HR experts have warned GP practices and PCNs to tread very carefully before making changes to the physician associate (PA) role in the wake of NHS England guidance that followed publication of the Leng review.
Kraft HR Consulting has said it has ‘significant concerns’ about the guidance and could put practices at risk of legal claims from PAs or in breach of insurance policies.
The Leng review, published last week, called for physician associates to be renamed physician assistants and have to work for two years in secondary care before moving to primary care.
It also put forward a template job description for those new to the role in primary care and has said that a named doctor (supervisor) should take overall responsibility for each physician assistant as their formal line manager.
All of its recommendations have been accepted in full by the Government prompting NHS England to issue two letters, one to practice and PCN managers with instructions on how to proceed and the other addressed to physician associates.
Practices have been told to reassure PAs that their jobs are safe and they will be supported in the changes that the Leng review proposes. They have also been asked to circulate the letter to PAs affected.
Liz Willett, director at Kraft HR, which specialises in working with general practice, said the letter also informs surgeries and PAs that with immediate effect:
- the job title will change to physician assistant
- employees with less than 2 years’ service will be moved immediately onto the proposed template job description that sets out responsibilities and requirements for a PA’s first role in primary care
- PAs must not triage patients or see undifferentiated patients.
Ms Willett has warned that: ‘As HR practitioners, this advice causes us significant concern.
‘We are very concerned with the instructions about immediate changes to role title, job description and redeployment without any reference to the necessary consultation and engagement required by employment law. We didn’t think the Leng review would take precedence over the Employment Rights Act.
‘If employing practices or PCNs make such changes without proper consultation, they are at risk of legal action themselves’.
She outlined that the main HR-related risks as being:
– changing the job title to physician assistant may result in a perceived and real loss of status which, if undertaken without proper consultation, could result in grievances and ultimately, claims of constructive unfair dismissal.
– changing job descriptions and duties requires consultation with the affected individuals. If undertaken without proper consultation, claims of constructive unfair dismissal may result ahead of time-consuming grievances being raised.
– the supervision model for PAs is not well defined but GPs are expected to implement it with immediate effect. Expecting busy GPs to immediately understand and support a new framework for working with PAs, with no training and support is poor change management and puts unreasonable pressure on the profession.
– the letters from NHS England appear to take no account of local workforce plans for the deployment of ARRS funding and PCNs’ autonomy to make decisions in this respect.
– the new job description for new physician assistants does not appear to have been put through job evaluation as a revised template. There may be pay and grading issues that have not been identified yet and will certainly result in the need for consultation.
Ms Willett also said that they had concerns around the implications of insurance cover for PAs if NHS England advice is not followed or if the supervision models does not meet expectations, particularly as it has been so ‘poorly defined’.
She explained: ‘Practices and PCNs are at risk because their insurance will be at risk – if they don’t follow NHS England advice, their insurance is unlikely to cover them. So consultation must happen quickly and perhaps interim measures agreed pending a more detailed review.
She added: ‘Our advice is stop and think – don’t send out the letter from NHS England to PAs without thinking it through; take HR advice and engage in consultation with PAs; and finally check your insurance coverage.
‘This is a fast changing situation, so practices and PCNs that employ PAs need to give this serious immediate attention,’ Ms Willett also said.
The trade union for PAs, the United Medical Associate Professionals, has said it does not accept the recommendations of the Leng review and is advising PAs not to sign or accept any new contract, job description, framework or agreement presented by employers.
It said it is seeking further advice on whether the guidance set out by NHS England in its letter is mandatory or to be carried out at employers’ discretion.
In a statement published this week it said: ‘The language points towards a request to action rather than a directive that must be complied with. However, we are concerned that employers may act on the impression that this is a directive, which may then lead to a potential breach of employment law.
‘We strongly recommend that all employers seek legal advice on the correct interpretation and legality of NHSE’s letter.’
NHS England said it had no additional comment but reiterated a statement issued by Dr Claire Fuller, co-national medical director (Primary Care) at NHS England, last week that said: ‘We welcome the publication of this review and the clarity it provides on how these vital and valued roles can best support high-quality care for patients as part of multidisciplinary teams.
‘Following legitimate concerns raised, it is right this review has gathered expert insight and evidence from across the health service and internationally and we will now work with the service and government to fully consider and implement its recommendations.’
A more detailed HR guide on how to manage the changes with PAs can be accessed here.
