Physician associates (PAs) must have a named supervisor ‘immediately’ available ‘at all times’ while working at GP practices and in secondary care, the BMA has recommended.
The union made clear that doctors – GPs, consultants and autonomously practising SAS doctors, depending on the setting – ‘should be available throughout a medical associate professional’s (MAP) shift’.
This would be a move away from ‘existing practices’ where in some cases supervisors have been ‘unreachable’, it added.
The BMA previously published a national scope of practice detailing that MAPs – including PAs – should never see ‘undifferentiated’ patients in a GP setting.
The new guidance, published today, sets out further recommendations on how doctors should work ‘safely’ with MAPs.
The document said that when supervising on a general practice session or a shift, doctors should be ‘immediately available to review patients with the MAP’ and that ‘at all times’, the name of a supervisor should be ‘readily available’ so that they can be contacted.
The guidance also said that employers should ensure that where MAPs are employed there is ‘adequate time’ allocated each working day for every patient to be ‘fully discussed’ with the supervising doctor and ‘reviewed in person’ by the supervising doctor if necessary.
‘This represents a major change in practice for some, but is seen as vital if the NHS is to ensure consistency in patient safety across all healthcare settings and end practices where MAPs could work unsafely and effectively unsupervised,’ the guidance added.
GPs should notify their medical defence organisation that they are undertaking such supervision and ensure they have adequate professional cover, the document said.
BMA council chair Professor Phil Banfield said: ‘Unfortunately, doctors have been left without clear guidance on how to supervise these staff placed under their care.
‘PAs have been asked to work above their training and competencies without direct access to their named supervisor who would be able to double check clinical findings and plans of management.
‘Nor can that responsibility for supervision just be passed over to those unable to undertake it safely because of their own workloads or those untrained to carry the risk of responsibility for others’ actions.
‘This is where critical patient safety incidents become more likely and catastrophic mistakes happen.’
He added that this is the first time ‘clear’ guidance has been produced for the NHS and for doctors.
He said: ‘The BMA is once again filling the void left by others by providing a straightforward set of recommendations that can be implemented locally so that doctors and employers are clear about their responsibilities.
‘It is that clarity which will give all staff and the public the confidence that patients are being treated by the right healthcare professionals at the right time.’
The guidance also added that supervisors should ‘prioritise the training of doctors, particularly resident doctors (trainees) and medical students’, in order to ensure that doctors are ‘suitably equipped’ with knowledge, skills and competencies for developing the expertise they must acquire to practice medicine.
The BMA also said that it considers that locally employed doctors, specialty doctors who do not practise autonomously, or doctors in training are not suitable to provide supervision and ‘must not be put into a position where they are asked to do so’.
Later this week, LMC leaders across the UK will vote on a motion which ‘condemns’ the use of PAs in GP practices for anything other than ‘administrative or simple procedural duties’.
And the RCGP has recently launched a consultation on the role of PAs in general practice.
The BMA ‘scope’ document was met with criticism by PA representatives, with one body threatening legal action against GPs who implement it in their practice.
The BMA recommendations
Recommendations for supervision – general
In each healthcare setting (private or public), MAPs must have an immediately available, named
supervisor. Consultants, GPs and autonomously practising SAS doctors are all suitable as MAPs’
supervisors. There should be a readily available register of supervisors.
The BMA considers that locally employed doctors, specialty doctors who do not practice
autonomously, or doctors in training are not suitable to provide supervision and must not be
put into a position where they are asked to do so.
We recommend that consultants, GPs and autonomously practising SAS doctors who supervise
MAPs delegate only the tasks described in the traffic light tables in our Safe Scope of Practice
for MAPs Recommendations to MAPs they are supervising in order to minimise risk to patient
safety caused by the possibility of dependent practitioners working beyond their competence.
Employers should ensure that where MAPs are employed there is adequate time allocated each
working day for every patient to be fully discussed with the supervising doctor and reviewed in
person by the supervising doctor if necessary.
Consultants, GPs and autonomously practising SAS doctors will need to be appropriately
indemnified for supervising MAPs (clinical negligence indemnity may be covered automatically
by state-backed NHS indemnity schemes). Consultants, GPs and autonomously practising
SAS doctors should notify their medical defence organisation that they are undertaking
such supervision and ensure they have adequate professional cover, noting the requirement
to double check patient symptoms, clinical signs and test results before agreeing to any
management plan of a MAP they have agreed to supervise.
Recommendations for supervising doctors
When supervising on a shift, or general practice session, you should be immediately available to
review patients with the MAP and you must delegate your supervising responsibility to another
appropriate consultant, GP, or autonomously practising SAS doctor who agrees to undertake
supervision when you cannot be present (clinics, theatre, teaching, leave). At all times, the
name of a MAP’s supervisor should be readily available so that they can be contacted with any
queries about delegations in place on a particular day or shift.
Source: BMA
For the sake of clarity the supervisor should be on site
Thf supervising doctor needs to be aware that unless they personally review each patient seen by the PA, they will assume responsibility for all the acts or omissions of the PA during their shift.
Supervisor need to be on site to be immediately available and review the patients. The only safe option. I would not leave my medical students students to it even if they have done 4 years which is twice what the PAs trained plus they have better grades.
The ‘supervising’ GP needs to make sure adequate defence cover is in place, and be prepared to pay a lot more in premiums !
Personally I hope this means GPs will avoid employing these PAs.
The whole system is buggered. I too would like to buy a Lamborghini for Fiesta money.
The ever useless BMA waits to see the lie of the land before making the recommendation. Stable door..horse bolted.
Hot potato. Everyone wants to get rid of them.
I