Supervising non-doctors should not form part of a sessional GP’s job description ‘unless expressly and mutually agreed’, according to new advice from the BMA.
The union said that with the expansion of the additional roles reimbursement scheme (ARRS) and the ‘diversification of the workforce’, GPs have seen a ‘dramatic increase’ in supervision responsibilities expected of them.
The BMA has previously recommended that physician associates (PAs) – who are usually employed by practices through ARRS – must have a named supervisor ‘immediately’ available ‘at all times’ while working at GP practices.
Now the union has released new guidance for sessional GPs, clarifying their supervision responsibilities of ARRS roles, including PAs.
GPs also should not be expected to sign prescriptions, request investigations or make referrals based solely on the clinical assessments made by ARRS staff, the BMA said.
The guidance pointed out that if investigations, referrals or prescriptions are deemed required after initial assessment by ARRS staff, patients ‘should be allowed the opportunity to consult a qualified GP’, and GPs should be ‘given the time’ and opportunity to make ‘their own full and proper assessment’ of the patient.
The BMA also said that supervision should not be included in a salaried GP’s job plan or locum agreement ‘unless expressly and mutually agreed’ and that provision of supervision is the responsibility of the employer.
‘With the personal liabilities and the potential risks to a GP’s professional licence that come with such responsibilities the clinical supervision of ARRS roles remains the responsibility of the employer,’ the guidance added.
It also pointed out that if additional supervision responsibilities are agreed, these need to be ‘remunerated with supplementary pay’.
The union added: ‘Should a sessional GP agree to supervise multidisciplinary team/ARRS roles as part of their agreed job plan, they must be allocated sufficient time to safely perform this role.’
BMA guidance for sessional GPs on supervising ARRS roles
- Provision of supervision for MDT/ARRS roles is the responsibility of the employer. With the personal liabilities and the potential risks to a GP’s professional licence that come with such responsibilities the clinical supervision of MDT/ARRS roles remains the responsibility of the employer. Supervision should not be included as part of a salaried GP’s job plan/locum agreement unless expressly and mutually agreed.
- Sessional GPs should not be expected to request investigations, make referrals or sign prescriptions based solely on the clinical assessments made by MDT/ARRS roles. If such interventions are deemed required after initial assessment by MDT/ARRS roles, patients should be allowed the opportunity to consult a qualified GP and GPs given the time and opportunity to make their own full and proper assessment of the patient’s healthcare needs.
- Should a sessional GP agree to supervise MDT/ARRS roles as part of their agreed job plan, they must be allocated sufficient time to safely perform this role. To enable GPs to safely undertake such clinical supervision it is important they have full knowledge of the qualifications, previous primary care experience, clinical limitations and the regulation of those they are supervising. It must be clearly outlined within the mutually agreed GP’s job plan: which roles they agree to supervise; the number of MDT/ARRS staff members they will be expected supervise on any given day; and what time within their workday will be allocated per supervisee to ensure safe and achievable supervision.
- There should be robust systems and protocols in place to ensure MDT/ARRS roles requiring supervision are working within their scope of practice. More information and support on scope of practice and supervision can be found here.
- Additional agreed supervision responsibilities should be adequately remunerated. The additional workload which comes with providing supervision of MDTs or ARRS staff should be remunerated with supplementary pay.
Source: BMA
A version of this article was first published by our sister title Pulse
