UK’s GP body votes to oppose use of physician associates in surgeries

The UK’s GP body has voted to oppose the use of physician associates (PAs) in doctor surgeries.

The governing council of the Royal College of GPs (RCGP) voted 61% in favour of opposing their role, citing patient safety grounds.

It comes after a survey of members for the college in June found 81% thought that negative effects on patient safety were one of the challenges of using PAs in general practice.

Half said they were aware of specific examples of patient safety being compromised, including PAs misdiagnosing people, inappropriate prescribing and lack of communication to patients and doctors.

PAs are graduates – usually with a health or life sciences degree – who have undertaken two years of postgraduate training.

They are supposed to support the work of doctors but hit the headlines after the death of Emily Chesterton, 30, in November 2022 from a pulmonary embolism. She was misdiagnosed by a PA on two occasions.

The British Medical Association (BMA) has also said its members are worried about the role of PAs and argues they should be stopped from diagnosing patients.

According to the NHS, PAs work under the supervision of a doctor and can diagnose people, take medical histories, perform physical examinations, see patients with long-term conditions, analyse test results and develop management plans.

Most associates work in GP surgeries, acute medicine and emergency medicine and there are NHS plans to extend their numbers.

The RCGP council voted on Friday in favour of opposing their use in general practice, with 31% against and 8% abstaining.

But the RCGP said that in recognition of the fact around 2,000 PAs already work in general practice, its council had approved three new sets of guidance to support GP practices employing PAs.

These covered the induction, supervision and scope of practice of PAs currently working in GP surgeries.

Professor Kamila Hawthorne, chair of the Royal College of GPs, said: “The role of PAs in general practice has dominated the medical agenda for well over a year now and we understand the strength of feeling amongst our members and their concerns for the safety of their patients.

“It became very clear at today’s council discussion that we needed to speak out in opposition to the PA role within a general practice setting and I am pleased that our processes have enabled us to do this in a collegiate and democratic way.

“We recognise that this new policy position may be unsettling for physician associates who are already working in general practice and for their employers, and we hope that our upcoming documents to be published in the coming weeks will provide some clarity on how these roles could be managed where they are in place.”

Earlier this year, NHS England said PAs were “not substitutes” for GPs and must be supervised.

A letter to all GP surgeries, primary care network clinical directors, integrated care board chief executives and NHS England regional directors said PAs were “specifically trained to work collaboratively with doctors and others” and all work undertaken by PAs “must be supervised and debriefed with their supervising GP”.

It added: “All clinical and administrative/clerical staff (for example, receptionists) must be educated on the PA role and make it clear to patients that they are seeing a PA.

“As part of good governance processes, all staff should be aware of how to triage patients so that they are seen appropriately by a clinician working within their level of competence.”

Ms Chesterton died in 2022 after she visited her local GP practice in Crouch End, north London.

She had been under the impression that she was seeing a GP after being triaged by a practice receptionist.

The PA failed on both occasions to spot her leg pain and breathlessness was a blood clot, which ultimately travelled to her lungs.

Ms Chesterton was instead told she had anxiety.

A coroner later ruled she “should have been immediately referred to a hospital emergency unit” where she would likely have been treated for pulmonary embolism and would have survived.

Her parents, Brendan Chesterton, a retired maths and ICT teacher, and his wife Marion, 65, a retired languages teacher, have backed calls for much tighter controls over the work of PAs.