The chair of the BMA’s GP committee for England has accused the RCGP of ‘a lack of transparency’ amid controversies surrounding the college’s position on physician associates (PAs).
In a post on X, which has now been deleted, Dr Katie Bramall-Stainer said that college chair Professor Kamila Hawthorne had not been transparent regarding her involvement in setting up a postgraduate course at the University of Surrey.
Professor Hawthorne designed and developed a postgraduate diploma programme for PAs at the university which started in 2016, as stated on her profile on the university’s website.
The RCGP’s official position on PAs is that they ‘have an enabling role to play for general practice’ and that they ‘must always work under the supervision of GPs’ and ‘must be considered’ additional members of the team, rather than a substitute to GPs.
In her post, Dr Bramall-Stainer said: ‘Some of the ire at the RCGP has been at a lack of transparency from the RCGP chair regarding how she helped set up the PA course at the Uni of Surrey. Perhaps [it] could have been better handled.’
When approached by Pulse about her post, Dr Bramall-Stainer said that ‘this mess is not the making of one person or one college’ but it is ‘an ideological political manoeuvre’.
Professor Hawthorne said that she has ‘always been very open’ about her involvement in designing the programme.
She said: ‘We are very disappointed that Dr Bramall-Stainer has chosen to raise this issue in this way, and I will be taking it up with her privately.
‘I was asked to design a physician associate programme for the University of Surrey in 2016 as part of my work to set up a new medical school.
‘I took this through to university accreditation stage and a colleague was appointed to run the course. I have always been very open about this and my work at Surrey finished in 2018.’
The description of the course at the University of Surrey mentioned a ‘hands-on’ clinical curriculum, where students can ‘learn to support doctors’ with taking medical histories, performing examinations, diagnosing illnesses, analysing test results and developing management plans.
It also said that through the course students will acquire the academic requirements needed to complete the Physician Associate Registration Assessment (PARA) and ‘register with the General Medical Council (GMC) to practise clinically once you’ve graduated’.
The course description said: ‘We’ll give you the skills you need to assess, diagnose and manage various medical problems as a self-assured, confident healthcare professional.
‘Spending time with an experienced senior doctor, whether working under supervision or alongside your mentor, you’ll assist patients who present with numerous different conditions.’
The Anaesthesia Associates and Physician Associates Order 2024, which received approval by the House of Commons and will now go before the full chamber of the House of Lords, will establish the GMC as the statutory regulator for PAs, meaning they set out the standards for their practice, education and training and operate fitness-to-practice procedures.
The BMA has expressed concerns around PAs roles in general practice, with the GPC for England calling for an immediate pause on all recruitment of PAs across general practice and PCNs, and a recent survey of 19,000 doctors by the union showed that 72% do not support the future regulation of PAs by the GMC.
Earlier this week, a health minister admitted that employing PAs ‘does not mitigate the need for more GPs’ and other practice staff.
Lets be honest here.
A certain type of managing partner GP is quite happy to accept essentially cost free PA’s rather than have to pay a salaried GP or split profit with an additional partner.
PA’s are the deathknell for primary care.
They are being used as doctor replacements in both primary and secondary care.
The long-term political plan of course is, if you wish to be guaranteed to see a doctor , you will have to pay privately.
The colleges and their gong chasers are dancing to the political tune ,
Ignoring the damage this will do to UK medicine.
“Physician” is a protected title which means Doctor. The title Physician Associate is totally misleading to the public and needs to changed (back) to Physician’s Assistant which accurate. The abbreviation only muddies the water further. PS I’m a managing GP partner who hasn’t accepted any PAs
This “Cambrian explosion” of ARRS species will inevitably lead to the extinction of the independent contractor species expedited by their own kind ie greedy CDs/managing partners. Talk about digging your own graves!
Given the decline in funding, and as a partner I’m earning less per session than my salaried doctors, we can’t afford to take on additional salaried doctors. We could not attract new salaried doctors and the combination of rate of pay & work-life balance prevented us from tempting some excellent locum GPs. So while additional salaried doctors would be desirable, even more so would be doctors wishing to be partners but that model of General Practice no longer seems an aspiration.
Use of PAs for us is not some clever way of increasing high drawings, but proven essential approach to maintain and expand capacity. Of course PAs must be fully supported & carefully supervised, and this needs time allocation for the duty doctor. But is this so very different from secondary care where there is a pyramid of supervision and expertise? There nurses and care assistants take basic problem list and undertake simple observation checks (and other responsibilities too of course), junior doctors act as clerking machines doing full system history & examinations to then present cases to SHOs who in turn present the salient aspects to the registrar who in turn are supervised by a consultant. As a GP am I not on similar clinical & managerial level to a hospital consultants and if they can work atop a pyramid why should it be impossible for primary care to broaden its pyramid too? We survived having practice nurses doing more than just dressings & injections and then nurse practitioners/ACP which no one seems to feel is controversial now? And yes I agree there are differences in depth, breadth & duration of training but I don’t see primary care having the leverage to change government’s blinkered downgrading of the service with ill-thought-through micro-management and disinvestment.
DHSC/NHSE need to justify why they continue to refuse to include GPs for ARRS claims.
I have ben a member of the RCGP for decades unfortunately – a completely useless organisation from my perspective unless perhaps from my point of view you are seeking a fast track to the honours list and totally unrepresentative of grass roots GPs from my judgement. I have no faith whatsoever in this organisation that from my contention has questionable excessive fees for younger GPs and excessive fees for courses in my opinion. It has been a waste of subscriptions in tens of thousands from my self individually.. My personal view is that the RCGP has been pivotal in the progressive and sustained decline of Primary Care.
Working alongside P.As. stresses me out———–funny, how Practice Nurses don’t seem to do that
On a side issue, some transparency from the RCGP as to how did a leading member of a proscribed terror organisation become a Member would be welcome.
And why was he thought fit to be a Trainer?
https://www.pulsetoday.co.uk/news/regulation/nhs-suspends-gp-who-led-banned-islamist-group/
@ David Haddock————and why did Jamie Oliver become F.R.C.G.P ?
I agree it does smell fishy, DH…but it’s repeating on me now, so cod you plaice sing a different tuna 😉