The Royal College of General Practitioners (RCGP) have drawn a hard line. There is no role, they say, for Physician Associates (PAs) in General Practice.
If that is the case then we should urgently pause recruitment into training.
Risks to patient safety
The call to end PAs from working in general practice was based on
- concerns that the ‘red lines’ for the PA role in general practice were not being adhered to,
- concerns that the claimed benefits of PAs – addressing unmanageable GP workload – were not being realised, and
- concerns because of the risks posed by undifferentiated illness.
Concerns over patient safety also came from the College survey where 50% of the respondents were aware of specific examples of patient safety being compromised by the work of PA These included misdiagnoses, lack of communication to patients/GPs, and a series of prescribing errors, such as
- incorrect medications and dosages,
- mismanaged treatment plans.
- Inappropriate use of antibiotics
- missing contraindications
- recommending unsuitable treatments.
These errors were due to gaps in knowledge; a consequence of their lack of training and experience.
Trish Greenhalgh, in her comprehensive analysis, points out how little safety data there is. There is also, incidentally, no evidence that PAs actually add any value in primary care (though there are studies that show the opposite).
PA Scope of Practice
It seems wrong to recruit new applicants into the role until we have the safety data. But even if we stopped training PAs now, there are 2,000 working in the NHS. How can we best make use of their skills?
Greenhalgh gives the obvious but elusive answer. Rather than using them as ‘under-trained doctors’, with all the problems that creates, we should instead be making use of their unique skills in ‘knowing the ropes’. They understand the system within a department and have knowledge and familiarity with local practice.
This contribution must be clearly defined in terms of a Scope of Practice. But such a Scope must be agreed across the country. Allowing individual hospitals to set their own rules is wrong and would lead to
- PA confusion and erosion of confidence
- being asked to do things they are not confident/qualified to do
- Confusion with other staff
- Toxicity and negativity.
The GMC still refuses to set a national Scope
For reasons we consider misguided at best, the General Medical Council (GMC) are refusing to enforce a national Scope. They are aware that the Colleges, who have the necessary expertise and experience, have issued guidance and rules. But they are undermining these efforts and leaving it to the local employer instead, putting their financial interests ahead of patient safety.
Royal Medical Colleges do have the knowledge to highlight the relevant risks but lack the teeth to enforce their experience.
Our judicial review
On the 13th May we are bringing the GMC to judicial review in the High Court. We are challenging their abdication of responsibilities. We think their refusal to implement ‘safe and lawful practice measures’ is both irrational and in breach of their legal duties. Our legal arguments are summarised here.
The case is being brought together with Marion and Brendan, parents of Emily Chesterton – the musician that died after a PA (working alone in General Practice) failed to recognise a pulmonary embolism.
The High Court judge who reviewed our case described it as raising “serious issues of importance to the relevant professions and to patients”; and he approved permission on all grounds – abdication of responsibilities, failure to investigate and encouraging unlawful practices.
We need to crowdfund £150,000
Legal challenges cost money. We have spent £150,000 on lawyers so far, donations from both doctors and the public. But we need another £150,000. Please contribute whatever you can, and please share our message with doctors, patients and donors.
An investment in the future of your profession.
A way to protect your patients.
A way to get the GMC to fulfil its duty to protect the public
And not just for anaesthetists – for every patient and every doctor