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GPs to vote on PAs being blocked from anything but admin tasks

GPs to vote on PAs being blocked from anything but admin tasks

LMC leaders across the UK will vote on a motion which ‘condemns’ the use of physician associates (PAs) in GP practices for anything other than ‘administrative or simple procedural duties’.

They will also vote on whether GPs should ‘call on the UK government and devolved nation governments’ 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’.

LMC leaders proposing the motions will raise ‘increasing concerns’ about the promotion of PAs in general practice.

One motion suggests that the GMC is ‘complicit’ in the Government’s plans to create a ‘cheaper’ primary care model, and that GPs ‘cannot and should not be replaced’ by PAs.

GP leaders will also debate the supervision of ‘new roles coming into general practice’ and whether ‘constraints’ should be placed on the number of colleagues a single GP can supervise at the same time.

This motion calls for medical defence organisations (MDOs) to develop guidance which ‘explicitly’ sets our supervision responsibilities for GPs.

The UK LMCs conference, which takes place on 23 and 24 May in Newport, Wales, will also cover a motion on AI replacing doctors.

The motion crucially proposes that ‘only a doctor with full training and appropriate levels of experience will be able to effective challenge an AI when it produces questionable results’.

Last year, England’s GP Committee called for an immediate pause on all recruitment of physician associates across general practice and PCNs, and the BMA recently called on NHSE to ‘pause’ the planned expansion of the PA workforce and training numbers.

The doctors’ union has also published guidance on the ‘scope of practice’ of PAs in both primary and secondary care, which stated that these professionals should never see ‘undifferentiated patients’ in a GP setting.

This ‘scope’ document was met with criticism by PA representatives, with one body threatening legal action against GPs who implement it in their practice.

Last year, UK LMC leaders called on the BMA to reject proposals which would allow SAS doctors to work in general practice as primary care doctors. 

But the recent 2024/25 contract cemented performance list flexibilities which were brought in during Covid, opening up the path for SAS doctors to be employed by practices and PCNs. 

Relevant motions 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
(ii) condemns the use of physician associates in general practice for anything other than administrative or simple procedural duties
(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
(iv) insists that patients are made fully aware of the role of any health care professional before any consultation
(v) necessitates that all GPC UK members openly declare any interest, financial or otherwise, in PAs from this point onwards.

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.

That conference notes that personnel in new roles coming into general practice require a significant amount of training, supervision, and support from existing general practitioners and calls upon GPC UK ensure that:
(i) any GP in a supervisory role is understood to be offering enhanced clinical expertise to complement and support those that are being supervised
(ii) protected time and appropriate remuneration should be provided to any GP taking on supervisory roles
(iii) all GPCs liaise with MDOs to develop guidance that defines and explicitly describes the role of supervisor to different cohorts of colleagues
(iv) constraints be placed on how many colleagues a single GP can simultaneously supervise to protect the safety of patient
(v) the role of GPs in primary care is protected by ensuring that AHPs supplement rather than substitute, with high quality, cost effective care provided by services that are GP-led and GP delivered.

That conference recognises that artificial intelligence (AI) is likely to impact the provision of care significantly over the next decade and calls for appropriate controls to ensure the safe introduction of systems in primary care, in particular that:
(i) only a doctor with full training and appropriate levels of experience will be able to effective challenge an AI when it produces questionable results
(ii) AI has the potential to improve consistency and safety of doctor led care, but only when doctors are enabled and indemnified to challenge it
(iii) while AHPs are likely to see similar gains in productivity, consistency and safety the use of AI will not remove the need for doctor oversight of patient care
(iv) that any introduction of AI should take lessons from sectors such as aviation and ensure that doctors are not so far removed from routine cases that they become de-skilled
(v) that GPCs should make it clear that primary care without GPs, especially in a world of data hungry AI, will lead to an unsustainable increase in cost and ultimately a two tier NHS.

 Source: BMA



Please note, only GPs are permitted to add comments to articles

David Church 9 May, 2024 2:12 pm

It is a great pity that these issues are being debated NOW, after deployment of significant numbers of PAs, and many more having commenced training on a promissory basis, rather than during the development phase of the concept.
It is clearly the case that if a Doctor needs to train for 3 years on a GP VTS training scheme before working unsupervised in general practice, seeing and managing undifferentiated patients, then so does (at the very least) a PA if they are aiming to do same job.
In fact, we have various levels of PA with differences in training level, quantity and quality and breadth, which are almost impossible to tell apart. Most of the ones we come across have less experience (because the number produced is increasing yearly – stands to reason there are more new ones; but also because established ones are not moving out to GP land), but it is harder to tell at what level they can work safely because of the lack of standardisation.
But even a starting out GP VTS Registrar is coming to GP with 5 years of medical school and 2 years as HO (FY1/2 minimum now, but often 3-4), which training is of a more generically standardised nature, making judging their breadth and competence easier – which is essential when working with MDTs in situations which can go rapidly from ‘routine’ to ’emergency’.
A big part of the debate that needs to be had is ‘WHAT IS A PA?’ Unfortunately, the highest common denominator is determined by the one who has trained in a narrow field in a totally different specialty, which stands all of them at a great disadvantage. Everyone seems to be ignoring the fact that PA training schemes are very very job-specific. AAs do not learn GP stuff, and vice versa. Endoscopy assistants do not learn AA or GP stuff, etc
Unreviewed development of the role by a certain royal college is a heinous crime against all those who need medical care in the future, as well as the PAs left in limbo and ostracised right now.
It is unfortunate for all that the professions have fallen for persuasion by a government intent on cheapening and deconstructing NHS halthcare at the same time, worsening relationships where they should be working together for patients.

