From Dr Zishan Syed, GP Partner, Maidstone, Kent
General practice as a speciality may soon become extinct and GPs are letting it happen right under their noses. The latest sticking plaster solution touted by Mr Hunt is that of physician associates.
Physician associates have not sat the applied knowledge test nor the clinical skills assessment – both essential (and expensive) components of the MRCGP exam, which GP trainees have to pass to qualify. It is an unacceptable threat to patient safety to allow other professionals to work in GP-like roles without being assessed in this way.
Furthermore there is no equivalent regulatory body, such as the GMC, to oversee physician associates. In the absence of a body with the same strict attitude towards regulation that the GMC has towards doctors (who are highly trained and competent professionals) I feel it is unacceptable for reasons of patient safety to have physician associates operating in the high-risk environment of general practice. This is especially the case when they have not gone through the same rigorous training as GPs.
Why should there be a two-tier system of working in general practice? With additional training for doctors to practise in a GP surgery but physician associates actively seeing patients after a two-year course.
And when things go wrong, as they often do in a high-pressured environment, it is the doctor who will take culpability.
As a clinician, I argue it is unacceptable for society to promote a system where one professional sees a patient and blame is divested onto a doctor when things go wrong.
If society is to promote physician associates then it must promote a fair system of law where such individuals take full responsibility for the patients they see rather than scapegoating GPs. In the present environment it is ridiculous to claim, as some clinicians do, that they are able to supervise physician associates while simultaneously seeing patients with complex problems in the outdated 10-minute appointment system.
Somehow in primary care we have got used to dangerous sticking plaster solutions such as these. Fundamentally, we need to make working conditions better for GPs and GP trainees rather than doing our utmost to make working conditions better for other professionals who want to work in general practice without taking the full medico-legal responsibility that it entails.
Physician associates will pose a threat to the future jobs of qualified doctors as the government will inevitably employ them for reasons of cost rather than quality.
At present the regulation of physician associates is done through a voluntary register. This register does not have the force of the law, meaning that physician associates can see patients even if they are not registered. This poses an unacceptable risk to patient safety in GP surgeries.
I have therefore set up a petition to call for a proper mandatory registration process for physician associates and I encourage all who are interested in patient safety to sign it.