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PA body warns of legal action against GP practices using BMA guidance

PA body warns of legal action against GP practices using BMA guidance

A representative body for physician associates (PAs) has warned GP practices implementing the BMA’s scope of practice of potential legal consequences. 

United Medical Associate Professionals (UMAPs), which was formed last year and aims to become a registered trade union, has discussed the ‘scope of practice’ document with both ‘legal consult’ and the conciliation service Acas. 

The body told its PA members that if employers implement the scope of practice, this could constitute grounds for an employment tribunal for ‘redundancy, unfair dismissal and/or a breach of contract’.

Earlier this month, the BMA set out ‘first of its kind’ guidance on how PAs should work in both primary and secondary care settings.

The guidance asserted that PAs should never see ‘undifferentiated’ patients in GP practices, and that GPs ‘should first triage’ all patients.

In response, UMAPs argued that it is ‘inappropriate’ for the doctors’ union to ‘unilaterally redefine and attempt to impose a scope of practice on another profession’, and highlighted a lack of ‘stakeholder engagement or peer review’. 

On Friday, UMAPs put out information on ‘support’ it is providing to professionals ‘affected’ by the BMA’s guidance.

‘It is understood that should the scope of practice be used by an employer, despite it being universally graded as not an authorised scope document, that this could constitute redundancy, unfair dismissal and or a breach of contract depending on the specifics of the case,’ the UMAPs statement said. 

It directed PAs and other medical associate professionals to Acas information pages on employment tribunals in order to ‘familiarise’ themselves with the ‘processes’. 

The statement continued: ‘We would encourage all members who face employers considering utilising this unauthorised scope of practice, to forward this email to them directly. 

‘For all employers who have carried out, or continue to inflict a detriment on our members, please know that we are currently gearing to support and empower all members in taking all actions of recourse available to them.’

Responding to the UMAPs statement, the BMA said its scope of practice document was ‘designed to assist the doctors whose job it is to supervise these roles’ and was written by doctors ‘in the absence of such a guide on a national scale’.

A spokesperson said: ‘In the absence of leadership from across the health system on this issue it became necessary on grounds of patient safety for the BMA to provide clear guidance to both employers and doctors on what MAPs could and could not do.

‘We will continue to engage with NHS England, Royal Colleges, NHS Employers, and the GMC to ensure the safe employment of these roles in the future.’

While many doctors welcomed the BMA’s scope of practice, UMAPs argued that it has been ‘widely acknowledged to be inappropriate’ and ‘outwardly rejected’ by NHS England. 

NHS England has not responded directly to the scope of practice document, however NHS Employers said it is ‘surprising’ to learn that the BMA did not engage with the Faculty of Physician Associates (FPA) when developing the guidance. 

In response to a question on the BMA’s guide in the House of Lords, health minister Lord Markham said the Government considers the PA scope of practice ‘to be a matter for the […] Royal College of Physicians (RCP)’.

Last week, the RCP faced ‘outcry’ from its members due to its ‘disgraceful’ handling of a debate on the role of PAs.

Following the debate, members have overwhelmingly voted through a motion calling for a scope of practice. 

They also carried a motion which asked the RCP to ‘limit the pace and scale’ of the PA rollout until issues of regulation and scope of practice are resolved. 

The BMA has also recently called for an independent inquiry into the use of physician associates (PAs) on medical rotas in place of doctors.

Note: This article was updated 26 March at 12.15pm to reflect that UMAPs is nog a registered trade union.



Please note, only GPs are permitted to add comments to articles

Jocelyn Selwyn-Gotha 25 March, 2024 12:35 pm

This should be a matter for the RCGP. They need to publish their own exhaustive guidance ASAP and put this debate to bed.

ANTHONY Roberts 25 March, 2024 1:04 pm

This will work wonders for PA recruitment.
What practice is going to take the risk?
Potentially screwed if you do employ one and something goes wrong and legal jeopardy if you try to manage their work.
Why bother?

David Church 25 March, 2024 1:09 pm

I don’t think it matters what NHSE thinks, (especially outside of England), the BMA guidance is based on GMC requirements and guidance, and the GMC now apparently regulates both professions.
Yes, it is time the RCGP were brought into discussions on this by the RCP who appear to have started the problem by not involving the GP profession and RCGP or BMA to start with. it might be worth noting that the employing GP partnership is, and always has been, fully responsible for any and all actions of any non-medically qualified staff they appoint, and for ensuring they do not breach any Medical Acts or Regulations or directions of the GMC.
The main problem is that all this should have been foreseen by the RCP and sorted out in advance, not leaving individuals to get stuck in awkward positions as a result of lack of planning by organisations responsible.

David Church 25 March, 2024 1:10 pm

It is also very important to keep clear the distinction between an PA and an Associate Physician, or Associate GP, which are entirely different things.