Yes Man 9 May, 2024 2:29 pm

The horse bolted when nurses became ANPs.

So the bird flew away 9 May, 2024 4:39 pm

Glad to see GP leaders waking up to danger. Reminds me of that saying “when GP leaders confer, the Government trembles and falls”……(hahaha)
Plato’s Coprophagus, book 1

Just Your Average Joe 9 May, 2024 6:57 pm

This is a unnecessary witch hunt – where PAs are being hung out to dry.
PAs are not doctors, nor are they GPs, but they are valued allied health professionals who are able to work safely within the competencies, and need to be supervised by a qualified GP, ideally in an educational environment used to supervising learners.

FY2 doctors, St2 and ST3 GP trainees, ANP, paramedics, pharmacists, physiotherapists, and all allied health professionals who are not GPs, all need to work within their competencies, and need supervision.

Some newly qualified GPs also benefit from support and opportunity to ask questions from more experienced colleagues.
It is only a fool who would not ask someone else for advice or information even if they consider themselves a very experienced GP, if something is outside their usual knowledge/skill set, hence we often refer to Secondary care and consultant colleagues.

Only private providers and idiots would leave a practice only attended by allied health professionals without adequate GP supervision on site.

Lets stop the bashing of a number increasing number of PA colleagues, who are becoming embedded in the NHS, and give them clear roles and support and supervision, but stop pretending they are doctors and placing them in situations, such as doctors rotas where they are not adequately skilled or trained/supervised to perform those roles, waiting for them to fail.

For those who are embedded and do a great job, and wish to progress, why not after 5 years ( can be debated to be less), offer them if adequately skilled and wanting to progress the opportunity via learning on the job as apprentices, to sit the PLAB – medical conversion exams and let them become doctors and progress their careers, as long as they can prove themselves to have the skills and knowledge base that their medical colleagues have, having gained those skills over the years worked.

It is about improving the NHS for all involved, not isolating colleagues who are a valuable aid in the workforce crisis in the NHS, that will take 10 years for the new medical students starting in August, and slow increase to 15,000, by 2030 to reach GP practices, if they are ever recruited.

paul cundy 9 May, 2024 10:50 pm

Just your average Joe,
“the workforce crisis in the NHS, that will take 10 years for the new medical students starting in August, and slow increase to 15,000, by 2030 to reach GP practices, if they are ever recruited.” shows such naivety, by 2030 the role of the traditional GP will have been extinguished. Eyes open we are already half way down that road, for a multitude of reasons. In 2030 you will face an AI driven chat bot for immediate advice, a PA or non doctor for a lesser problem and a real GP, who won’t know you but will have acess to every page of your voluminous multi source electronic records to sort through whilst you “consult” with them.
And this new system will cost three or four multiples of our current NHS because it will have no initial front door, it will have probably more than the current multiple entry portals each of which anyone can use to enter the system multiple times because to refuse entry on the basis “you’ve already called the system” is too potentialy damagng that no administration will ever support it.
I may be dead by then but at least lok back and see if I was right.
Paul C

Post Doc 10 May, 2024 1:06 pm

The fact is that PA training in Primary Care can create a veneer or simulacrum of clinical ability, which may falsely reassure patients and even fool clinical supervisors. Caveat emptor!

Not on your Nelly 10 May, 2024 1:25 pm

The government remains scared of consultants and worried about junior doctors. They treat GPs with the contempt they always have and laugh in their faces with this nonsense. Sadly, the BMA has been totally ineffective in the pats 15 years fighting for PGs causes, with recurrent contract impositions and ignoring GPs with regard to pay, workload or bullying by patients and patients groups. Is anything going to change?

Anonymous 12 May, 2024 9:43 am

The noctor will see you now.

Sujoy Biswas 12 May, 2024 10:21 pm

@Just Your Average Joe
No one is bashing PAs, infact quite the opposite the posts demonstrate sympathy for their situation. Stating facts isn’t a bashing.

Bob Hodges 13 May, 2024 2:55 pm

I couldn’t agree more with David Church. The problem here has been the massive expansion in numbers without defining scope first, and the lack of consistent threshold of training and competence on graduation.

Leaving it to GP practices and PAs to work it out themselves is the only option right now.