But it will further destabilise practices who are already struggling.’
Delegates also demanded that ‘protected time and appropriate remuneration should be provided to any GP taking on supervisory roles’.
The latest guidance suggested PAs must have a named supervisor ‘immediately’ available ‘at all times’.
It had previously said PAs should never see ‘undifferentiated’ patients in a GP setting.
And the RCGP has recently launched a consultation on the role of PAs in general practice.
Motion in full
That conference has increasing concerns about the development and promotion of physician associates in general practice and:
(i) agrees that GPs, as expert medical generalists, cannot and should not be replaced by physician associates CARRIED
(ii) condemns the use of physician associates in general practice for anything other than administrative or simple procedural duties LOST
(iii) believes that the GMC is complicit in the government’s agenda to create a cheaper and inferior delivery model of primary care by using PAs in place of GPs CARRIED
(iv) insists that patients are made fully aware of the role of any health care professional before any consultation CARRIED
(v) necessitates that all GPC UK members openly declare any interest, financial or otherwise, in PAs from this point onwards. CARRIED
That conference calls on GPC UK to call on the UK government and devolved nation governments via the devolved nation GPCs to ensure that general practitioners are the main provider of primary care and ensure that any plans of replacing this professional workforce with non-medical professional entities be rejected. CARRIED
The PAs I have met are hardworking conscientious individuals and they find themselves in the middle of a controversy which is not of their making which is quite devastating for them. The ones who are already here and already in training should be regulated and supervised, just like other allied healthprofesionals. But maybe there should be a re-think on further expansion of this controversial profession.
Just like communism. Fantastic on paper, dreadful in real life. What politicians and the public need to see is what happens when GPs are not in the picture.
What about noctors replacing GPs?
13k patients, 4 partners, 6 ANPs employed full time and 2 salaried doctors only offered part time.
Along with the GMC, the RCGP the RCP, ICBs, PCNs and countless GP partners have all played their part in the de-medicalisation of the Primary Care workforce. The GPC and LMCs have been slow to react to the PA issue but other non-medical “Practitioners” are firmly embedded in Practices and arguably also undermine the status of General Practice. The problem has developed over two decades and will probably take just as long to fix.
I do not see why the profession need to pay for the GMC if they are working for the government. Our money is better spent elsewhere.
If anyone still remembers a year ago it was impossible to recruit a GP. Locums were hard to find too.