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New RCGP Guidance Places Strict Limits on PAs

New guidance from the Royal College of General Practitioners (RCGP) on physician associates significantly restricts their role in general practice.
In a document outlining the new scope of practice and matters relating to supervision, the college says physician associates (PAs) should only see patients first triaged by a GP. They should not see walk-ins or patients who present for a second time with the same unresolved issue.
They should also only undertake work delegated to them by their GP supervisor.
In an email to members seen by Medscape News UK, RCGP Council Chair Kamila Hawthorne said the new guidance “aims to offer clarity and support to GPs and employers managing these roles, ensuring safe and effective practice where they are in place”.
The guidance follows a vote by the RCGP UK Council last month to oppose a role for PAs in general practice on patient safety grounds. The United Medical Associate Professionals (UMAPs), the professional body representing PAs and other medical associate professionals, say the RCGP position is not substantiated by clear empirical evidence. They have backed the call by the Academy of Medical Royal Colleges for an independent review into the regulation of these roles.
Medscape News UK asked UMAPs for comment on the new RCGP guidance but did not receive a response by time of publication.
Explain Role to Patients
The new RCGP guidance covers the induction, preceptorship, supervision, and scope of practice for the 2000 PAs already working in general practice in the UK.
The guidance stipulates:
PAs should explain they are not doctors when introducing themselves to patients, and wear clear name badges to that effect.
PAs must not be the only healthcare practitioner on call, or the duty clinician in the GP practice.
PAs must not be given responsibility for clinical triage or undertake clinical triage.
PAs should always document the care and advice they give to patients, with notes made at every PA appointment signed off by a GP at the end of a surgery day.
In addition, the list of minor conditions an associate can see must be agreed and documented, with clinical protocols for diagnosis and management. 
It suggests the seven common minor illnesses used in the Pharmacy First programme in England as “a good starting point”.
The guidelines also make it clear that PAs should not see paediatric patients, patients with learning difficulties, or those with suspected mental illness.
These guidelines relating to the scope of practice for PAs in general practice are stricter than those issued by NHS England last March, but stop short of those of the British Medical Association, which were updated last month. The union’s position is that PAs should be in an “assistant role to doctors”, helping with “simple practical procedures, administrative tasks, and working with patients in a supportive, well-defined and specified role”. It believes PAs should not make “independent treatment decisions” and must not see “undifferentiated patients”.
Regulation by the GMC
Meanwhile, the General Medical Council (GMC) has confirmed that regulation of physician associates (PAs) will begin on December 13, but registration will not be legally required for another two years. 
Chief executive Charlie Massey wrote to royal colleges and NHS organisations last week to outline ‘key upcoming milestones’. He also confirmed that the GMC will publish responses to its consultation on PA regulation, prior to the commencement of December’s regulation. PAs and anaesthesia associates (AAs) will be able to register from December 16.
The role of PAs has come under scrutiny following the death of 30-year-old Emily Chesterton, who suffered a pulmonary embolism in 2022. She was misdiagnosed by a PA on two occasions. The government’s decision to expand the numbers of medical associates and to establish the GMC as their regulator has come despite concerted opposition from the medical profession. 
Asked by Medscape News UK to respond to the new RCGP guidelines, an NHS spokesperson said: “The NHS has always been clear about the role medical associates play in supporting clinical teams to provide high quality care for patients — they are not replacements for doctors, but support teams with specific tasks they are trained to do, under supervision.” 
The confidence of the public and the medical community is essential as the NHS develops a workforce for the future, which is why the NHS has issued updated guidance on the appropriate deployment of these roles, the spokesperson said.
“We will continue to work together with government and medical and patient groups to provide clarity on these roles for patients and the public, ahead of the GMC regulation coming into effect at the end of the year.”
Siobhan Harris has been a health and medical journalist for WebMD/Medscape since 2009. She has a law degree from the University of Sheffield and a postgraduate diploma in journalism. She has also worked as a national and international news journalist for ITN, BBC, and BFBS Forces News.
 
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