Physician associates (PAs) ‘should not be used as replacements for doctors’ on rotas, NHS England has stressed in new interim guidance on the ‘integration’ of medical associate professionals.
The commissioner wrote to ICBs and trusts yesterday to outline guidance for the ‘effective integration’ of PAs into multidisciplinary teams.
NHS England said it is ‘important’ to ‘emphasise that PAs are not substitutes for doctors’, as they are ‘supplementary members’ of the team and they ‘should not be used as replacements for doctors on a rota’.
The full name and job title of each healthcare professional, including PAs, should be ‘prominently visible on any rota system’, the letter added.
NHS England said it set out the guidance to ‘bring attention’ to the latest to have come from its ongoing Long Term Workforce Plan work developing the curricula, core capability frameworks, standards for CPD, assessment, appraisal and supervision guidelines for MAPs.
The work being carried out in cooperation with the GMC, royal colleges, trade unions, doctors and medical associate professional groups has yet to conclude but in the meantime, following this guidance ‘will help to protect the confidence’ and wellbeing of PAs and patients, NHS England said.
The letter, signed by chief workforce officer Dr Navina Evans and national medical director Professor Sir Stephen Powis, said: ‘It is essential that medical associate roles are introduced safely and in a supportive environment. This should include trust and primary care employers ensuring oversight of the supervision and tasks being carried out.’
The guidance also stressed PAs must introduce themselves and their role ‘clearly’, to ensure that patients ‘understand who is caring for them’.
And it pointed out that PAs are not able to prescribe, and that trusts should have policies in place including access and restriction requirements to electronic patient records for each professional group.
‘PAs are not able to prescribe; therefore in the context of electronic patient care records, every trust should have a comprehensive policy outlining access and restriction requirements for each professional group,’ the letter said.
‘This policy should cover aspects such as appropriate access to prescribing, laboratory reports, imaging results and patient clinical notes, whilst also implementing restrictions to prevent access to skills or responsibilities falling outside of a role scope of practice.’
Guidance ensuring PAs do not replace doctors
PAs should not be used as replacements for doctors on a rota. Understanding the challenges faced by trusts in accurately reflecting multidisciplinary staffing within rota software constraints, we encourage you to:
- Assess the current capabilities of the rota software used to represent staffing within each department.
- Ensure each department has undertaken a department-specific assessment to establish safe minimum staffing levels, considering skillsets and scopes of practice, supported by a service evaluation of patient group needs.
- Ensure that the full name and job title of each healthcare professional, including physician associates, are prominently visible on any rota system.
- As part of the induction process, educate all staff members on how the rota is informed, operated and displayed to promote understanding and transparency.
Source: NHS England
Legislation bringing the PA role under GMC regulation has recently passed through Parliament, and will come into force at the end of this year, despite attempts to kill it.
But on Friday last week, the RCGP changed its stance on the regulation after a vote argued the GMC is the wrong body to take on the job.
Also last week, the BMA published ‘first of its kind’ guidance recommending that PAs should never see ‘undifferentiated’ patients in a GP setting.
PAs have been around since 2003, however the role has expanded over recent years, and last year NHS England committed to increasing PA training places to over 1,500 by 2031, bringing the workforce to 10,000 by 2036.
Last year, the BMA called for an immediate pause on all recruitment of physician associates across general practice, and a survey found that almost 90% of doctors think PAs pose a patient safety risk.
And earlier this month, the House of Lords heard that GPs and other doctors have reported 70 instances of avoidable patient harm and near misses ‘caused by PAs’.
Next bit of correspondence, “there were no prescribers in the hospital, GP to prescribe……” Really safe and healthy.
This system introduced by NHSE/HEE is so weak that the structures PAs are actually working in have already been overtaken by a country mile. It is a failed initiative with harms already extant and ingrained. Advanced clinical practitioners already exist and are the sensible and safer alternative to increasing skill mix.
NHSE can dictate what should happen, but they’re too late. We already know what should have happened.
Guidances are issued by guides before hiring staff, not after such melodrama. NHS innovators new way of working could mean PA replacing Consultant, Registrar and GP’s with their great skill set . Only provided the public would buy this crap .
Past few weeks had patients directed to me from AE to prescribe anticoagulation for patient.
Then from a ward to prescribe rescue meds for COPD for an inpatient who was running out of meds, admitted with severe exacerbation of his illness.
This is not a system, it’s an effing mess
My comment above is not about PAs. It’s about the mess of nhsE
But you can use ARRS funding for a PA but not for a Dr or a nurse. Classic say one thing and do another with funding or not funding. Like we value you but here’s a 2% uplift and completely un negotiated contract imposition. Remember when they said contract changes only in exceptional circumstances back in 2004. Yeah right. GP is genuinely cash strapped with 20% drop in partner income. We are going to operate in the environment the politicians create. If they are not happy shove your edicts change the funding environment or shove it.