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Increased onus on GP practices to supervise physician associates

by Eliza Parr
8 April 2024

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All GP practices employing physician associates (PAs) must have a policy to restrict access to prescribing, new NHS England guidance has said. 

A letter sent to practices at the end of March has suggested practices give PAs smart cards that do ‘not permit access to prescribing activities’.

It warned surgeries that PAs are not ‘substitutes’ for GPs or junior doctors, while outlining the steps required to ensure safe implementation of the role.

It also said PAs ‘must be supervised and debriefed’ by a GP, who must have ‘confidence’ in the PA’s competence.

The guidance said: ‘We ask that practices review their processes to ensure that they have appropriate supervision, supporting governance and systems in place.

‘It is important to emphasise that PAs are not substitutes for general practitioners or doctors in training; rather, they are specifically trained to work collaboratively with doctors and others as supplementary members of a multidisciplinary team alongside nursing and other ARRS colleagues,’ it added.

Practices have also been asked to ensure all staff are ‘educated’ on the physician associate role and ‘make it clear to patients that they are seeing a PA’.

NHS England said the guidelines for general practice have been developed based on discussions with the Royal Colleges, trade unions, and the GMC. 

On prescribing, NHS England reiterated that PAs ‘are not able to prescribe’ and practice policies must reflect this. 

The guidance said: ‘Therefore, in the context of electronic patient care records, every practice should have a comprehensive policy outlining access and restriction requirements for each professional group. 

‘This policy should cover aspects such as appropriate access to prescribing, results, referrals, and patient clinical notes, and provide assurance that clinicians are not able to undertake activities falling outside of their role’s scope of practice (for example, by providing a smart card loaded with TPP or EMIS system role profiles for PAs that does not permit access to prescribing activities).’

Last year, it came to light that a patient who died after seeing a PA at her GP practice had not been aware that those appointments were not with a doctor.

The changes aimed at putting more safeguards in place around the PA role are also reflected in the new PCN contract, published on 1 April.

In the updated PCNs Network DES for 2024/25, NHS England has added new clauses ‘clarifying role requirements’ for PAs hired through the Additional Roles Reimbursement Scheme (ARRS), with some putting greater onus on GPs.

For example, GP supervisors must now be ‘satisfied’ that there is appropriate governance when PAs see undifferentiated patients.

They must also ‘take into account a physician associate’s knowledge, skills and experience gained through their training and development’.

PCNs must also now ensure that GP supervision of PAs includes ‘appropriate debriefing’. 

GP spokesperson for the Doctors’ Association Dr Steve Taylor told our sister publication Pulse that the changes to the DES are ‘effectively making PAs less financially viable’ due to putting in place more supervision requirements for GPs to follow. 

He said: ‘Having actively promoted and funded ARRS at the expense of GP practice funding, it appears, by amending the contract, that NHS England have decided that they need to cover ARRS by placing the responsibility of any failure to supervise on GP supervisors. 

‘It was clear from the start that PAs seeing non-differentiated patients, a NHS England stipulation, would be unsafe in practice. By amending the contract they are effectively making PAs less financially viable due to supervision requirements.’

Last month the BMA released a PA ‘scope of practice’ which said they should never see undifferentiated patients in a GP setting. 

A version of this story first appeared on our sister publication Pulse.