RCGP strengthens ‘red lines’ on Physician Associates working in general practice

Following discussion at its UK governing Council meeting today, the Royal College of General Practitioners has strengthened and updated its position on the role and regulation of Physician Associates (PAs) working in general practice. 

The Council confirmed the College’s existing ‘red lines’ on PAs, and voted to add two more, explicitly stating that the training and retention of GPs must be prioritised and that the responsibilities and skills required by GPs to supervise PAs must be recognised and resourced. 

The RCGP’s updated position now stipulates: 

  • PAs working in general practice must always work under the supervision of qualified GPs. 
  • PAs must be considered additional members of the team, rather than substitutes for GPs. 
  • PAs do not replace GPs or mitigate the need to urgently address the shortage of GPs. 
  • PAs must be regulated as soon as possible. 
  • Public awareness and understanding of the PA role must be improved. 
  • Training, induction and supervision of PAs within general practice must be properly designed and resourced. 
  • At a time of significant GP workforce challenges, funding allocations, resources and learning opportunities within general practice must be prioritised for the training and retention of GPs. 
  • The significant responsibility and skills required for supervision must be recognised and resourced, with GPs able to choose whether they are willing to undertake supervision of PAs. PAs should not be employed unless sufficient supervision can be provided. 

Whilst continuing to recognise that regulation of PAs is vital and must happen as soon as possible, Council members raised significant concerns that PA regulation by the General Medical Council could increase confusion amongst patients about the differences between doctors and PAs. It was therefore passed by Council vote that the RCGP should change its stance on this issue and that another regulatory body would be more appropriate to take this crucial work forward to regulate PAs. Regardless of the regulatory body, as previously stated, it is also important that any costs of the regulation of PAs must not be transferred to doctors. Given legislation was passed through the House of Lords last week, the RCGP will need to enter into discussion with the GMC and other key stakeholders to look at how these concerns can be addressed. 

Council also agreed that the RCGP should consult with members on the role of PAs in general practice settings, including their scope of practice and supervision arrangements. This consultation will commence in the coming weeks and will inform the development of College guidance. 

Professor Kamila Hawthorne, Chair of the RCGP, said: “At our Council meeting today, we brought together GP voices from across the country, with wide-ranging views and experiences on this pressing issue. We had a rich, thoughtful and informed debate on the role of PAs working in general practice, what this means for our patients, and what the next steps for us as a College should be. 

"While recognising that regulation is overdue, there was deep concern amongst our members that if the GMC takes on the role of regulator for PAs this will create further confusion for patients over the differences between doctors and PAs.  In addition, we have articulated two further principles that must underpin the role of PAs in general practice, including the vital need to ensure that their supervision is adequately resourced and funded. 

“We hope that by reaffirming and strengthening our red lines, we will be able to bring some more clarity to our members - and we will continue to make the case to Government and other decision makers, that PAs in general practice, must be deployed in a way that ensures the safety of our patients and the sustainability of our healthcare system. 

“The College’s position comes from the recognition that PAs can fulfil a potentially supportive role in general practice by taking on specific workload areas, but this must be done in the right way. I’m pleased that our upcoming consultation with members will help us set standards and produce some practical guidance on how best to incorporate these team members.  However, PAs are not GPs, cannot replace GPs, and must not be used to ‘plug the gaps’ of GP shortages that have been created by years of underinvestment and poor workforce planning. 

“GPs are the equivalent of hospital consultants, specialising in general practice, and we need thousands more of us to deliver the increasingly complex care our patients need. No matter how many additional roles are introduced, they will never be a substitute for GPs and decision and policymakers need to realise this.” 

Further information

RCGP press office: 0203 188 7659

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.