‘They are not a substitute for GPs’, says College Chair

College Chair Professor Kamila Hawthorne has been featured in The Telegraph commenting on non-GP roles in primary care and the need for regulation of Physician Associates. Professor Hawthorne said:

“General practice is buckling under the strain of ever-rising demand and, at the same time, facing a severe shortage of fully-qualified GPs, so there is no doubt that these additional roles are making a valuable contribution to our wider practice teams and the care of our patients.

“However, these are 'additional' roles, they are not 'substitute' GPs. The current and any future, government must never view them as such. Nor is it necessarily the case that they 'free up' GP time as they must work under the supervision of GPs and, as we are seeing particularly with Physician Associates, they require very high levels of support. There are many aspects of the work of a GP that only a GP can do, however many additional roles lie within the practice - they extend the range of services we offer, but don't necessarily reduce the GP workload.

“It takes 10 years to train a GP, we are highly qualified consultants in general practice, and other members of the team cannot - and should never be expected to - undertake the full range of expert and complex work a qualified GP can do, as it would lie outside their professional boundaries and be unsafe for patients.

“It is disappointing that many of the actions we called for in 2017 to ensure Physician Associates could be safely and effectively integrated into the multidisciplinary team have not yet been delivered and it is clear that much greater guidance, support and regulation are urgently required. We are also asking for clarity around the introduction of ‘SAS’ doctors in general practice and we have a number of ‘red lines’ around this role, as well as that of Physician Associates. They must have a careful induction into Primary Care, which is very different from working in hospitals, and ongoing supervision by a qualified GP.

‘'While we very much support the expansion of the multi-disciplinary team in general practice to meet growing demand and deliver a wider range of services in the community, this must occur alongside an increase in the number of family doctors, not instead of it – put simply, we need many more GPs.

“General practice has been allowed to wither on the vine for over a decade due to lack of investment and poor workforce planning and we simply do not have enough GPs to meet demand. Last month, GPs delivered over 32 million appointments, a rise of nearly 5 million appointments per month from September 2019, all with 827 less fully qualified, full time GPs than in December 2019. The average number of patients per GP in England is now an overwhelming 2,296 - an increase equivalent to an extra 153 patients per GP since the end of 2019 – and this is not sustainable, as more GPs are leaving the profession currently than are entering it.

“Our new manifesto for the General Election sets out the seven solutions we need to improve care for patients and safeguard the future of general practice and the wider NHS. As well as increasing the number of medical graduates going into GP training, we are calling on all the major political parties for a fully funded national retention scheme to encourage existing GPs to remain in the profession, and measures to cut bureaucracy so that GPs can spend more time when it is needed most – with their patients.”

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Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.