The expansion of clinical and non-clinical teams through the introduction of the Additional Roles Reimbursement Scheme (ARRS) was aimed at reducing the ever-increasing pressure on general practice and to improve access. Of course, there are benefits associated with these roles, but there are also some challenges.

Role clarity is perhaps one of the most significant challenges the Physician Associate (PA) cadre faces; they’re there to complement the existing clinical team, not replace, and concerns about how they’re working in general practice have been steadily increasing. During a recent practice visit, I asked if they employed a PA and the response was, “No, they’re too complex to manage.” This was first-hand experience of resistance to this specific ARRS role.

However, lots of practices do successfully employ PAs, yet I do wonder how such negativity in the media is affecting those currently working in the role. They’re an asset to both primary care and secondary care and I think there’s some unfair criticism of PAs, yet I don’t believe the new supervisory requirements will help to overcome this resistance.

So, have the BMA done enough to reduce this resistance by introducing the Safe scope of practice for Medical Associate Professionals (MAPs), which should be adopted by NHS organisations who employ PAs? This guidance has three key concepts:

1. PAs follow, and do not give, medical directives; they act upon the medical decisions of a doctor. A PA does not make independent treatment decisions
2. PAs must not see undifferentiated patients
3. National standards for supervision must be set and adhered to

The supervision of PAs has been the subject of much discussion and debate, and only last week the BMA published specific guidance for the supervision of Medical Associate Professions (MAPs), which is to be read in conjunction with the safe scope of practice. Points to note:

• GPs are suitable supervisors; they must provide one-on-one supervision
• GPs must consent to supervising PAs (in writing) to be properly indemnified
• GPs can only delegate tasks in line with the traffic light table (Safe Scope of Practice document)
• Every patient must be discussed with the supervisor in full and then reviewed in person if necessary

Supervisors can save a record of their formal supervision sessions with the PA to HR Checks Manager, part of the HR Package, in the HUB.

I started off by saying the aim of the ARRS roles was to reduce pressure, yet this new guidance requires PAs to be debriefed fully by their supervisors about every patient. Also, the supervisor needs to be available to review the patients in person if necessary. Is it just me or do you agree that this will do nothing but increase the workload of GPs? Where are supervisors going to find the time to supervise without this directly increasing their workload or reducing the availability of GP appointments in practices?

The supervisory requirements are undoubtedly a cause for concern for PAs, and let’s face it, no other role in the practice is subject to so much scrutiny (supervision). Is there sustainability in employing PAs in general practice or do the challenges outweigh the benefits? And what do you do if all your GPs don’t consent to supervising PAs?

Unfortunately, there are so many questions still waiting to be answered, meaning that there are around 3,250 PAs wondering what the future holds. From December 2024, PAs will be regulated by the GMC; maybe then they will be treated like their colleagues and follow similar supervisory and revalidation requirements. Only time will tell. Here’s hoping for a positive outcome.