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GMC asks NHS England to reassure doctors there is ‘no plan to replace them with PAs’

GMC asks NHS England to reassure doctors there is ‘no plan to replace them with PAs’

The GMC has asked NHS England to address the perception that there is ‘a plan for health services to replace doctors with physician associates (PAs)’, amid an ongoing controversy around their roles.

GMC chief executive Charlie Massey wrote to NHS England’s Dr Navina Evans, chief workforce, training and education officer, and national director Professor Sir Stephen Powis pointing out that discussions around PAs ‘have escalated and grown more intense in recent weeks’.

He said that this is having an impact on PAs and anaesthetic associates (AAs) already in the workforce and on students who are in training to take up these roles, and that organisations are being challenged to consider their positions on the development and deployment of these professions.

The letter, first reported by HSJ, said: ‘As we’ve developed the regulatory model for PAs and AAs, we’ve spoken with a range of individuals and organisations across the four countries of the UK.

‘Through this work we’ve identified several issues which it would be helpful for NHS England, the Department of Health (Northern Ireland), and the NHS in Scotland and Wales to collectively address.’

These included ‘directly tackling’ the perception that there is a plan for the health services to ‘replace’ doctors with PAs or AAs ‘by convening and leading a system-wide discussion on an agreed vision for these roles’.

Mr Massey added: ‘This should include how PAs and AAs fit into multi-disciplinary teams alongside other professions (especially doctors and advanced clinical practitioners), the frameworks needed for them to work safely, and a balanced position on PA and AA scope of practice.

‘We believe governments should also consider what they can say about future training numbers to make it clear that their workforce plans envisage significant growth in doctor numbers, as well as amongst PAs and AAs.’

The GMC also said that there is a need to be ‘more explicit about commitments to safeguard postgraduate medical training’ as the PA and AA workforce increases.

Mr Massey said: ‘Our approval of training is on the basis that training organisations can deliver the opportunities for trainees to achieve their curricular requirements and thus meet in full the requirements of promoting excellence.’

It comes as the Department of Health and Social Care is preparing legislation for the regulation of PAs and AAs, after closing a long-awaited consultation which suggested PAs could get prescribing rights in order to relieve pressure on GPs.

The GMC’s letter also mentions that legislation needed for the GMC to be the regulator of PAs and AAs will be laid before Parliament before the end of the year and that following that, the GMC will hold a public consultation on the regulation at the end of 2024.

Professor Stephen Powis, NHS England’s national medical director, said: ‘There is emphatically no plan to replace doctors in the NHS, with the NHS Long Term Workforce Plan setting out a doubling in the number of medical degree school places to 15,000 by 2031, compared to 1,500 physician associate places – this in turn will mean a major expansion of specialty training which we are committed to working with the Royal Colleges on.

‘Physician associates are highly trained practitioners that support and work under the supervision of a GP after having significant clinical experience during their training.

‘The NHS has been working closely with the GMC on the development and regulation of this role for many years and we are pleased to see their commitment to ensuring regulation is agreed as a matter of urgency.’

Meanwhile, NHS England has just launched a national NHS campaign aimed at increasing patients’ confidence in the triage process and ‘non-GP’ roles used by practices.

Earlier this week, doctors who have worked with PAs have been asked to share their experiences with the Doctors’ Association.

In July, Pulse reported on a GP practice’s decision to stop employing physician associates after an incident of ‘poor quality’ care contributed to the death of a patient.

Last week, an ICS social media post encouraging patients to see physician associates at their GP practice for persistent abdominal pain sparked criticism among ongoing controversy around PAs.


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

David Jarvis 25 October, 2023 11:17 am

I’m not worried about PA’s I am worried about who is going to replace me when I retire for the sanity of my remaining partners and for my own health needs when they arrive. I wonder how the GMC feel they have helped with medical staffing?

John Graham Munro 25 October, 2023 11:24 am

Did Charlie Massey fall asleep himself when composing this diatribe?

Left Back 25 October, 2023 1:05 pm

We should all be worried about PAs: the potential risk they pose to patients, the extent to which they may be expected to work far beyond their competence, the degree to which they can be adequately supervised, and much else besides

Darren Tymens 25 October, 2023 1:19 pm

The issue is mostly about scope of practice.
– scope of practice is clearly defined, and
– they are regulated (by their own regulator please, the GMC exists to stop people who aren’t doctors from practising as doctors), and
– PAs don’t operate outside of their registration, and
– training of other roles doesn’t suffer from having them around
…then there is a useful place for them in the system.
IMHO they can and should function in a hospital setting as someone who can take a history and perform a basic examination, and triage a patient. They should then report to a doctor who can repeat the key parts of the history and examination and decide on investigations and management, which the PA can help enact alongside the medical and nursing team.
But they shouldn’t operate autonomously: every patient should be reviewed by a doctor. This is where the problem – and the potential safety issues lie. By and large they are bright, motivated people who want to contribute as much as possible – and this is where extension of scope can occur as hard-pressed teams push them to act outside the natural limits of their responsibility.
Similarly, the system appears to see them as a quick, cheap and easy option for replacing doctors, and doesn’t seem to care about the very real risks of doing this.
They are also being introduced into general practice, which cannot offer them the oversight they require – this is not an appropriate or safe environment for them to practise in. They should not operate autonomously and without proper oversight; they are not the solution to lack of GPs, but they may be helpful in certain hospital settings with lots of support around them.
If PAs want to act as doctors, and if the system wants them to, the answer is simple: train them to be doctors alongside everyone else – no short-cuts.

