GPs should not treat patients not seen by a GP, the guidance says

GPs should not treat patients who have not been seen by a GP, new guidance says.

Medical assistants, or PAs, should also declare that they are not a doctor and wear clear name badges when seeing patients, according to new guidance by the Royal College of General Practitioners (RCGP).

The college’s official position is that PAs should not work in general, but it has produced guidance on working with them in line with NHS plans to increase their use.

Physician assistants (PAs) are graduates who have completed two years of post-graduate training but do not have a medical degree.

Their role is to “support doctors to assess and manage patients” and around 3,500 work across GP surgeries and hospitals.

This work was reviewed after the death of Emily Chesterton, who suffered a pulmonary embolism in 2022 at the age of 30.

He was misdiagnosed twice by a PA he believed to be a doctor.

RCGP guidance includes a scope of practice, which states that PAs should not see a patient who has not been examined by a doctor first and should only carry out work assigned to them by their GP manager.

PAs should keep records of the care and advice they give to patients, including information shared on behalf of the GP, with notes made of each appointment signed by the GP at the end of the day surgery, according to the guidelines.

Name the badges

Staff must wear “highly visible name badges”, and PAs must ensure patients understand their role and the fact that they are not a doctor when they present themselves.

The guideline also states that practices must have a list of members of the multidisciplinary team on their website, with a description of each part of their work and protocol when booking appointments to explain to patients who they will see, with the option of discussing who they will see. love to see.

In June, a survey of RCGP members found 81 percent thought that negative effects on patient safety were one of the problems with using PAs in general.

Professor Kamila Hawthorne, head of the RCGP, said: “I don’t think there’s been proper guidance given out there. It’s not clear to anyone who should be giving that guidance.

“I think we’ve all thought that it should be NHS England that does it, because NHS England is the organization that has developed and promoted them and they’re talking about progress in careers related to doctors.

Surely they should have been thinking about what will happen to high school students after they graduate? Medical professionals do a lot of terrible training, but nothing prepared for PAs. ”

The RCGP recommends that all PAs who wish to work in general attend a one-year program to transition them into the workplace, also known as publicists.

Under supervision

The College recommends that PAs always work under the supervision of a named physician. All named supervisors must have educational and supervisory training prior to participation.

Professor Hawthorne, who supported the development of the PA role, said the RCGP’s “initial position” was to support the position but “our council doesn’t think so” at the moment.

“Who knows if, as time goes by, we will change it again. But for now, I think it’s better to stick with the reality of where we are now,” he said.

“There are too many PAs that we feel are not being regulated and we are seeing indiscriminate cases of people who may not have anything wrong with them, but they may have something wrong with them. they, and the PA is not experienced enough and not trained, of course, to know who is seriously wrong and who is not,” he added.

It comes as the British Medical Association (BMA) said it is funding a legal challenge by Anesthetists United which calls for more clarity on the use of PAs and partners, anesthetists’ partners.

The legal challenge was supported by Ms Chesterton’s parents.

An NHS spokesman said: “The NHS has always been clear about the role that clinical partners play in supporting medical teams to deliver high-quality care to patients – they are not replacements for doctors, but teams. of support that have specific tasks that they are trained to do, under supervision.

“We know that the trust of the public and the medical community is vital as we build the NHS workforce fit for the future, which is why the NHS has issued updated guidance on the appropriate delivery of these jobs, and We will continue to work with the government, medical groups and patients to provide a clear explanation of these duties to patients and the public, before the GMC legislation comes into force at the end of the year.