RCGP calls for halt to recruitment of Physician Associates in general practice, following consultation with more than 5,000 GPs

The Royal College of GPs has published the results of its consultation with members on the role of Physician Associates (PAs) working in general practice settings and made initial recommendations pending further work in this area.

First and foremost, it is calling for practices across the UK to review their recruitment plans and halt the additional recruitment and deployment of PAs into general practice until PAs are regulated and practices are in a position to implement the RCGP's forthcoming guidance on scope of practice, induction and supervision, work on which has already begun and will be informed by the consultation results.

This recommendation follows a number of concerning findings from the consultation, which was completed by 5,112 RCGP members and conducted independently by Research by Design (RbD). These include concerns around patient safety and standards of induction and supervision of PAs working in general practice. A full summary can be found here.

Recognising that some GP practices will already be working with PAs, the College is recommending that, as well as adhering to its 'red lines' on PAs working in general practice (which were updated in March and can be found in full here, that they take steps to ensure:

• appropriate time for supervision is included within GPs' and PAs’ daily timetables;
• processes of triage, induction and supervision are reviewed to ensure they are robust and safe for patients;
• PAs do not see patients who have not been triaged by a GP and should only undertake work delegated to them by and agreed with their GP supervisor, in line with the agreed scope of role for that PA in the practice; 
• transparent and accurate methods of introduction of all members of the multi-disciplinary team seeing patients are visible to patients, including on the practice website, on consulting room doors, on name badges and when appointments are booked; and
• patients who have already consulted a PA for a problem, and who re-present again with the same problem which has not been diagnosed and resolved, should not re-consult a PA, but should see a GP.

As well as a halt to recruitment of PAs in general practice, the College is also calling for governments across the UK to:

• take urgent action to grow the GP workforce and ensure that PAs are not used as substitutes for GPs or a means of mitigating the need to address the chronic shortage of GPs; 
• commission an urgent review of the ways in which PAs work in the NHS; and
• ensure appropriate resources are provided to support multidisciplinary team (MDT) professionals working within general practice, including appropriate induction, supervision, and teamworking support. 

The College is also reiterating its longstanding call that regulation of PAs must proceed as soon as possible. It is the RCGP's position that a regulatory body other than the GMC would be more appropriate to take forward this crucial work - but recognising that GMC regulation is well advanced, and now in legislation, the College will continue to work with the GMC to ensure there is clarity over the differences between doctors and PAs.

Professor Kamila Hawthorne, Chair of the RCGP, said: "The fundamental issue here is that of patient safety and maintaining the high standards of general practice we have worked so hard to attain.

"We understand the picture emerging from these results is disturbing, and will be of concern to many, including patients, GPs and Physician Associates themselves. Our intention is not to disparage the individuals who are working as PAs in general practice or their profession, but to address and act on the concerns that more and more of our GP members have been raising.

"It is not the case that we heard nothing positive about PAs working in general practice - there are reports from our survey of where the role has been working well. But it is clear that there is not a sufficiently robust framework for supervision and scope of role in place in GP practices, and this is having implications for patient safety.

"The College has always been supportive of members of the wider practice team in general practice, and we have said that within the right framework and parameters, PAs have the potential to make a useful contribution to the care and services we deliver for patients. We thank all members who responded to our consultation, for providing us with such a comprehensive picture of the current situation on the ground. We will be taking our learnings from this consultation and using them to produce guidance around scope of practice, induction and supervision.

“We also need to see urgent action from government and NHS leaders to grow the GP workforce and ensure that PAs are not used as a substitute for GPs, and to support general practice to implement safe ways of working for PAs in general practice, including a robust system of professional regulation and significantly increased resourcing for GPs to support PA supervision."

Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.