If we say goodbye to physician associates in general practice, what next?

If we say goodbye, as you have already decided, to PAs in primary care then we also must say goodbye to nurse practitioners too. They do not have a national examination of competence nor the safety of being non-prescribers and working under supervision of a doctor. Do you really believe doctors only will see minor illness( at least 30% primary workload) , advise about preventive health or take time with elderly frail who need comprehensive geriatric assessments ? Are doctors the right professional to see these patients? Perhaps you should ask Professor Leng this question: How will removing PAs and nurse practitioners from primary care help our NHS care for our elderly ahead?

above highlight important tensions within the evolving workforce model in primary care. However, the concern many doctors have is not simply about protecting roles, but about ensuring patient safety, clinical accountability, and sustainability of care.

Physician Associates (PAs), and to some extent Nurse Practitioners (NPs), have been brought into primary care without the same rigorous, standardised training and national regulatory oversight that doctors undergo. While NPs have nursing regulation, their scope varies widely and they, like PAs, are often deployed in roles that blur lines of responsibility — including the diagnosis and management of complex conditions.

Doctors are trained over many years to manage risk, uncertainty, and complexity — which are the daily realities of general practice. While minor illness and preventive care seem straightforward, they often mask more serious pathology or involve nuanced decision-making that depends on a depth of training not yet matched by other roles.

The central issue is this: if we delegate core clinical tasks to less-trained staff, do we risk fragmenting care and compromising safety? Doctors are not saying they should do everything alone — but they are saying the current model of task-shifting has outpaced safe supervision and governance.

Removing or reducing the roles of PAs and NPs may appear regressive, but it might prompt a necessary recalibration: investment in more doctors, proper team structures, and clear lines of accountability — all of which are crucial if we’re to look after frail older patients and manage rising demand safely and effectively.

Ultimately, the question isn’t just who can see these patients — but who should, when it comes to both quality of care and long-term system resilience

Just ask Chat GPT and see what it says..

J S, excellent, thoughtful and respectful comments. Hopefully, the Govt will realise that they cannot substitute the complex probabilistic working of GPs with other roles and still expect to get the same medically (and cost) effective outcomes.
You can’t replace a symphony with segued jingles and expect to have the same joyful experience.

I agree with all the above.
I want to see ‘Care Navigators’ eliminated before they get a chance to properly usurp the roles of our Specialist Receptionists.
Then I want to see the elimination of ALL kinds of ‘Practitioners’. A ‘practitioner’ is just someone who ‘practices’ because they are not expert yet. A fully qualified GP Doctor is an expert in many forms of medicine, surgery, specialties and care navigation. They should not be called ‘practicing doctors’ any more than any hospital consultant is called a ‘practicing doctor’.
All the othe rsuperfluously named ‘practitioners’ are dreadfully misnamed.
If my patient needs a Nurse, or an Art Therapist, they need a Nurse or an Art Therapist, not a ‘practitioner’. This would remove the tendency for some ‘practitioners’ to use that title to imply they are medically qualified doctors or specialists, when they are not.
I have worked with some excellent staff burdened with the title of ‘practitioner’, but I have also been exposed to the horrors of an ‘Advanced Nurse Practitioner’ who was dangerously overconfident yet actually not as good as our experienced and common-sense State Enrolled Nurse.
Perhaps to avoid ‘Practitioner’ whilst stcking with what is familiar to patients, we could call those Doctors “Geepies”

The linking of PAs to ANPs is not valid. Apart from the difference between the NMC (ANPs) and GMC (PAs) approaches to regulation, ANPs aren’t described using terms suggesting they are a doctor eg “physician associate” or “trained in the medical model” or “medically trained”. Let’s not get unfocussed.

In the USA a Nurse Practitioner is a qualified Nurse. In the UK the title ‘Nurse’ is due to be statutorily protected. A medical practitioner is a protected title (but a medical professional is not). So Nurse Practitioner title does also raise considerable confusion over exactly whom a patient is seeing.
I agree with JS’s comments.

Given the toxic nature of the PA debate, with both sides dug into their trenches, what’s needed here is good old fashioned British compromise that will equally dissatisfy both parties.

The current status quo is utterly disastrous for unemployed GPs, but just throwing thousands of PAs on to the unemployment scrap heap with now useless degrees would be cruel and unusual punishment for innocent people who just a few short years ago thought Primary Care needed and wanted them.

A well trained and properly supervised PA with regular revalidation can still be a vital member of a Practice’s MDT, but their numbers need regulating, and the current concept that “entrepreneurial” Partners can staff a whole surgery with barely supervised PAs needs to be stamped out tout suite.

This change will give GPs struggling to find employment a better shot at landing decent salaried posts with a view to future Partnership, which will guarantee a job for life and secure continuity of care for patients.

This would help avoid a rapid return to the unsustainable pre-PA situation of the last decade, when Partners were floundering as they couldn’t find replacements and were forced to employ expensive Locum/salaried doctors or hand back their contracts.

Several of our PAs started out as students in our practice and then showed their ability and work ethic and drive, so when they approached us for jobs we were delighted to take on such high quality colleagues.

A good PA is an excellent addtion to a primary care team, and in darker days where we advertised for years without finding partners or salaried doctors willing to join a practice as they saw it imploding, PA staff helped stabilise and turn things around, and now we are fully staffed with GPs as well – with a large complement of GPs who mostly wish to work part time, but find the practice a welcoming environment now. This is largely due to the young and enthusiastic, willing to constantly learn and evolve, approach of the PAs.

they are excellent at following guidelines and protocols and are fuly supervised and work at the leel of a St2/ST3 GP – both of whom need supervision. No they are not at the level and experience or quality of a salaried GP coilleague, but they see minor illness and triaged patients allowing more complex care to be done by GPs.

I will continue to support my PA colleagues as they deserve fully, as they supported our practice when GPs were not willing to comimitt to a practice in change. Although they have grown in expereience they are still given every opportunity to ask quaetions and seek a GP to give a second opinion.

As part of a wider primary care team, they are a valued colleagues, as are ANP, pharmacists and our mental health support worker. None are GPs – but all provide great care for our patients as part of a team approach.

The PA’s we have will be welcome to stay long term no matter what the BMA/RCGP advise – unless the government demands their sacking, in which case they should seek legal redress as they were misold their degrees and career pathways.