An unofficial representative body has shared new guidance to ‘support’ GP partners in employing physician associates (PAs), warning that the use of ‘restrictive’ scope documents could result in legal challenge.
The new guidance, produced by United Medical Associate Professionals (UMAPs), advises on the qualifications, recruitment, prescribing powers and clinical supervision of physician associates.
Unlike the BMA and the RCGP’s scope of practice guidelines, UMAPs has said that PAs should ‘provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems’ in an example PA job description.
It claims to be a consolidation of ‘all known accepted literature’ regarding PA employment, and is much less restrictive than ‘scope of practice’ documents previously published by the BMA and the RCGP.
UMAPs criticised these documents, arguing that they have ‘been responsible for unlawful contract changes for PAs which have been successfully challenged’.
According to UMAPs chief executive Stephen Nash, his organisation has already dealt with 30 cases against GP practices over the last year where PAs have challenged ‘redundancies without proper cause and unfair dismissals’. He also claimed he was ‘aware of exponentially more’ cases not being handled by UMAPs.
Mr Nash said that ‘most’ of these cases are still ongoing but there have been ‘positive outcomes’ in some cases where practices ‘were able to maintain their physician associate workforce’.
Mr Nash said: ‘The BMA document was effectively in law a position stand from that organisation on what they think physician associates should do, and it was heavily restrictive […] it was very much a trade union position stand.
‘But then it was being pointed to [by GP practices] as reason for redundancy. It had no legal or statutory power and therefore it wasn’t an official document that they should use in that capacity.
‘Employers were welcome to look at it but it had no jurisdiction to say “this is what should happen”. So when that’s implemented it would then be grounds for unfair dismissal potentially, it was certainly a breach of contract.’
UMAPs is ‘not there to just callously go around suing GP partners’, Mr Nash said.
He said: ‘We absolutely do not want to be in legal dispute with GPs – we think they’ve been advised poorly, and it’s not their fault that they’re doing this. We are desperate to avoid conflict with them, but the guidance that they’ve been given is incorrect and is going to lead to that if they follow it.’
The new UMAPs guidance for employers, which was co-produced with the College of Medical Associate Professionals (CMAPs), states that the scope of practice for PAs is defined by their curriculum and after employment will ‘naturally evolve over time’.
It said: ‘A PA’s skill set is not limited to those obtained as a student. As a PA develops, so will their skills. These skills will vary between PAs as they evolve to fit the needs of their chosen specialty.’
In response to the UMAPs guidance, the RCGP said that its own scope of practice is ‘advisory’ and ‘aims to support GP practices and current employers of PAs’.
A spokesperson continued: ‘The College’s policy position to oppose a role for PAs in general practice was adopted at our September governing Council meeting.
‘However, there are around 2000 PAs already working in general practice and our guidance is intended to be a practical resource for their employers and to help provide clarity on how these roles are managed.
‘We have always been clear that it is for employers to decide whether to follow our guidance and that it is their responsibility to ensure the appropriate treatment and handling of existing PA contracts.’
Last week, the BMA threatened to move towards industrial action over the lack of a nationally agreed scope of practice for physician associates.
The union warned NHS England to urgently address the concerns of doctors in order to prevent any industrial action.
The GP Committee UK also recently voted in favour of ‘phasing out’ the physician associate role in general practice.
Earlier this year, UMAPs warned GP partners against implementing the BMA’s scope of practice of potential legal consequences.
A version of this article was first published by our sister title Pulse.