Not on your Nelly 25 October, 2023 2:28 pm

“significant clinical experience during their training”. lol. its more funny every time I read it. 2 years of training is nothing like significant. That is an fy2 level who needs to ask for help and guidance for EVERY SINGLE patient they see. The problem…they don’t know what they don’t know, Watch out for more disasters.

Cameron Wilson 25 October, 2023 9:10 pm

There’s never a Plan! The only Plan in town is look around for any available bod and draft them in under the pretext that they can deal with the most varied,complex role in the NHS!
We have had Pharmacists,Paramedics, and PA’S to name but a few. If car mechanics who have diagnostic skills were in abundance I am sure a role could be found!
About time the GMC,CQC etc started to call out this blatent dilution of quality.

David Church 25 October, 2023 9:26 pm

I would have thought the GMC should uphold honesty.
Why are they asking the NHSE to lie?

Prometheus Unbound 25 October, 2023 10:16 pm

My experience of seeing PAs in primary care is lack of any provision for supervisory time, lack of PAs feelng that they should need any supervision, and PAs saying I have put the medications on the system, please issue them. Its not “let’s discuss this patient and possible medications”.

Dr No 25 October, 2023 10:24 pm

General Practice is being dismantled in plain sight. Reluctant as I am to ascribe this to incompetence rather than venality, the evidence has become blindingly obvious. We are being given our marching orders, our notice to quit, a constructive dismissal claim would be supportable don’t you think? I won’t list the serial aggressions perpetrated on us, you know them too well. Well, I’ve got the message assholes. Bye on 31.12.24. And good fucking riddence.

Dave Haddock 26 October, 2023 1:52 pm

Expanding PAs in NHS GP will guarantee that the currently poor service becomes rapidly much worse, ensuring that even more people would be prepared to pay to see a real GP.
Hence more opportunity for GPs to escape the ghastly NHS into Private Practice; good news.

Centreground Centreground 26 October, 2023 5:48 pm

The proven incompetence of NHS England seen in the current parlous state of the NHS and the criminal waste of NHS taxpayer funds by PCNs including the appointment of potentially higher-risk staff into frontline roles such as ANPs and PAs is risking not only Primary care but is having a devastating event on training in hospitals with PAs given preferences in training in procedures over junior doctors.
This travesty is worsened by lower qualified PAs having higher salaries than those junior doctors who have greater qualifications.
Also going unnoticed, as with most doctors, the latter train significantly more in their own time as opposed to asking for paid study leave for every minute and every time they approach anywhere near a book or educational website/meeting with this again being a hidden additional cost.
We all know that this current fiasco of ARR roles who do of course have a role to play , but would have been much more so if this introduction of staff had been managed by competent practices themselves and not to some degree the same workshy leaders now swarming amongst PCNs , many of whom do anything to avoid being in their own practices and have led us to this NHS decline and now current NHS debacle in the first place
In Primary Care , the enablers of this foreseeable decline in Primary care i.e., Clinical Directors of PCNs need to be accountable for this worsening state of affairs and the undue risk and stress they have incurred on their colleagues for their own financial gain.

Truth Finder 27 October, 2023 3:02 pm

Replace? How do you replace an A student with all the attributes to get there with an E student? If I’m a patient, I know who I’ll want to see even if I have 9 lives.

a S 27 October, 2023 7:50 pm

Unfortnately the only game in town is saving money so quality of care is irrelivant. Other health care proffesionals are taking over all UCC work and many other once GP work. There are far to many GP’s than needed now. I know many driving hours for a few hours shift to earn some scraps and many can’t even find any work at all. We need to reduce the numbers of GP’s by half. The country can’t afford to employ any more especially as most of the money is needed to prop up company profits.

Mo Anon 28 October, 2023 10:31 am

PA’s are replacing GP’s. Some partners and OOH service preferably booking PA’s and ANP’s. There are More IMG doctors and with twice a year intake of GP’s, there are fewer and fewer jobs each year.
You have to go through 5 years medical school, minimum 2 years foundation, 3 years GP training and then your qualified to work as GP. This is a minimum 10 years, but most of my colleagues have done other specialities and then come to general practice.

Nisha Nair 30 October, 2023 9:58 am

It’s laughable to hear PAs are highly qualified in the ”statement”. 2 years training and no clue about even minor illness when they enter GP land. Their knowledge is so minimum, it is very worrying that they are looking after patients. GP jobs are taken over by these individuals and putting patients at risk. This is a systematic attack on doctors.

john mccormack 31 October, 2023 9:31 pm

It takes twice as long to train a carpenter and no one gets hurt if the plank is cut wrong