Three quarters of PAs see scope of practice restricted following Leng review
More than three quarters of physician associates (PAs) (76%) say their scope of practice has been restricted since the publication of the Leng review.
And PAs claim this has impacted not only waiting times in general practice, but also the workload of their doctor supervisors, according to a survey by United Medical Associate Professionals (UMAPs).
The PA trade union surveyed 459 PAs, just under half of which (215) were working in general practice, during December and January.
It found:
- 76%) of PAs said their scope of practice has been restricted since the publication of the Leng review;
- seven in 10 respondents said their workplace had introduced ‘new protocols or guidelines regarding PAs’ following the review; and
- 51% of PAs report an increase in the workload of their consultant or supervisor as a result of the Leng Review.
Published last summer, the Leng review did not set a scope of practice for PAs, although it did suggest suitable tasks for newly-qualified PAs and it backed BMA and RCGP scopes which had said PAs should not see undifferentiated patients.
According to the general practice-based PA respondents to the survey, since the Leng Review there has been an increase in longer patient waiting times of 1-4 weeks and 4-8 weeks, and a drop in patients being seen in a matter of days.
PAs working across specialties also suggested the Leng review had made their role less rather than more clear, in contrast to its stated purpose. Nine in 10 respondents (91%) agreed their role was ‘very’ or ‘quite’ clearly defined before the review, while fewer than a third (32%) said this remained the case following the review.
The numbers of PAs working in general practice has been declining since the publication of the review, with the latest figures showing only 1,020 PAs being employed via ARRS in England as of last month.
Main recommendations from the Leng review included 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.
Commenting on the findings, UMAPs general secretary Stephen Nash expressed that the Leng review had ‘effectively sidelined’ thousands of ‘highly-qualified medical professionals’, which was ‘disastrous’ to patients, PAs and doctors.
However, Dr Steve Taylor, GP spokesperson for Doctors’ Association UK (DAUK), told Pulse: ‘I would say their scope has been reduced rightly, because I think there was significant risk for patients with somebody that’s had such limited training to be seeing undifferentiated patients.
‘I feel sorry for PAs because they were offered something that was really not necessarily the right thing, and it’s been nipped in the bud before it fully flourished.’
Dr Taylor further disputed the survey’s findings that the restricted scope was increasing patient wait times and GP workloads.
He said: ‘If you look at the absolute number of appointments seen in general practice, that has continued to rise.
‘Even if patients were having to wait a bit longer to see somebody, at least they are seeing somebody more safely’, he added.
By the union’s estimates, its survey size represents around 13% of roughly 3,500 working in the NHS in England – though the GMC’s chief executive Charlie Massey last week said the number registered with the GMC was now closer to 4,000.
Mr Massey told the House of Commons Health and Social Care Committee that the regulator is working on implementing Leng review recommendations on PAs although some – such as their renaming to physician assistants – are awaiting Government legislation expected later this year.
The session also saw Mr Massey apologising for the fact the regulator was ‘not clearer about distinguishing between (PA and doctor) roles’ at the outset.
