The College of Medical Associate Professionals (CMAPs) acknowledges the recent publication of the Royal College of General Practitioners’ (RCGP) guidance on the induction, preceptorship, supervision, and scope of practice for Physician Associates (PAs) in general practice. While we recognise the RCGP’s efforts to offer clarity on the PA role, we must express our disappointment with the restrictive scope of practice outlined and the implications this may have on patient care and the professional standing of PAs. The Faculty of Physician Associates have also recently given their response regarding their sadness at such a restrictive document.
There are approximately 2,000 PAs working in primary care, where they are essential members of the healthcare workforce, highly valued for their contributions, and a crucial resource in meeting the growing demands of patient care. We acknowledge that efforts are needed to ensure the standardisation and appropriate integration of the role, but the RCGP’s suggested scope of practice is impractical for PAs across the UK.
We appreciate the RCGP’s Induction and Preceptorship guidance, which provides a structured and supportive framework for new PAs entering general practice. The emphasis on GP-led supervision, regular competency reviews, and ensuring that PAs understand their professional limits are commendable steps towards maintaining high standards of care. These recommendations align with the General Medical Council’s (GMC) expectations for newly qualified PAs and reinforce the collaborative ethos between supervising GPs and PAs.
Concerns Over Restrictive Practice Guidelines:
However, the College of MAPs is deeply concerned about the restrictive scope of practice set out in the guidance, particularly where it diverges from the competencies agreed upon by the GMC and NHS England. The RCGP’s scope places unnecessary limits on the role of PAs, many of whom have been extensively trained to manage a wide range of clinical situations and conditions.
It is deeply troubling that the RCGP’s recommendations restrict PAs from completing tasks they are trained and qualified to perform, as per the GMC’s Physician Associate Registration Assessment (PARA) and educational framework. PAs are trained to recognise conditions, arrange appropriate investigations, suggest management plans according to national guidelines and refer patients appropriately, yet the RCGP’s guidance imposes an extremely low ceiling on their clinical autonomy. With appropriate supervision, in keeping with suggestions from RCGP supervision document and aligned with the GMC recommendations, PAs can be a safe and valuable addition to the primary care workforce.
It is widely accepted that defining a specific scope of practice for clinical staff working in healthcare is extremely difficult. An essential part of healthcare is adaptability and versatility. The scope of practice is based on an individual’s education, training and competence.
Impact on Patient Care:
Prohibiting all PAs from seeing certain patient groups—such as those under 16, pregnant women, those with learning disabilities, patients with mental health conditions or individuals with co-morbidities—significantly and unnecessarily limits PAs ability to provide timely patient care and support their general practice team. This will lead to delays in care and ultimately harm patients by limiting their access to skilled healthcare professionals. In addition, many PAs have dedicated time to developing a special interest in these areas with their supervisor’s support. The RCGP’s suggested scope does not account for PAs who have evidenced their competency, with additional training and further assessment, for example.
The document creates a dynamic where PAs are unable to perform the duties they are trained for and were appointed to do, despite close supervision. There is no clear pathway for progression or reduced supervision if a supervisor is confident in a PA’s ability. This could foster an environment where PAs feel undervalued and hesitant to contribute to patient care out of fear of overstepping boundaries, even when trained and competent.
We are particularly concerned that these restrictions could lead to systemic inefficiencies and potentially compromise patient safety. PAs play a critical role in expanding the capacity of general practice teams. By narrowing their scope, the RCGP risks underutilising a capable workforce, thereby exacerbating the strain on an already stretched primary care system.
The guidance also introduces confusion about the professional development and integration of PAs within general practice teams. Although the guidance was published very recently, it is already out of touch with many processes in primary care and has not considered the move for many practices towards a digital triage with human supervision.
Restricting a PA’s role to administrative tasks or limited clinical functions when they are trained to manage more complex cases creates unnecessary bottlenecks in patient flow. This will delay treatment for patients, reduce the capacity of practices, and undermine the integrated, team-based approach that is crucial for effective general practice.
