UMAPs Open Letter regarding National Health Service England Publication “Ensuring safe and effective integration of Physician Associates into general practice teams through good practice” 

Written by UMAPs Ltd

April 5, 2024

Dear Professor Sir Stephen Powis, Dr Navina Evans and Dr Claire Fuller,  

UMAPs wishes to take the opportunity to acknowledge NHS England’s (NHSE) work and dedication regarding their communications on the safe and effective integration of Physician Associates (PAs) in General Practice.   

We recognise the continued reinforcement of NHSE position that PAs remain an integral part of the MDT and NHS Long Term Workforce Plan. We hope this will reinforce confidence for GP’s and practices investing in Physician Associates. Those services utilising PAs in the front line of their urgent and same day provision should feel reassured by the inclusion of references, finally reinforcing the ability of PAs to see undifferentiated patients.  

This document provides well needed advice in what has been a recently confused, pool of guidance for the appropriate standard for effective, efficient and safe clinical supervision for Physician Associates – which has led to significant mismanagement of our members in recent months. The BMA Scope of practice document, and its suggested implementation in Primary care, has caused additional concern for already stressed GP Partners. Where implemented it has put our members in direct confrontation with Employers with risks of litigation. It has also denied patients access to well trained, caring professionals who were passionately and safely improving health outcomes. The continued promotion of this document is causing harm and we urge the BMA to consider its withdrawal.  

Whilst it is perfectly reasonable for the BMA, a trade union, to draw attention to medical issues impacting is members, it is well outside of scope and jurisdiction to write a scope of practice document for another profession. 

Throughout the debate on Physician Associates, one core point has been apparent, which is the universal focus and concern to maintain and protect patient safety. This has been balanced with ensuring and promoting their right to access timely and well targeted care. As a profession, we have seen the rare but tragic incidences of patient harm attributed to clinician error, ineffective PA supervision and system failure. The case of Emily Chesterton has been used as an example, and we are grateful to the parents of Emily Chesterton for their campaign to raise awareness of appropriate supervision responsibilities for practices employing PAs for the general practice. As a profession, we have all reflected on this event, and part of the outcomes of this is the recognition that appropriate care and provision must be invested in, from the offset, when considering employing any associate professional (arguably any professional) role in general practice.       

Ultimately, PAs need to be supervised in clinical settings, working under the dedicated supervision of a named consultant or general practitioner. As previously mentioned, UMAPs welcomes a nationally recognised minimum standard of supervision for new PAs in general practice. From our discussions, this guidance does not place an unnecessary new burden of debriefing every single patient with the supervising GP, regardless of simplicity, and we welcome the clarity from your retention of the previous stance on supervision and debrief shown in your 2023 guidance on supervision requirements. Referencing the NHSE May 2023 Supervision guidance for primary care network multidisciplinary teams, we recognise this facilitates GPs to implement appropriate debriefing for PAs, dependant on experience in specifically General Practice.  This means that despite additional time upfront for supervisors, PAs will still be a solid investment for the primary care workforce which will rewards GP partners with a permanent, well-trained Medical Associate Professional over time.   

We would echo calls for the GP preceptorship to be made mandatory for all new starting PAs in General practice. This would enable GP specific training post qualification whilst working that would equate to an additional training time of 1-2 years. This would allow quality assurance for partners and the public alike.  

We were also very glad to understand that removing “prescribing activities” from the user roles, did not reference our long-established practice of proposing medications for authorisations from our supervising doctors and that this should continue.   

Rightfully, there was concern from GP partners engaged with us, that this document increased the burden of supervision and the restriction of proposing a prescription unnecessarily made the business case for PAs in primary care exponentially less convincing. Your welcome clarification around these points has helped us calm these fears to support those GPs who have employed PAs safely for over 2 decades. In these practices, where the PAs are an integral part of patient access and care and have adequate supervision, there is no need to add an additional burden to their PAs or duty supervising doctors and so they can indeed retain their workforce. 

It is clear that your statement is essential in the work to ensure that new PAs, Clinical supervisors and Practices understand what is expected as part of the ongoing development of clear, safe and effective clinical working relationships. UMAPs, on behalf of our subscribed membership, wishes to ensure that every PA is best cared for and supported in this pursuit, whilst keeping patient confidence, safety and care at the forefront of clinical practice.   

We are looking forward to supporting the engagement between appropriate and relevant stakeholders as we approach GMC regulation later this year. Your continued promise to engage on these issues together adds hope that our members views will be acknowledged and considered during the ongoing discussions to balance the need for optimal patient safety, the support of MAPs in the workforce and their efforts to facilitate timely patient access to their NHS.   

PA Stephen Nash, 
Founder/Chief Exec. UMAPs 
On behalf of UMAPs Caretaker Committee 

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