NHSE FAQ waters down physician associate review actions for GP practices

A new NHS England FAQ document appeared to water down ‘immediate actions’ which were issued to GP practices immediately following the publication of the Leng review into physician associates (PAs).

NHS England wrote to organisations last week (15 August) to address ‘short-term uncertainty for affected staff groups’ and ‘provide clarity for staff, patients, and employers’ on implementing the Leng review’s recommendations. 

But the document seemed to row back on previous NHS England advice – and LMC leaders warned it could ‘muddy the water’ for a lot of practices.

The review into the safety and effectiveness of the role found 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.  

The Government accepted the recommendations in full and instructed NHS England to implement the changes ‘as quickly as possible’. 

At the time, NHS England listed ‘immediate actions’ for organisations to take on issues such as the name change, not seeing undifferentiated patients, and primary care entry requirements. 

However, the new FAQs document said any changes are contingent on ‘local change management policies’, employment law and discussions with trade unions.

The document did not explicitly say that NHS organisations should change the ‘associate’ to ‘assistant’ immediately, instead leaving it to individual organisations’ employment policies. 

It said: ‘The immediate action for organisations is to make changes to the way in which roles are referred to in the workplace, to ensure that patients are not under the misapprehension that they have seen a doctor.’

However, it then says: ‘Any changes to official job titles should be done in accordance with the organisation’s local change management policy, with proper regard to employment law and involve affected members of staff and local trade unions.’ 

Addressing the issue of PAs seeing undifferentiated patients, it said it echoed Professor Leng’s conclusion on ‘not seeing undifferentiated patients except those already triaged into minor ailments as aligned with existing clinical guidance issued by the RCGP’. 

It referred NHS organisations to RCGP guidance for first contact presentations. 

The college’s guidance for PA responsibilities, published last year, severely limits the scope of the role. It says 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.    

But NHS England also referred in the document to a new expert clinical group, which will comprise of members of the medical Royal Colleges and ‘experienced leaders’, which will ‘look at revised clinical protocols’ in the ‘medium term’.

These will set out ‘steps to follow once a clinical management decision has been made,’ it said.

Dr Paul Evans, chair of Gateshead and South Tyneside LMC, said the FAQ document was ‘unhelpful’ and ‘will likely muddy the water for a lot of practices’.

‘There are a few practices in our area who have hired PAs, and I think it is unhelpful for them, and will cast doubt in their minds’, he said.

Dr Evans said GP practices considering which changes to make with NHS England guidance in mind should ‘prioritise patient safety’.

He said: ‘No matter how it is done, and what steps have to be taken to make sure this is done legally, practices need to prioritise patient safety and essentially use physician assistants as physician assistants and put them in roles where they will work within the scope of the RCGP and BMA guidance.’

Pulse has reached out to NHS England to comment on the FAQ document.

Last month, NHS England failed to change PA role descriptions in the new PCN DES specification. 

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 PA trade union United Medical Associate Professionals (UMAPs), the failure to change the specification was a result of a legal case UMAPs has brought against NHS England over implementing the review.  

It claimed that NHS England agreed to make ‘no changes’ to the PA or apprentice role description to reflect that PAs should not see undifferentiated patients ‘until the case has been heard’. NHS England did not confirm or deny whether this was the reason for the specification remaining the same.

UMAPs was also pursuing a large number of employment cases against GP practices on behalf of PAs ahead of the Leng review recommendations.