An ICS social media post encouraging patients to see physician associates at their GP practice for persistent abdominal pain has sparked criticism among ongoing controversy around PAs.
In a now-deleted post on X (formerly Twitter), Norfolk and Waveney ICS said on Saturday that physician associates (PAs) can help with this symptom as they are ‘highly skilled at diagnosing conditions’.
This post was then raised in a House of Commons debate on Tuesday, where Labour MP Barbara Keeley used it as an example to show that growing the NHS workforce via PAs is not safe.
Ms Keeley said: ‘After the tragic case of Emily Chesterton, who was misdiagnosed after seeing a physician associate twice at a GP practice and no GP at any point, when will the lesson be learned that the NHS workforce cannot be safely expanded by this route of associates with only two years’ medical training?’
Following Ms Chesterton’s death, which was raised in Parliament by the same MP, her GP practice in North London decided to stop employing physician associates.
Norfolk and Waveney ICS’s now-deleted post on X said: ‘Got abdominal pain that isn’t going away? A Physician Associate based in your GP practice can help.
‘They can help you stay on top of any health concerns. They are highly skilled at diagnosing conditions and can perform physical examinations if needed.’
The ICS later put out a statement saying PAs are ‘recognised’ by the Royal College of Physicians (RCP) as ‘complementary to GPs, not a substitute for them’.
Their local primary care campaign has been raising awareness of the different roles within general practice in order to help ‘provide patients with the right care at the right time, by the right person, in the right place’.
The statement added: ‘Within a GP practice that employs these additional roles, a named GP will be available to provide support to all members of the practice team, such as a duty GP and the Physician Associate will be able to escalate concerns or seek senior support if required.
‘Physician Associates, along with other roles in the wider general practice family are all valuable. And we will continue to raise awareness of the different roles and how they can support the treatment, diagnosis and care for our patients across Norfolk and Waveney.’
Yesterday, NHS England launched a similar campaign which aims to raise awareness of non-GP roles across general practice, including physician associates, as well as pharmacists, mental health practitioners, and others.
Dr Steve Taylor, a GP and Doctors’ Association UK spokesperson, said Norfolk and Waveney ICS’s post was ‘clearly a huge error of judgement’ and demonstrated ‘a complete misunderstanding of the difficulties of dealing with undiagnosed, undifferentiated patients’.
‘With over 100 causes of abdominal pain, a PA clearly does not have sufficient training to know what is serous and what is not. The ICS in this case, the Government and NHSE have stretched the lines of what a PA can, should and shouldn’t be able to do in general practice. This is a patient safety issue and the public has to be aware,’ Dr Taylor added.
In response to the ICS’s post, Professor Trisha Greenhalgh, a GP and academic in primary care at the University of Oxford, wrote on X: ‘After 6 years at medical school I was just about able to judge whether I needed to pass an abdominal pain case to a more senior colleague or if I could safely deal with it myself.’
However, chief executive of Doncaster LMC Dr Dean Eggitt said the issue lies with how institutions are using PAs, not with the role itself.
He said: ‘I think the government strategy of using them is sound, is fine. The ICS communication was sound and fine. It’s just that some organisations are using them wrongly, and they need help to use them in the correct way.
‘Using them even for undifferentiated abdominal pain is fine, if you’re using a Physician Associate in the way you’re supposed to use them – i.e. to collect data, to speak to the patient to examine the patient, and then speak to the doctor to do the processing, analysis of the information.’
In response to MP Barbara Keeley’s question in the Commons debate, health secretary Steve Barclay said the NHS needs to ‘ensure that patient safety is to the fore’ and highlighted the need for the right regulation.
However, he also used his response to criticise the Labour Party’s unwillingness to support reform: ‘Physician associates are people with masters’ degrees: these people are highly skilled. Of course, we need to get the regulation right.
‘However, the Labour Party talks about reform, but when it comes to standing up to the trade unions, it is not willing to do so, which is why, when there is an innovation such as physician associates, it wants to block it.’
The RCGP has also recently updated its guidance on physician associates, highlighting its position that they have ‘an enabling role to play for general practice’ but they ‘must not and do not replace GPs’.
‘We are very clear that physician associates must always work under the supervision of GPs and must be considered complementary/additional members of the team, rather than a substitute to GPs,’ the guidance said.
In general practice, PAs are currently part of ARRS and can perform diagnostic and therapeutic procedures and develop treatment management plans, under the supervision of doctors.
The Department of Health and Social Care (DHSC) is currently preparing legislation for the regulation of PAs and anaesthetic associates (AAs), and in May it closed a long-awaited consultation which suggested PAs could get prescribing rights in order to relieve pressure on GPs.
Regulation is expected to begin ‘in the second half of 2024 at the earliest’, according to the GMC.
Last month, the BMA laid down its position on PAs, highlighting concerns around ‘patient confusion’ and an ‘unjust’ pay differential.
And earlier this week, the Royal College of Anaesthetists held an ‘extraordinary general meeting’ at which members voted in favour of pausing recruitment of AAs.