CMAPs implores the RCGP to align its guidance with the national standards set by the GMC, which reflect the competencies of newly qualified PAs. As the GMC continues to develop the registration framework for PAs, including their educational and professional standards, the RCGP’s guidance should support, rather than limit, the role of PAs in general practice.
We wish to acknowledge our colleagues at UMAP’s statement regarding potential legal action against the RCGP for their scope of practice for Physician Associates and commend their commitment to safeguarding our profession, taking a stand when many have not. We are proud to stand alongside them and watch with interest, ready to lend our support as needed.
Working together for better patient outcomes:
We invite the RCGP to reconsider its guidance and work collaboratively with stakeholders, including the GMC, NHS England, CMAPs and practicing PAs, to ensure that any scope of practice reflects both the capabilities of PAs and the needs of the general practice community.
We call for a constructive review of this guidance, with a view to ensuring that PAs can continue to provide safe, effective, and timely care for patients under appropriate GP supervision. CMAPs supports the RCGPs values of compassion, inclusivity, sustainability, accountability and integrity, and we call on them to bring these values to the forefront of this work – for all colleagues and, most importantly, for patients.
We also encourage further robust research into the role of PAs in primary care, which has consistently shown that PAs contribute significantly to patient care outcomes. This evidence should inform future revisions of any professional guidelines concerning PAs. CMAPs will be delighted to support research into the role of PAs in primary care and provide colleagues and patients with clear and factual conclusions.
Developing a Specialised Postgraduate Training Pathway
We are keen to work closely with the RCGP and collaborate on addressing the challenges facing the Physician Associate (PA) profession. While we recognise the need for improvements, the current situation with PAs in general practice has been left unaddressed by stakeholders, resulting in missed opportunities. We firmly believe that the development of a specialised postgraduate training pathway for PAs in general practice is essential to fully realise the potential of this workforce.
Whether through collaboration with the RCGP, former fellows of your college, or other partners, we are committed to making this pathway a reality. We warmly invite the RCGP to join us in this important venture, working together to create meaningful progress for the profession. CMAPs is open to alternative partnerships should the RCGP be unable to engage, as our priority is ensuring this critical pathway is developed for the benefit of both PAs and the wider healthcare system.
Conclusion
The College of Medical Associate Professionals believes that the role of the Physician Associate is integral to the future of primary care. We welcome the focus on induction and supervision, and we urge the RCGP to avoid limiting the scope of practice for PAs in ways that undermine their contributions to patient care and the general practice workforce.
We are committed to working with the RCGP, as well as other stakeholders, to ensure that the PA profession continues to thrive. We look forward to continuing this dialogue and invite the RCGP to join us in shaping the future of the PA workforce.
Warmest regards,
Officers of the Interim Board
Alice Fitzpatrick BSc (Hons), PgDip, CMAP(PA)
Jack Hill BSc (Hons), MSc CMAP(PA)
Mobashar Rashid BSc (Hons), PgDip, CMAP(PA)
Pauline Weir BSc (Hons), PgDip, CMAP(PA)
References
GMC, September 2022, Physician Associate Registration Assessment (PARA) Content Map; https://www.gmc-uk.org/-/media/documents/pa-registration-assessment-content-map-pdf-87634361-1_pdf-104351674.pdf (accessed 18th October 2024)
FPA, October 2024, FPA Response to RCGP change of position on physician associates working in general practice; https://www.fparcp.co.uk/about-fpa/news/fpa-response-to-rcgp-change-of-position-on-physician-associates-working-in-general-practice (accessed on 30th October 2024)
UMAPs, October 2024, URGENT: Notice on potential legal action against the RCGP; https://umaps.org.uk/blog/2024/10/28/urgent-notice-on-potential-legal-action-against-the-rcgp/ (accessed on 30th October 2024)
