NEWS: RCGP shifts stance on Physician Associates

As reported by The BMJ, Royal College of General Practitioners alters position on regulation of physician associates in general practice, emphasising the need for clarity and appropriate supervision amidst concerns over GP shortages

After a debate at the college’s UK council meeting on 8 March, members passed a vote which stated that “RCGP should change its stance on this matter and that another regulatory body would be more appropriate to take this crucial work forward to regulate PAs.”

RCGP chair Kamila Hawthorne said that while recognising that regulation is overdue, “there was deep concern among our members that if the GMC takes on the role of regulator for PAs this will create further confusion for patients over the differences between doctors and PAs.”

The RCGP council also voted to add two additional “red lines” on PAs to its existing list. The list now explicitly states that the training and retention of GPs must be prioritised and that the responsibilities and skills required by GPs to supervise PAs must be recognised and resourced.

The updated list of “red lines” is as follows—with the final two being new:

•  PAs working in general practice must always work under the supervision of qualified GPs
•  PAs must be considered additional members of the team, rather than substitutes for GPs
•  PAs do not replace GPs or mitigate the need to urgently tackle the shortage of GPs
•  PAs must be regulated as soon as possible
•  Public awareness and understanding of the PA role must be improved
•  Training, induction, and supervision of PAs in general practice must be properly designed and resourced
• At a time of significant GP workforce challenges, funding allocation, resources, and learning opportunities in general practice must be prioritised for the training and retention of GPs
•  The significant responsibility and skills required for supervision must be recognised and resourced, with GPs able to choose whether or not they are willing to undertake supervision of PAs. PAs should not be employed unless sufficient supervision can be provided

Hawthorne said, “We hope that by reaffirming and strengthening our red lines, we will be able to bring some more clarity to our members—and we will continue to make the case to government and other decision makers that PAs in general practice must be deployed in a way that ensures the safety of our patients and the sustainability of our healthcare system.”

Because legislation has passed through parliament, RCGP said it would seek to “enter into discussion with GMC and other key stakeholders to look at how these concerns can be tackled.”

College guidance incoming

The council also agreed that in the coming weeks, RCGP would consult with members on the role of PAs in general practice settings—including their scope of practice and supervision arrangements—to help inform college guidance.

Last week, the BMA published its own guidance on PAs which stated that they should be barred from referring patients for procedures, making initial assessments of “undifferentiated” patients, and prescribing drugs.

Hawthorne said the college’s position was that PAs can fulfil a potentially supportive role in general practice by taking on specific workload areas, but that “this must be done in the right way.”

“PAs are not GPs, cannot replace GPs, and must not be used to ‘plug the gaps’ of GP shortages that have been created by years of underinvestment and poor workforce planning,” she said.