RCGP has been equivocal about government’s changes to use of ‘associates’ without medical training to treat patients

The Royal College of GPs has deleted an article that detailed the extent of the lack of supervision by fully-qualified doctors over the actions and decisions of the ‘physician associate’ (PA) roles – who have only two years’ training – whose use the government is expanding.

The use of PAs, which is considered by ninety percent of doctors to be dangerous to patients and confuses many patients, who do not realise that they have not been seen and treated by a fully-qualified medic, is being pushed by the government as a way of ‘downskilling’ the NHS, reducing costs and allowing increased profits for private providers, under the guise of the so-called ‘NHS Workforce Plan’ as part of the ‘Integrated Care Systems’ (ICS) project.

ICS, formerly called ‘Accountable Care Organisations’ (ACOs) after the US system it copied, were renamed after awareness began to spread that ACOs were a system for withholding care from patients and that care providers were incentivised to cut care because they receive a share of the ‘savings’. The system remained the same, but the rebranding disguised the reality.

Now, as Pulse magazine has revealed, the RCGP has deleted a case study that revealed a shocking lack and laxity in the supervision of a PA:

According to the now-deleted case study, held a ‘minimum’ of 27 10-minute appointments each day and asked the on-call doctor to review patients for an ‘urgent opinion’ only ‘once every two to three months’…

…After screenshots circulated on social media, the RCGP removed the case study at the PA’s request…

…The case study previously said: ‘[The PA] has three, ten-minute appointment slots in a row, and at the end of those slots has a ten-minute break for administration and including having prescriptions signed by a GP.’ 

It said supervision is ‘shared’ between GPs working at the practice, and that for ‘non-urgent concerns’ there is a ‘ten minute debrief with an on-call doctor’ which takes place every two to three weeks.

Matt Kneale, co-chair of the Doctors’ Association UK which along with the British Medical Association is opposing the changes, said:

Much of the concern from doctors in recent months has built up from a lack of transparency from Royal Colleges about where they stand on physician associates.

While we are grateful that the RCGP has removed what can, at best, be described as unprofessional practice, we maintain that the College needs to sit down with wider stakeholders on the concerns around PA roles and scope more generally.

The RCGP has voiced ‘concerns’ about the new system, but has not formally opposed it, despite the outrage of doctors and the increasing examples of companies hiring PAs instead of doctors and even making doctors redundant to switch to PAs.

The government’s expansion and renaming of these roles, along with backdoor to regulate them via the General Medical Council (GMC), which regulates doctors – is part of what experts call ‘scope creep’: physician’s assistants and anaesthetist’s assistants, as they were originally called, are valuable roles in carefully limited settings, but NHS England, the government body appointed to run (and run down) the NHS has been using them way beyond their original scope, for example even to perform some types of brain surgery and expecting them to ‘learn on the job’.

The government used a ‘statutory instrument’ to pass these changes, avoiding proper parliamentary scrutiny, but both the Tories and Keir Starmer’s Labour support these and other measures to cheapen the NHS for private involvement and only independent MP Claudia Webbe spoke against them during the brief debate. Green peer Natalie Bennett has tabled a motion in the House of Lords in an attempt to kill the instrument, but without support from the notional ‘opposition’, it is unlikely to succeed.

During the Statutory Instrument debate, Tory former Health Secretary Therese Coffey gushed about the potential for using three associates to anaesthetise patients during operations, with just a single consultant anaesthetist monitoring remotely as an ‘efficiency’.

At least two people have already died avoidably because of misdiagnosis by PAs. Emily Chesterton, 30, who didn’t realise she wasn’t seeing a doctor, was treated for a calf strain when she had a deep vein thrombosis that led to a lethal embolism. Ben Peters, 25, was sent home from A&E with a ‘panic attack’ that was really a serious heart condition.

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