One in five PCNs reduced their use of physician associates in the past year

Exclusive More than a fifth of PCNs have cut the number of physician associates they employ in the past year, a Pulse and Management in Practice survey has found.

The survey polled GPs and practice managers, with 21% of respondents from 425 distinct PCNs reporting a reduction in PA numbers in the last 12 months.

Of those, many cited the restrictions on what work PAs can undertake independently as having limited their use in general practice, while others stated that these restrictions mean PAs need too much supervision that practices don’t have the resources to provide.

In March 2024, the BMA laid out a national scope of practice for physician associates and anaesthesia associates in what it hailed as ‘first of its kind’ guidance. It stated that GPs ‘should first triage’ all patients before deciding which cases a PA can see, and that associates should never see ‘undifferentiated’ patients.

Last autumn, the RCGP followed suit and published its own guidance that significantly limits the scope of practice of PAs already working in general practice. The move came after the College voted overwhelmingly in favour (61%) of completely opposing the role of PAs in the setting.

Responding to the survey, one GP said: ‘We had a PA but now don’t use them because of the change in guidance. We can’t afford to pay someone with such limited scope.’

A practice manager said: ‘BMA constraints meant [our PA] could do very little. It is such a shame as they had a biomedical sciences degree and could even help with some HCA and nursing elements. We had to let them go.’

Another also said they’d been forced to make their physician associate redundant ‘primarily due to the additional time needed to support the role, as the BMA made it impossible for them to work independently’.  

They described the limitations placed on PAs as ‘a missed opportunity, which could have been avoided’.

One GP accused the government and NHS of being ‘totally irresponsible’ over the handling of the controversial PA role, which he said were ‘pushed onto us’ due to a lack of GPs yet are now prevented from doing the job they were employed to do.

He said: ‘They [the NHS] have dumped this problem on GPs to face legal action and the costs associated with it. We are in a no-win situation.

‘As for the PAs, they have been encouraged to take on debt for second degrees with the promise of a well-paid clinical role. They are now being told their employers can’t employ them for the role they were trained in. This leaves them potentially with no job, or a job with less pay, but they still have huge debt.

‘The Government and NHS have let these clinicians down in a big way. On top of that, they have left the problem at the feet of GPs with no clear resolution.’

Dr Stephen Taylor, who is the GP spokesperson for Doctors Association UK, echoed this sentiment, saying that PAs are entitled to feel aggrieved because ‘they have been given false information about their careers’.

‘It is really the fault of policy leads at NHS England for failing to understand the risks and the complexity of seeing undifferentiated patients. A simple consultation is really only simple in retrospect having taken a full history, appropriate examination and tests.’

He added: ‘The challenge for practices is that with better guidelines for the supervision of PAs, many practices have seen that the role of PAs is unsustainable. 

‘NHS England stipulated PAs see undifferentiated patients with limited supervision in ARRS. This was never safe for PAs or patients. So, the new guidelines will have made many if not all PA roles difficult to maintain.’

Last month, Professor Gillian Leng’s independent review into the safety and efficacy of physician associates was published.

The DHSC accepted all of Professor Leng’s recommendations, which include that the role should not be scrapped but instead renamed as physician assistant, that PAs undergo more extensive training and their focus shifted to preventative care, such as NHS Health Checks and lifestyle support.

Professor Kamila Hawthorne, chair of the RCGP, said: ‘The College’s position, following consultation with members and discussion at our governing Council, is to oppose a role for PAs in general practice. This is due to valid concerns about patient safety and the suitability of the role in a general practice setting.

‘Recognising that there are already PAs working in general practice settings, we have developed guidance on induction, supervision and scope of practice for practices already employing PAs. Our position and our guidance are advisory, and decisions regarding PAs rest with GPs as employers.’

Other respondents to the survey said they’d seen fewer PAs employed or their PCN had let some go because there had been concerns or complaints about their competence.

‘We had a PA one day a week and participated in the training of PAs for one year,’ said one GP. ‘They were not confident (understandably) and did not have sufficient depth of clinical knowledge.  

‘PAs do not alleviate GP burden if I still have to check their history, examination findings and prescribe for them. They are increasing my workload.’

Some 79% of GPs and practice managers who answered the poll said their PCN had not reduced the numbers of PAs in the last year. More than a quarter (28%) of those said in comments that they had never employed physician associates in the first place.

The BMA declined to comment.

Stephen Nash, general secretary of PA union United Medical Associate Professionals (UMAPs), said: ‘This survey shows precisely why the BMA’s guidance and Leng Review recommendations are so disastrous.

‘GP surgeries are now losing highly motivated and experienced medical professionals because we are being prevented from carrying out the jobs we are trained to do. This is wreaking havoc on NHS backlogs and patients’ access to care.’

He added: ‘Despite pressure from the BMA and NHS England, according to this survey the vast majority of Primary Care Networks are retaining their PA staff. This is a testament to PAs’ hard work and expertise.’

It comes as UMAPs’ legal bid to stop NHS England from implementing Leng review recommendations was unsuccessful last week.

Previously, the BMA accused the GMC of ‘blurring the lines’ between PAs and doctors and claimed that the GMC’s guidance being applicable to both roles ‘conflated the professional roles’.

The High Court dismissed the BMA’s claims, but the Court of Appeal has granted the union permission to appeal the ruling.