Fay Wilson 25 March, 2024 1:33 pm

Is not this advice for doctors / BMA members supervising PAs? Given the lack of regulation or standardised training I should think doctors need guidance from somewhere.

Reply moderated
So the bird flew away 25 March, 2024 2:47 pm

Until then, uneasy lies the head that takes on a PA..

Turn out The Lights 25 March, 2024 3:12 pm

Now unemployable in primary care t with this threat.Especially in a non corporate practice.

C B 25 March, 2024 3:59 pm

The Government wants us to employ PA’s and thinks they are cheaper than employing GPs. Of course they are not taking on the clinical risk for PAs who require supervision for every patient they see in a similar manner to a 5th year medical student. PAs are only cheap because practices are not getting the proper payment for their supervision. If you add on the circa 30,000 a year minimum that we should get paid to debrief every one of their patients then the “cheap” PA becomes more expensive than a salaried GP. I refuse to take on the risk of a clinician who is the equivalent of a 5th year medical student. The end.

Reply moderated
Just Your Average Joe 25 March, 2024 5:05 pm

This may go against the majority view, but PAs are a really valued part of my clinical team, and are able to work within the practice and under the supervision of the GP team working along side them. They don’t replace salaried colleagues who are also part of the team, but have helped fill the gap where recruitment of a GP Partner or salaried colleague was impossible despite spending thousands on recruitment.

The change in working dynamics with triage of patients to PA’s, as well as others such as ANP’s in our team, does mean the patient complexity seen by the GP team can be greater, but PA’s and ANPs are highly skilled and valued and greatly improve patient care.

The partnership remains responsible for all patients seen, including those seen by our salaried GPs, as well as GP trainees, and good support and supervision is vital in any practice.

What is not advised is for private corporations/Out of hours providers or even GP practices to fill the building without adequate supervision and support that all colleagues in primary care require.

Not on your Nelly 25 March, 2024 7:22 pm

The RCGP is irrelevant to this discussion by having no idea about on the ground working. At least the BMA has the GPs backing while the RCGP are ……pointless to this or any GP discussion.

paul cundy 25 March, 2024 7:46 pm

Great, we’ll see you in court, typical of the role, acting beyond your competence, you accuse the BMA of “impose a scope of practice on another profession’,” but mydears you are not a profession. Err, end of court action.

Reply moderated
Mark Howson 25 March, 2024 10:52 pm

I guess they are talking about those practice that have employed PAs on a contract and so they have expectations. If you then change the way they work I can see legally how it becomes constructive dismissal. However if a body like the GMC says what their scope of work is then it’s legally binding. They legally become no longer capable of fulfilling their contract.

neo 99 25 March, 2024 10:56 pm

UMAPs argued that it is ‘inappropriate’ for the doctors’ union to ‘unilaterally redefine and attempt to impose a scope of practice on another profession. Err, yes it is when the doctors are taking clinical responsibility for their work, supervising then and accepting the clinical risk. Stakeholder involvement is not necessary and If UMAPs wants to to have say, then feels free to work as independent practitioner. Oh dear, you can’t! There in lies the problem. If the supervisors can’t define the work scope then PAs should not be employed at all given the medicolegal and safety risk.

paul cundy 25 March, 2024 11:05 pm

Dear All,
You can lawfully change a contract of employment as long as you provide prior notice and a reasonable time, say 3 months and the opportunity to discuss. So, July, they can all be gone.
Paul C

Centreground Centreground 26 March, 2024 10:56 am

The more pressing question in my opinion is who is going to regulate the GMC and decisions to which many qualified doctors object to – it is a matter of whether the GMC is fit to continue to practice and whether it should be struck off as as the regulatory organisation for doctors and replaced.

Centreground Centreground 26 March, 2024 10:58 am

above intended for other article

Ghost of Victor Meldrew 26 March, 2024 4:52 pm

I have nothing against non medically qualified individuals helping us in our work and I work with ANPs and Paramedics, though not PAs. It is interesting to note that PAs consider themselves as a separate profession, if so they must take full legal and financial responsibility for their actions.
I have been a GP for 46 years. It used to be a profession but government attitude ably abetted by the press has reduced it to a trade, hence the public’s attitude to us and our level of pay. They will miss us when we are gone.

Truth Finder 27 March, 2024 3:22 pm

Professionals take responsibility, deal with their own problems and do what they feel is best for the patient. Don’t come and bug us then. It may seem cheaper at first until the tribunal and litigation comes. Not to mention the constant distraction knocking on your door.

David Church 27 March, 2024 8:28 pm

Ah, but what if they use NHSE guidance instead – becasue that is ‘compulsory’ ?
Or is the GP expected to take responsibility for that as well?