PAs still covered by indemnity if practising outside Leng and RCGP recommendations
Physician associates (PAs) working in GP practices are still covered against clinical negligence liabilities even if their activities differ from recommendations made by the Leng review and the RCGP, NHS Resolution has said.
It clarified that indemnity under the Clinical Negligence Scheme for General Practice (CNSGP) ‘is not conditional upon having followed RCGP guidance or implemented changes as per the Leng review’.
Their guidance to LMCs also added that GPs and other clinical staff responsible for the supervision of PAs within general practice can also be reassured that they will be indemnified under the scheme, in respect of incidents ‘involving PAs which result in a clinical negligence claim that is brought against the partners/principals or practice’.
The Leng review, which was published in July and whose recommendations were accepted in full by the Government, found that PAs should be renamed ‘assistants’, should not see undifferentiated patients outside of clearly determined protocols, and that they should have at least two years’ training in secondary care before being allowed to practise in primary care.
GP practices were asked by NHS England to take ‘immediate actions’ implement the changes, but last month an NHS England document appeared to water down these actions, saying that any changes are contingent on ‘local change management policies’, employment law and discussions with trade unions.
NHS Resolution, which runs CNSGP, the state indemnity scheme for general practice in England covering clinical negligence liabilities arising in general practice in relation to incidents that occurred on or after 1 April 2019, said that the question of scope of practice for PAs is ‘not a relevant consideration for NHS Resolution’ in determining eligibility for indemnity under the scheme.
It said: ‘NHS Resolution can confirm that PAs working for general practice who are carrying out activities connected to delivering NHS primary medical services on behalf of the provider under a primary care contract in England, namely one which falls within Part 4 of the NHS Act 2006 (GMS, PMS and APMS arrangements), will be indemnified under the Clinical Negligence Scheme for General Practice (CNSGP) for clinical negligence liabilities arising from incidents that occurred on or after 1 April 2019.
‘This is because CNSGP provides indemnity cover for all GPs and staff working under an NHS GP contract in England in respect of liabilities in clinical negligence.
‘This indemnity extends to activities carried out by PAs which are connected to the delivery of other NHS services provided by general practice and known as “Ancillary Health Services” where these services fall within the relevant definition in regulation 2 of the CNSGP Regulations.’
The Leng review did not set out a scope of practice for PAs but set out a proposed job description for newly-qualified PAs working in primary and secondary care, which were based on their core training and informed by initial scopes of practice produced across the royal colleges, including the RCGP.
The job description for PAs in general practice severely limits their practice, by suggesting they should ‘play a central role in all aspects of preventative care, including undertaking NHS health checks and provide lifestyle support, and support the administration of basic therapeutic procedure’.
The PA scope of practice produced by the RCGP in October last year stipulated that PAs must not see patients who have not been triaged by a GP; nor patients who present for a second time with an unresolved issue.
On clinical scope, the guidance suggests PA’s qualifications would be suitable for seeing the same seven minor illnesses captured by Pharmacy First, noting that this is a ‘good place to start’.
Pulse has approached the RCGP and DHSC for comment.
Last month, NHS England failed to change PA role descriptions in the new PCN DES specification, and the document continued to refer to ‘physician associates’ and stating PAs employed under additional roles reimbursement scheme (ARRS) could ‘provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems’.
According to the trade union for PAs, UMAPs, the failure to change the specification was a result of a legal case UMAPs has brought against NHS England over implementing the review.
UMAPS had also requested interim injunction to stop NHS England issuing instructions to organisations on implementing the review’s recommendations while a judicial review is ongoing, but this was refused.
