The Royal College of Physicians has recently proposed 16 receommendations relating to physician associates in the UK.
Managed voluntary register
Among the 16 proposals that were presented to the RCP council, the final recommendation may be the most contentious. The recommendation that the RCP move to close the PA managed voluntary register (PAMVR) to new members, while providing support to existing registrants through the transition period to GMC regulation, was proposed.
However, consensus on this recommendation was not reached and the RCP will likely seek urgent legal advice about this recommendation, before making a final decision later.
The MVR exists to prove to employers that their PAs have passed a nationally recognised examination set by the RCP for qualifying as a PA, and has a code of conduct and mechanisms to investigate the fitness of PAs to practice.
Prohibiting new registrants from joining could encourage employers to hire non-FPA PAMVR members, which could pose a risk to patient safety. PAs will be heavily pushed to join the GMC register from December 2024, even though it will not be required until 2026 or 2027. The RCP has recommended that as soon as the GMC register opens, the NHS should require applicants to be on the GMC register in order to be hired.
The other recommendations in the report commit the RCP to publishing an update to members about the FPA-RPC financial relationship, and an explanation of how the RCP will lobby to prevent the PA role from expanding further.
Additionally, the RCP has committed to other works, such as:
- publishing an open letter outlining its updated policy position on support for the Long Term Workforce Plan.
- consulting other parties on National Guidelines for Safe and Effective Practice for PAs, by the end of July.
- The RCP will write to the GMC, to get clarification on the GMC’s role in supervising the national scope of practice for PAs after qualification.
Prescribing powers for PAs
The RCP also intend to obtain additional guidance from the GMC about the PA’s arranging prescriptions for their patients, including whether the patient needs a direct review by a doctor before a prescription is written. The RCP will also commission the medical defence organisations to to comment on the legal ramifications of doctors writing prescriptions on behalf of PAs.
In the future, any process by which PAs could gain prescribing powers, the rules governing this, and whether or not PAs will be classified as medical or non-medical prescribers, are also being investigated by the RCP’s work. The RCP has further stated that they will issue guidance to doctors to abide by the existing legal and regulatory guidelines on delegated prescribing and requests for ionising radiation.
Scope of practice of physician associates
The RCP state that other royal colleges and specialist societies should create national scopes of practice for PAs in their field. The RCP will interact with the Royal Pharmaceutical Society to establish a clear understanding of the role PAs play in prescribing medication. The RCP will work with with the Royal College of Radiology to establish best practice for PAs when ionising radiation is requested for their patients.
Research into PAs impact
The RCP has stated that it will review evidence, such as from the British Medical Association and other sources, about PAs and seek to investigate further concerns include related to the standard of training, supervision, competency, and the possibility of role misunderstanding. The RCP will aim to establish an evidence basis for the economic analysis of PAs, and an assessment on the introduction of PAs and its effects on patient safety and training of junior doctors and medical students.
The RCP highlight that doctors should be properly financed and have dedicated time for supervising PAs, and also that educational supervision of doctors and medical students should be given precedence over the supervision of other professional groups.
Finally, the RCP council has decided to reiterate to RCP members and pertinent stakeholders that restricting the pace and scope of PA position deployment is now RCP policy. This has been the RCP’s official policy since their EGM in April. However, the RCP admit that the pace and scope of PA role growth are not solely the RCP’s responsibility.
The recommendations from the RCP come on the back of news where the RCP has promised to collaborate with the Faculty of Physician Associates to create a detailed plan for its transfer to an independent Faculty of PAs.