Royal College of GPs sets out ‘red lines’ for physician associates to prevent confusion

The Royal College of General Practitioners (RCGP) has strengthened and updated its position on the role and regulation of physician associates (PAs) working in general practice.

After consulting with GPs across the country, the College voted that it should change its stance on PA regulation being undertaken by the General Medical Council (GMC) as council members raised significant concerns that this could increase confusion amongst patients about the differences between doctors and PAs. It now says that another regulatory body would be more appropriate to take this crucial work forward to regulate PAs.

It also said it was important that any costs of the regulation of PAs must not be transferred to doctors. Given legislation was passed through the House of Lords last week, the RCGP will need to enter into discussion with the GMC and other key stakeholders to look at how these concerns can be addressed.

Council also agreed that the RCGP should consult with members on the role of PAs in general practice settings, including their scope of practice and supervision arrangements. This consultation will commence in the coming weeks and will inform the development of College guidance.

Professor Kamila Hawthorne, Chair of the RCGP, said: “While recognising that regulation is overdue, there was deep concern amongst 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.  In addition, we have articulated two further principles that must underpin the role of PAs in general practice, including the vital need to ensure that their supervision is adequately resourced and funded.

“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.”

‘Red lines’ on work undertaken by physician associates

The Council confirmed the College’s existing ‘red lines’ on PAs, and voted to add two more, explicitly stating 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 RCGP’s updated position now stipulates:

• 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 address 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 within general practice must be properly designed and resourced.
• At a time of significant GP workforce challenges, funding allocations, resources and learning opportunities within 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 they are willing to undertake supervision of PAs. PAs should not be employed unless sufficient supervision can be provided.

Professor Hawthorne added: “The College’s position comes from the recognition that PAs can fulfil a potentially supportive role in general practice by taking on specific workload areas, but this must be done in the right way. I’m pleased that our upcoming consultation with members will help us set standards and produce some practical guidance on how best to incorporate these team members.  However, 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.

“GPs are the equivalent of hospital consultants, specialising in general practice, and we need thousands more of us to deliver the increasingly complex care our patients need. No matter how many additional roles are introduced, they will never be a substitute for GPs and decision and policymakers need to realise this.”

The decision follows the publication of new guidance from the British Medical Association setting out the scope of responsibilities for physician associates and anaesthesia associates.

The recommendations are designed to work at a national level across all medical practices and use a simple ‘traffic lights’ system identifying what MAPs might be expected to do on their own (green), what they might do under supervision (orange) and what they must not do (red).