Most GPs would welcome any strategies that allow them to relinquish some of their workload.
So, in February when the Government launched a consultation to expand the role of physician associates (PAs) – saying the plans would ‘relieve pressure on GPs and improve access to services’ – there was surely cause for celebration.
These PAs could be given prescribing responsibilities, adding to their job role as set out under the Additional Roles Reimbursement Scheme (ARRS). That involves providing diagnostic and therapeutic procedures and developing treatment management plans, under the supervision of doctors.
And, to reflect the fact that PAs could be doing more clinical work, the GMC will have powers to regulate them (and anaesthesia associates) under the Government’s plans.
Any PAs who have already voluntarily signed up to a Royal College of Physicians register could potentially switch over to the GMC register.
However, doctors are not jumping for joy at these proposals. On the contrary, thousands have slammed them as ‘unsafe, premature, and lacking the necessary safeguards’.
One concern is that, on the street, there is already confusion about the new roles in general practice.
Patients are largely unable to discern between, say, a physician associate and a traditional physician – ie, a doctor – despite the wide disparity between the two in terms of qualifications and training.
Give PAs a seven-digit GMC registration number and a prescription pad, and who could tell the difference? You might argue that it doesn’t matter, as long as the non-GP is operating safely and within their scope of practice.
But what happens when they are not?
The case of Emily Chesterton demonstrates how disastrous the consequences can be. Ms Chesterton, aged 30, visited her GP practice in north London twice for the same problem and was seen by the same physician associate on both occasions.
The PA misdiagnosed her swollen leg, calf pain and breathlessness as a sprain, long Covid and anxiety, and sent her on her way. At the second visit the PA prescribed propranolol for anxiety, without the prescription being signed off by a GP as required.
Ms Chesterton later died after suffering a pulmonary embolism and a cardiac arrest. In March, an inquest concluded that had the PA sent Ms Chesterton to an emergency department on either occasion, ‘the likelihood is that she… would have survived’.
Ms Chesterton’s avoidable death prompted further calls for firm action, with the BMA urging the Government to change the titles physician associate and anaesthesia associates to ‘physician assistant’ and ‘physician assistant (anaesthesia)’ respectively.
It is ‘abundantly clear that the public find the title “physician associate” highly misleading and confusing’, the BMA said. (Indeed, Ms Chesterton believed she had been seen by a doctor; her mother told the BBC that ‘physician associate sounds grander than a GP’.)
GMC regulation of PAs will muddy the waters even more, according to the BMA – the union holds firm that it should be the remit of Health and Care Professions Council, not the GMC.
All this controversy around PAs has stirred up a sense of unease; that the Government is moving to replace GPs with a less qualified and cheaper workforce.
In response, NHS England said there is ‘emphatically no plan to replace doctors in the NHS’, pointing out that the number of medical school places is set to double to 15,000 by 2031, compared with just 1,500 places for physician associates.
Exactly how this will play out is anyone’s guess. The Government’s consultation closed in May and the resulting legislation was laid before Parliament on Wednesday 13 December. However, the regulation won’t come into force until the end of 2024.
The expansion of additional roles in general practice can certainly be a positive step, freeing up time and resources time and widening access – as long as strategies are safe and effective.
If that cannot be assured, it will be patients who pay the ultimate price.
How many patients know what a G.P. Associate is———–because that’s what I am—- apparently
The problems that need solving: 1) Regulation – GMC have been tasked to manage that by government 2) Patients need to know who they are seeing – a responsibility of every member of the team – a widespread issue not just PAs. Should surgeons be called Dr ? 3) good supervision by Doctors 4) An understanding by all of us that we can all make mistakes 5) An end to unprofessional attacks on PAs in social media 6) respect and support to all members of our team – we are as good as our team.
