In a survey reported in June, the Royal College of General Practitioners (RCGP) asked for its members’ views on physician associates (PAs) in general practice.1 In the light of the responses the college drew up some principles for how PAs should be working—covering induction, supervision, and their scope of practice. These guidelines haven’t yet been made public, but one paragraph was circulated: it advised that where PAs were already in post, their scope and role could be set locally by their supervising GP.2
This proposed exemption from the guidelines caused some dismay on social media. Members had indicated in the survey that they didn’t think the way PAs currently worked was safe, so many people pointed out that it made no sense to say we must do better with future PAs while carrying on as we are with those already working.
At an RCGP council meeting on Friday 20 September, that paragraph was voted down. Even more significantly, an amendment was passed asserting that there was no role for PAs in general practice.34 Recognising that around 2000 PAs currently work in general practice so there’s still a need for guidance on their scope and supervision, the college intends to do more work on this before publishing its guidelines.
The idea that staff with only two years’ formal training could safely see undifferentiated patients without direct supervision was always fundamentally flawed. Why do we insist that GPs study for five years in medical school and then do another five years’ postgraduate training in order to see patients safely, if a PA can do the same work with a fraction of this? The RCGP, whose charitable objective is “to encourage, foster, and maintain the highest possible standards in general medical practice,” has now rightly, if somewhat belatedly, rejected this idea.5
The RCGP council’s ruling raises many questions. If general practices choose to ignore it and carry on using PAs with minimal supervision—as many have done up to now—how will that affect their medicolegal liabilities when things go wrong? Carrying on as before could be risky, as they’d now be ignoring both BMA and RCGP guidance, and no advice is forthcoming from the General Medical Council.6
We also need to consider the PAs who are already in general practice and how they can be safely redeployed. Many would be capable of completing a graduate entry medical course and should be encouraged and enabled to do so. Other roles will need to be found for those who don’t want to follow this path or are unable to. And they’re all due an apology, as they’ve been promised the impossible and sold a career that can’t exist: that of doing medicine without medical training.
It’s also worth stopping to ask how we got here. The PA project, while resoundingly rejected by practising doctors in the Royal College of Physicians and the RCGP, had its supporters within the leadership of both colleges, as well as NHS England and the General Medical Council. When the dust settles, it will be interesting to work out where exactly the support came from and what the motivations were.
