GPs told to ‘take HR advice’ when implementing PA review recommendations
GP practices in Cornwall have been advised to ‘take HR advice’ when implementing recommendations made by the independent review into the safety and effectiveness of physician associates (PAs).
Kernow LMC shared guidance produced by HR firm Kraft HR Consulting, advising practices to ‘carefully consider’ implications following the review.
The document said GP practices should be wary of claims of constructive unfair dismissal which ‘may be preceded by thorny and time consuming grievances’ from PAs.
The Leng review, which was published last month 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 then asked by NHS England to take ‘immediate actions’ implement the changes, but last week 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.
The HR guidance shared by Kernow LMC recommended ‘consultation with the affected individuals’ before changing the PA job title, job descriptions and duties.
It recommended practices ‘check their insurance coverage’ and ‘take HR advice and engage in consultation with PAs’.
It said: ‘If your current PA model includes them seeing undifferentiated patients and being involved in triage, the drivers for change will be urgent, particularly as clinical liability insurance may well be affected.
‘There may be interim changes that you can quickly agree in order to give you time to think about alternative models of deployment that will best support patient demand and workflow management.’
If a PA has made an employment grievance against a GP practice, the practice should ‘engage in consultation with the affected staff on the change’, according to the document.
It also said that the supervision model for physician assistants within the review is ‘not well defined’ but GPs ‘are expected to implement it with immediate effect’.
It added: ‘Implementing a new system of GP supervision requires support and change – expecting busy GPs to immediately understand and support a new framework of working with the PAs with no training and support is poor change management and puts unreasonable pressure on busy GPs.’
It therefore recommends supervising GPs are consulted on any changes and ‘feel clear and supported on their role as supervisors of PAs’.
Last week, Pulse revealed that GP practices could face total combined damages of £30m from discrimination claims initiated by PA trade union United Medical Associate Professionals (UMAPs).
Shakespeare Martineau, the law firm representing UMAPs, said the Leng review’s changes ‘could potentially trigger a new wave of tribunal cases against employers’.
Head of business partnership for Kraft HR Consulting Liz Willett, who wrote the guidance, reiterated GPs needed to set out a strong business case for making changes in the absence of any ‘statutory weight’ behind the Leng review.
She told Pulse: ‘The main thing to note is that the Leng review has not yet passed through parliament, so at the moment it is advice without any statutory weight.
‘If practices follow the guidance in those letters from NHS England without engaging in a proper HR process, I am significantly concerned that they will put themselves at risk of successful tribunal claims.’
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 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 last week.
Pulse has approached the Department of Health and Social Care and NHS England for comment.
