UK GPs vote to scrap physician assistants

The RACGP is urgently calling for a stop to the proposed expansion of physician assistants (PAs) in Australia after GPs in the United Kingdom voted to do the same, saying GP-led medical assistants already have a role to play.
 
The British Medical Association (BMA) GP Committee recently voted to put an end to hiring PAs in general practice, resulting in an ‘overwhelming majority’ in favour of the role of PAs being deemed ‘fundamentally unsafe’, for no new PA appointments in general practice, and existing roles to be phased out.
 
‘The role of a [PA] is inadequately trained to manage undifferentiated patients, and there should be an immediate moratorium on such sessions,’ the passing vote states.
 
In Australia, RACGP President Dr Nicole Higgins told newsGP this is a national issue and wants the Department of Health and Aged Care to ensure PAs are not rolled out – because they are a less qualified, cheaper workforce solution to substitute for doctors.
 
Dr Higgins said Australia already has a solution.
 
‘We already have medical assistants within Australia – they are health professionals trained to work under supervision of the doctor and not independently, which really supports our team approach,’ she said.
 
‘And that’s a model I actually do think we should be really promoting.’
 
Currently training a medical assistant in her own practice, Dr Higgins said they can work supervised, supporting much of GPs’ administrative burden.
 
‘PAs often work as a bridge between the different team members, such as doctors and nurses and allied health under the supervision of the GP,’ she said.
 
‘That model is still providing support and coordination, working with GPs and within the general practice team – it’s a model that we already have in general practice, which is why we don’t need PAs.’
 
Introduced in 2005 in Australia to help ease workforce pressures, medical assistants’ roles combine administrative and clinical responsibilities under the supervision of any health or medical practitioner.
 
In the UK, the BMA says any existing PA roles should be given opportunities to retrain into ‘more suitable ancillary NHS roles’ with patient safety and workforce solutions the priority.
 
‘It’s no secret that we desperately need more staff in general practice, but we need to be sure that staff who see patients are suitably trained and competent to see them unsupervised,’ Chair of the BMA’s GP Committee Dr Katie Bramall-Stainer said.
 
‘Workload is inextricably linked to the recruitment and retention of the workforce, so additional roles should not generate more work for already-stretched GPs.
 
‘The bottom line is getting more GPs into the workforce … the [UK] Government must urgently invest in practice staff such as GPs and general practice nurses.’
 
Dr Higgins previously warned that any rollout of PAs in Australia will devalue general practice and limit GPs’ scope of practice, following a Queensland Government proposal to embed them in Sunshine Coast Hospital as a workforce solution. 
 
‘In Queensland, they’ve been having those discussions but haven’t actually included general practice, so that’s the challenge,’ she said.
 
‘But this is something that’s being entertained as a workforce solution all around Australia.’
 
The RACGP has also repeatedly raised concerns about the Australian healthcare system not following the same failing path as the NHS, with UK doctors leaving in droves, placing more pressure on the overstretched workforce.
 
It says that increasing PAs in Australia may reduce GP numbers and resourcing for the current health workforce roles. 
 
With role substitution also remaining a key concern amid the ongoing Federal Government’s Scope of Practice Review, Dr Higgins reiterates the message of ensuring GPs’ role is not devalued.
 
‘The reason we don’t need PAs in general practice is they are non-medically trained health professionals who aren’t qualified to diagnose and manage the problems that present within general practice,’ she said.
 
‘And it’s a very different situation to the hospital system. Role substitution is not a workforce solution.’
 
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