PAs should still not work in general practice, says RCGP following Leng review
The RCGP has reaffirmed its opposition to the role of physician associates (PAs) in general practice, in a response to the independent review into their safety.
College chair Professor Kamila Hawthorne said that the RCGP’s position is that it ‘opposes a role for PAs in general practice’, following the review’s findings which were published this morning.
The RCGP voted to oppose the role of PAs in general practice last year, and went on to set out a clear scope for the 2,000 PAs who currently work in practices, which severely limited their roles.
Professor Hawthrone added that the college is now ‘considering’ the Leng review’s findings and recommendations but any change to their position ‘would need to be agreed by college council’.
The review, which places a heavy emphasis on the role of the RCGP, determined PAs do not need to be scrapped entirely. However they should be renamed, more thoroughly trained and they should not see undifferentiated patients.
Quoting the RCGP guidance, the report said PAs should only act as a ‘first point of contact’ for patients with ‘common conditions’ and only ‘within clear clinical pathways and escalation processes’.
In its evidence to the review earlier this year, the RCGP said that there is ‘no role’ for PAs in general practice, arguing that its ‘red lines’ for the use of PAs were ‘in many cases not being adhered to’.
Professor Hawthorne said: ‘Our position is that the college opposes a role for PAs in general practice.
‘Nevertheless, recognising there already are PAs working in general practice, we developed guidance on their induction, preceptorship, supervision and scope for working in general practice.
‘These, together with the current council position, were approved by college council in September 2024, helping to spark a national review of the issues, with a letter to the Secretary of State for Health from the Academy of Medical Royal Colleges.
‘We’ll be considering the Leng review’s findings and recommendations but any change to our position would need to be agreed by college council.’
The review echoed the RCGP and BMA recommendations for PAs not to see undifferentiated patients, and said that the college should provide an ‘induction guide’ for new PAs and a ‘supervision guide’ for doctors supervising PAs.
It said: ‘As a new physician assistant in primary care, you will be given an initial induction programme to provide basic experience of working in this setting. In general practice this will be in line with an induction guide provided by the RCGP.
‘Your role will include the provision of care under the supervision of a doctor, using a wide range of technical and communication skills to support the smooth running of the practice. In general practice, your supervision will be provided in line with the supervision guide provided by the RCGP.’
The review also recommended that PAs should be renamed as physicians assistants; they should have at least two years’ training in secondary care before being allowed to practise in primary care; and they should not see undifferentiated patients outside of clearly determined national clinical protocols – in line with guidance set out by the RCGP.
A proposed ‘job description’ for newly-qualified PAs joining general practice suggests they should ‘play a central role in all aspects of preventative care, including undertaking NHS health checks and provide lifestyle support, and support the administration of basic therapeutic procedure’.
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READERS' COMMENTS [4]
Please note, only GPs are permitted to add comments to articles
Really RCGP do you speak for patients who need to be seen but struggle to get any primary care appointment. They live in areas where life is tough and RCGP fellows are few. Our PAs and nurse practitioners keep these areas going with dedicated doctors who work harder than most GPs for less reward. Time for a change so these areas get the resources and staff they need to reverse our health divide. PAs must be part of the solution as well as the increasing doctors already planned.
I agree with RCGP position that PAs should not work on general practice. Leng identified the unevidenced implementation and unaccountable expansion of PAs and their protean roles. The substitutions of doctors by PAs was both a clear but unspoken intention by govt/ consultancies of the dumbing-down of medical care and a clear risk to patients.
I’m surprised that some GPs have so little regard for what GPs are and do, particularly the nature of needle-in-haystack skills of parsing undifferentiated patients and recognition of complexity in seemingly simple presentations.
Where simple task-based processes are required, then commensurate cheaper practitioners already exist.
Where more GPs are (unarguably) required, the solution is retention and recruitment of more GPs – not the uncontrolled experimentation of substitution of doctors by inferiorly qualified and trained bums-on-seats at the expense of patients. The deaths of Emily Chesterton and other recent coroners’ cases are as clear as day. Those who have sought to deny and obfuscate the dangers inherent in these cases are wilfully ignorant or complicit. This experiment should end.
Shaun Meehan. Your argument is that poor primary care (in form of PA and ANP) is better than no primary care. That patients in such regions should just have whatever is given to them. That instead of paying a proper wage to doctors to treat patients there (may be at a premium), it is okay to be treated with a non-doctor. You will argue about access but the real reason is money. As a GP partner it is free to hire PAs to improve your margins. How will your margin suffer from these recommendations is the real question ? Too much self righteousness here sometimes. Yes, I don’t doubt you care about patient access but probably care more about your margins and why shouldn’t you as the government has put partners in such a tight spot. In my humble opinion we should cap appointments, provide good care, work privately and advocate for only doctor led treatment with clear roles for ANP and PAs. This review goes some way in that direction.
Nick Mann and Muhammad Hamza absolutely spot on both