PA union seeks injunction against NHS England in bid to pause changes to the role

The trade union for physician associates is seeking to prevent NHS England from implementing the recommendations of the Government’s review into the role while it is in the middle of a judicial review into the changes.

United Medical Associate Professionals (UMAPs) said it is seeking an injunction against NHS England to stop it from ‘rapidly forcing through changes’ to the PA job role while a judicial review it has brought against both NHS England and health secretary Wes Streeting is ongoing.

A hearing for the injunction has been scheduled for Friday (15 August) at the Royal Courts of Justice in London, the union said.

The Leng review into the safety and effectiveness of the role – led by former NICE chief executive Professor Gillian Leng – 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.

Following the review’s publication last month, the Government accepted the recommendations in full and NHS England wrote to ICBs and PCNs asking them to take some ‘immediate actions’, including adopting the updated terminology recommended by the review.

UMAPs – which was officially recognised as a trade union by the Government – responded to it by writing to members saying it did not accept the review’s findings and was seeking legal advice to dispute them.

It submitted its judicial review claim on Monday, having previously sent pre-action letters to the Government and NHS England.

It said that implementing the Leng review recommendations before the end of the judicial review period ‘would pit GP surgeries and hospital trusts against their employees’ and will ‘expose employers to tribunal claims’.

NHS England has not yet changed PA role descriptions in the PCN enhanced service specification, which continues to state that PAs employed under the additional roles reimbursement scheme (ARRS) can ‘provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems’.

According to UMAPs, NHS England’s failure to change the specification was at the request of the union, but NHSE did not confirm or deny to Pulse whether this was the reason it had not changed the specification.

Despite this, UMAPs has criticised NHS England for taking other steps to implement the recommendations.

It said: ‘The NHS recently declined UMAPs’ request to not send out any further instructions on implementing the Leng Review.

‘The health service also refused to issue clarification to employers, asking them to hold off immediate implementation of the Leng Review recommendations until after the judicial review had been heard.’

Pulse has contacted NHS England for comment.

In separate legal action, the BMA has been granted permission to appeal the GMC’s use of the term ‘medical professionals’ to cover both PAs and doctors.

Leng review recommendations for PAs

Positioning of the role: The role of physician associate should be renamed as ‘physician assistant’, positioning the role as a supportive, complementary member of the medical team.
Credentialling: Physician assistants should have the opportunity for ongoing training and development in the context of a formal certification and credentialling programme. This should include the ability to take on added responsibilities that are commensurate with that training, including the potential to prescribe and order non-ionising radiation.
Career development: Physician assistants should have the opportunity to become an ‘advanced’ physician assistant, which should be one Agenda for Change band higher and developed in line with national job profiles.
Undifferentiated patients: Physician assistants should not see undifferentiated patients except within clearly defined national clinical protocols.
Initial deployment in secondary care: Newly qualified physician assistants should gain at least two-years’ experience in secondary care prior to taking a role in primary care or a mental health trust.
Teamworking and oversight: The physician assistant role should form part of a clear team structure, led by a senior clinician, where all are aware of their roles, responsibilities and accountability. A named doctor should take overall responsibility for each physician assistant as their formal line manager (‘named supervisor’).
Identifying the role: Standardised measures, including national clothing, lanyards, badges and staff information, should be employed to distinguish physician assistants from doctors.
Professional standards: A permanent faculty should be established to provide professional leadership for physician assistants, with standards for training and credentialling set by relevant medical royal colleges or the Academy of Medical Royal Colleges.