Employ at your peril. All mistakes by them are counted against you as the GP or Consultant from the point of view of the GMC NHSE CQC and the lawyers. Wheather you were there or not or had seen the patient or not. Why would you risk your license for something you have no control over? With untrained people making decisions about things they don’t have a clue about and don’t know what they don’t know. Would emply, wouldn’t see , wouldn’t trust . End of story
Please can those making these decisions actually engage, listen and address the genuine concerns of clinical frontline GPs. I work 40-60 hours a week doing clinical GP only in a GP surgery and inland Urgent Care Centre attached to an Emergency Department. It’s appalling what is happening to the standard of care and many others are really concerned too. Non-doctors without clinical competence are working autonomously and are loosely supervised if at all and sometimes by non-doctors themselves too. Its like the blind leading the blind and a complete free for all. Patients are being mismanaged on a collosal scale and its creating soo much extra work that needs fixing by GPs and unecessary patient distress and a complete waste of NHS resources. It’s not the non-doctors fault. It’s the fault of enabling doctors who likely don’t actually do much clinical medicine because it’s too much, but think the solution to poor access is to lower the standard of care and make the job of GPs in providing decent care even harder rather than paying them a respectful wage! Pause, engage and address the concerns. There needs to be clear guidance and standards on supervision and those doctors who agree to ‘supervise’ need to take this role seriously rather than just collect the extra paycheck. But the level of supervision required makes little financial sense if done properly!! And there’s this whole conflict of interest that those doctors pushing this agenda seem to have financial ties to the expansion of PAs. Its a travesty.
Indeed, a travesty. As described, it would seem that the politicos, the NHS’s heading heads & the GMC pay no heed to the profession’s concerns.
If it is that PA’s can only work in primary care under the supervision of a (fully qualified) G.P. then GPs / GP practices should simply not admit them into nor employ them into their GP practice.
It seems unlikely that proper and safe supervision of PA’s by GPs can save a GP’s time or unburden their practice load.
As a locum GP, I travel round practices and see many different ways of working.
I have supervised PAs, which has been an allocation of one 10 min slot to me to sign their drugs and authorise xrays.
But
I have seen.patients who have unnecessarily been referred up to secondary care by PAs and paramedics, when a GP might have managed their care.
I see some patients that have also had repeat visits to a PA or paramedic when I have been able to resolve their problem in one visit.
It is currently economic to use PAs as they are free centrally funded.
But it may also push extra work load onto secondary care with clinic referrals.
It also can increase repeat visits.
When PAs are no longer free labour, then cost effectiveness will come into play as they are around 75% the cost of a salaried GP, but with only 20% of the training.
The crux of the problem is that most of thd two year training that PAs undertake is aimed at teaching them to acquire communication skills that mimic GP consultation techniques. So a confident PA can probably sound pretty convincing. And present a case in such a may that a supervising GP or patient will not raise any concerns. Until something goes wrong. The employing organisation or GP practice will have vicarious liability, but if the supervising GP is salaried, they may share the medicolegal risk, and have to account for any failure to spot the errors or omissions of the PA.
Of course GP partners could refuse to employ PAs thus making them redundant. But as usual when there’s money involved they agree to every harebrained scheme HMG concoct to divide and ruin our profession. Power to the junior doctors for holding HMGs feet to the fire.
Physician associates and advanced clinical practitioners encouraged by the Clinical Directors of PCNs continue to damage the stability of the NHS demanding salaries of 45k to 70 k plus pension but routinely repeatedly seeing the same problem multiple times or referring back to the GP hence actually effectively tripling or quadrupling their salaries on a cost per patient basis. In addition ‘ Unable to contact patient’ is almost becoming the norm as an entry and difficult to control. PCN Clinical Directors who have made extravagant financial personal gains over the years and continue to lead the destruction of the NHS and of the careers of fellow GPs combined with the few practices financially benefiting from training these poorly thought out roles engaged on an inadequate basis need to be accountable for the peril they have placed their colleagues in and the impending disaster as the consequences of this financially motivated and low quality foundation based race to the bottom gathers pace.
Again, completely agree with Centregroundx2. Why aren’t GPs also out on strike at the terrible moral injury currently being suffered by them? And the scandalously poor levels of service they’re being forced to provide? We didn’t become GPs to become scapegoats for the crappy political-managerial complex destroying the NHS. And all those PCN Dr/collaborators should be named and shunned and their earnings publicised so we know what they’re taking to screw over the NHS.