Non-GP doctors working in practices must not see undifferentiated patients, says BMA

Non-GP doctors working in general practice must not provide care to undifferentiated or untriaged patients, the BMA has said in new guidance.

The performers list regulations were amended in May last year to permit primary care providers to employ doctors who are not GPs to deliver services under the terms of their GMS/PMS contracts.  

The GMC had previously advocated for the change, as exclusively revealed by Pulse in 2022, proposing that the regulations should be changed to allow non-GP doctors to provide primary medical services.

But the amendments to the regulations have been controversial, with LMC leaders rejecting plans for ‘primary care doctors’ in GP practices last year, and arguing this represented ‘a retrograde step’ in both safety and efficiency in patient care.

Now the BMA has produced guidance for practices to ‘prevent or minimise the potential damage’ caused by the ‘poorly considered decision’ to change the regulations.

And it called for the Department of Health and Social Care to reverse the change ‘immediately’, while strongly urging GP employers not to employ non-GP doctors in general practice ‘in place of GPs’.

It comes after the BMA’s GP committee England chair last year said that plans for non-GP ‘primary care doctors’ to be allowed to work in practices are ‘colluding in the demise of the profession’.

The examples of doctors included in the plans cited by the GPC included doctors finishing foundation training, international doctors who are not qualified GPs, Specialty and Associate Specialist (SAS) doctors and other non-GP doctors.

In the new guidance, the union said that these doctors ‘will not be fully trained GPs’ and ‘will not be on a training programme’ to become GPs, but could be allowed to provide care to patients with undifferentiated, untriaged conditions.

‘This poses a significant risk to patient safety, undermines the existence of the general practice training programme and opens such doctors to potential exploitation, as they will not receive the protections provided to salaried GPs by the BMA standard GP contract, or to SAS doctors by the Staff, Associate Specialist, and Specialty Doctor Contract,’ the union said.

It added that with no role limits placed on non-GP doctors working in general practice, the regulatory change ‘allows doctors who fail the RCGP exams to effectively work as GPs anyway’, ostensibly providing care to patients in exactly the same way as they would have had they passed the MRCGP.

It added: ‘Not only does this call into question the value of the MRCGP, it also cannot be a solution to differential attainment in these exams nor inflexibility within existing training conditions.

‘If the exams are not fit for purpose, then they need to be improved; if they are fit for purpose, then they should serve to enable only those passing them to work as GPs.’

It stressed that non-GP doctors working in general practice ‘must not provide care to undifferentiated,
untriaged patients’.

‘Managing undifferentiated illnesses, particularly in a time-constrained setting with limited immediately available investigations, is a particular skill that takes GPs years to develop and hone, and for which they are trained through well established, challenging, postgraduate programmes,’ the BMA said.

It added that it is ‘extremely concerning’ that DHSC and NHS England have ‘pushed ahead’ with this hugely ‘significant’ change to general practice without proper consideration of the consequences or the agreement of the medical profession.

It said: ‘We call on the Department of Health and Social Care to reverse this regulatory change immediately.

‘We strongly urge GP employers not to employ non-GP doctors in general practice in place of GPs. There can be a role for non-GP doctors to work in a general practice setting, but this must be restricted by regulation to the provision of care to patients within the doctor’s clearly specified specialty and with fully resourced supervision and oversight by a GP.’

However, the union stressed that there can be a role for non-GP doctors working ‘as specialists’ in a general practice setting.

The guidance added: ‘Non-GP doctors can work as specialists seeing referrals in a general practice setting; indeed, this has been happening for some time in some areas as consultants were permitted to work in general practice under the previous regulations.

‘In principle, we support the idea of patients being able to see specialists closer to home and of secondary care doctors being able to run independent clinics in a general practice setting, but it will be important for employers to consider how they can function effectively outside of established secondary care pathways.’

RCGP chair Professor Kamila Hawthorne said: ‘The College’s position is that qualified GPs are the only doctors who can work as generalists in a general practice setting, and we share many of the BMA’s concerns on this issue.

‘Without greater clarity on how non-GP doctors would work in a general practice setting, including with appropriate pilots and evaluation, and clear entry requirements and induction and supervision arrangements, we would not support non-GP doctors working in general practice.’

It is unclear how many non-GP doctors currently work in primary care but NHS England modelling for the long term workforce plan included in a NAO report projected the number could rise to 4,000 in the next decade.

The Government and NHS England have previously said that they will work together to ‘ensure that doctors other than GPs are more easily able to work in primary care’.

According to the 2023 workforce plan, the medical workforce ‘is expected to change over the next 15 years’, with more SAS doctors and doctors in training choosing different career paths including general practice.

Ensuring that doctors other than GPs can work easily in primary care will give general practice additional capacity, improving patient access and creating opportunities for these doctors to develop and progress in their careers, the plan said. 

The BMA has previously said that this could cause doctors to be open to exploitation under a ‘two-tier system’.

Pulse has contacted the Department of Health and Social Care and the GMC for comment.