Strict new rules on supervision of Physician Associates (PAs) in A&E have been issued by the Royal College of Emergency Medicine (RCEM). The requirements are now for ‘direct supervision by a senior clinician’ and for patients to be reviewed in person by a senior clinician if they are being sent home.
These rules supersede previous guidance.
While this represents a significant shift towards patient safety, it is crucial to understand that this guidance is merely advisory and lacks legal enforceability.
What Does the Guidance Say?
RCEM has now stated that:
- PAs entering the emergency medicine workforce should only operate at the basic Tier One level – they must work under direct supervision by a senior clinician.
- As a minimum requirement, all patients admitted to hospital must be discussed with a senior clinician; any patients being discharged should be reviewed in person by a senior clinician.
- The College does not support further expansion of the PA workforce within Emergency Medicine.
This guidance is a direct response to growing concerns about the risks posed by under-supervised PAs in acute care settings
The weakness – no legal enforcement
Despite these strong recommendations, RCEM itself admits that it has no power to enforce them. Each NHS Trust ultimately decides how it deploys PAs, meaning some hospitals may continue allowing PAs to work beyond their competence. RCEM also acknowledges that many departments currently operate outside these recommendations.
Under the Bolam principle, hospitals that allow PAs to work unsupervised in a way that contradicts RCEM’s guidelines could be deemed legally negligent. And if a patient suffers harm due to the lack of proper supervision it could be liable. We have previously published a legal perspective explaining this.
But why do we have to wait for something to go wrong?
Legal action against the medical regulator is needed now
While RCEM’s new stance is a step in the right direction, it is far from sufficient. Only legal action and firm regulation will ensure that patient safety is not left to the discretion of individual hospitals.
Anaesthetists United and the bereaved parents of Emily Chesterton are bringing a judicial review of the GMC to Court on May 14th, over their failure to properly determine what Associates can and cannot do – their ‘scope of practice’. We have spent over £160,000 of crowdfunded money. But the costs have risen faster than we had anticipated, and we are now worried about whether or not we can afford to proceed.
We thank those of you that have donated, and we would ask you to do two things.
Firstly we are aware that there is considerable lack of awareness of the case in the medical world, and there are a lot of people that we are simply unable to reach. Please help us reach them, through either personal contact, WhatsApp/Telegram groups etc. You could also get an AU tshirt, coffee mug or name badge to spread awareness.
And we are disappointed at the lack of institutional support by the Colleges, Specialist Societies and professional bodies in medicine – many of whom are calling for exactly the same as us – a nationally-defined and enforced Scope of Practice for Associates. Despite agreeing with us, the institutions will not endorse us. We have written to many and have received only evasive replies. agreeing with our goals but going no further. The BMA and the Doctors Association have supported us, for which we are very grateful.
If you are a member of a College/Specialist Society, and if you think they should get off the fence and help us win the most important legal fight of the decade,then approach them urgently and exert your pressure as a member.