RCGP withdraws PA case study with ‘errors’ after criticism

The RCGP has withdrawn a case study detailing the work of a physician associate (PA) in general practice, following criticism from doctors online.

A 2017 paper on the RCGP website previously included the case study describing the schedule and supervision arrangements for a PA who had been working in a GP practice for four years. 

Screenshots of the case study were posted on X with many doctors criticising the low level of supervision for the PA and ‘unprofessional practice’.

According to the now-deleted case study, the PA held a ‘minimum’ of 27 10-minute appointments each day and asked the on-call doctor to review patients for an ‘urgent opinion’ only ‘once every two to three months’.

The RCGP told Pulse that it had originally been posted to their PA webpage in 2017 but ‘due to an error by the College, editorial changes were later made to it’ which made it ‘factually incorrect’. 

After screenshots circulated on social media, the RCGP removed the case study at the PA’s request.

The college’s stance on PAs states that they ‘must always work under the supervision of GPs’ and are ‘complementary’ members of the team rather than substitutes for GPs.

A spokesperson for the RCGP said: ‘It appears that a test environment used for internal purposes and displaying web content that had not been brought up to date was accidentally made publicly available. 

‘In this time, snapshots of the page containing the case study were taken and circulated on social media.’

They added: ‘The College takes full responsibility, and we apologise unreservedly. At no point has the individual [the PA in the case study] been at fault.

‘We ask all social media users involved in the current debate around PAs to be respectful of each other’s views and mindful of the impact that social media can have on individuals, particularly those who find themselves in the public domain through no fault of their own.’

The case study previously said: ‘[The PA] has three, ten-minute appointment slots in a row, and at the end of those slots has a ten-minute break for administration and including having prescriptions signed by a GP.’ 

It said supervision is ‘shared’ between GPs working at the practice, and that for ‘non-urgent concerns’ there is a ‘ten minute debrief with an on-call doctor’ which takes place every two to three weeks.

‘[The PA] and the doctors in the practice also aim to have a daily lunch meeting when they can discuss complicated cases as a team. Other healthcare professionals such as Health Visitors are also invited to join where appropriate,’ the case study added.

Dr Matt Kneale, co-chair of the Doctors’ Association UK, which is currently exploring legal avenues to challenge plans for the GMC to regulate PAs, told Pulse the RCGP’s removal of content without ‘full statements of retraction’ is ‘worrying’. 

He said: ‘Much of the concern from doctors in recent months has built up from a lack of transparency from Royal Colleges about where they stand on physician associates. 

‘While we are grateful that the RCGP has removed what can, at best, be described as unprofessional practice, we maintain that the College needs to sit down with wider stakeholders on the concerns around PA roles and scope more generally.’

Earlier this month, BMA GPC England chair Dr Katie Bramall-Stainer accused the RCGP of a ‘lack of transparency’, saying that college chair Professor Kamila Hawthorne had not been transparent about her involvement in setting up a PA postgraduate course.

Controversy around the role of physician associates has been heightened over recent months as legislation to bring them under GMC regulation makes its way through Parliament. 

The relevant statutory instrument (SI) was rubber stamped by the House of Commons in January, and regulation is expected to begin in the second half of this year.

The House of Lords will debate the SI in its main chamber following a motion by Baroness Bennett which expressed concern with the legislation – this move was welcomed by doctor leaders.

The BMA has warned the proposed legislation ‘will add further, dangerous confusion’ with patients being left under the impression that they have seen a doctor, and over 10,000 doctors have written to their MP to urge them to oppose the change.

And the BMA’s GPC for England called for an immediate pause on all recruitment of PAs across general practice and PCNs.

In July, Pulse reported on a GP practice’s decision to stop employing physician associates after an incident of ‘poor quality’ care contributed to the death of a patient.