‘They said not to worry, then I was made redundant’: Uncertainty continues for PAs in primary care

Posed by a model. Credit: Getty/SolStock

By Emma Wilkinson

Ahead of the publication of the Leng review, Doctors.net.uk looks into the impact the lack of clarity around PAs in primary care is having on GPs and those in the controversial role.

The outcome of a government-commissioned review into the safety of physician associate (PA) roles is due this summer.

Former NICE chief executive Professor Gillian Leng, who is looking at cost-effectiveness of the role and how it should be supervised, has admitted she is “walking a tightrope”.

Put in place after serious concerns were raised by medical leaders about regulation and scope of practice, the review has found PAs had been employed to fill gaps where doctors could not be recruited which Professor Leng said “was concerning for a number of reasons”.

Yet the only clue she has given away on the recommendations so far has been that a change in the name of PAs “could add clarity”.

General practices who have been left navigating how to safely employ PAs - who may have been with them for many years - are hoping the review will provide some clear answers.

The Royal College of General Practitioners issued guidance last year severely limiting the work PAs were able to do and has told the Leng review there is “no role” for the roughly 2,000 PAs working in general practice.

PA trade union United Medical Associate Professionals had estimated that guidance from the RCGP and BMA in 2024, which advised strict limits on the PA role, led to around 200 redundancies.

Sarah* qualified as a PA in 2018 after a previous undergraduate degree in biomedical science. She had worked in two GP practices over six years.

When the RCGP guidance was published she was told she no longer had a job.

“It totally took the floor out from under me,” she says. “My practice had already made some changes to ensure there was enough supervision after the BMA statement. They had always been very supportive and had told us not to worry and that we were valued. Then the next week we were made redundant.”

The practice told the team they felt duty bound to follow the RCGP guidance. “I was 95% of the way through a diploma. I had worried that my role would change and wondered what that would look like. But I had never thought I would be out of a job completely.”

Sarah says she had always had good feedback and felt well supported and supervised by the practice with a debrief at the end of the day but also had the ability to seek advice straightaway if she was concerned.

'I do feel exploited'

What happened to her is not a “normal redundancy”, Sarah explains, “it is a career ender”.

There is no equivalent role in the NHS and she has not seen any PA vacancies currently advertised. To provide for her family she searched for months for another job before finally landing a band 2 NHS admin role.

“I do feel exploited," she says. "I had spent years training and learning and working hard. You think about all the extra hours you’ve done, and in the end it doesn’t matter in the slightest. It was heartbreaking and I haven’t come to terms with that.”

It also feels like a huge waste for NHS England who paid thousands for her training, she adds.

“I don’t think I could go back to working as a PA now because you need that support behind you. I do want to use my experience but it’s really hard to see how to do that.”

Sarah had done an audit of the PAs in her practice that she was in the process of writing up when she was made redundant. She says it showed that the PAs she worked with knew when to debrief and were aware of their limits and that they were safe.

Credit: Getty/SolStock

Leng has asked practices to provide evidence of how PAs were working to inform the review as well as their own views and experiences of working with PAs. She has said the role was introduced without “a clear vision” but also that the evidence she has had to work with is “limited”.

A spokesperson for the BMA says they had produced guidance on what PAs can safely do because of the “repeated failures by the previous government, senior NHS leaders, and the GMC to provide clear safe practice parameters for PAs”.

“This led to a situation where there were increasing cases of patient harm being reported, while concerns across the medical profession escalated,” they add.

RCGP chair, Professor Kamila Hawthorne says the college’s guidance was intended to “provide clarity on how these roles can be managed with patient safety in mind". 

“We wish to reiterate that the RCGP PA guidance is advisory" and "aims to support GP practices and current employers of PAs", she says.  

She adds: “We have always been clear that it is for employers to decide whether to follow our guidance and that it is their responsibility to ensure the appropriate treatment and handling of existing PA contracts.” 

Dr Ellen Welch, Doctors Association UK vice chair and a GP in Cumbria, says she very much feels for all the PAs working in general practice who are now struggling to find employment. “I would like to think there is a role within a struggling system for them to use their skills," she adds.

But she agrees "it is not appropriate for them to be working independently seeing undifferentiated patients in the same way as a GP."

"The position was rolled out without adequate planning with no definition around their scope of practice and, sadly, we have seen the consequences of this with some fairly high-profile cases of patient harm,” Dr Welch says.

'A reaction to bad practice'

But Dr Rebecca Ryell’s practice in North Cornelly, Wales, is one of those who hired PAs because they could not get doctors. It was encouraged by the health board who were trying to avoid the practice closing completely.

They have continued to employ their PAs – who they have invested time and energy in – while they wait for the outcome of the Leng review.

“Since the RCGP guidance we have changed our whole system to total triage. We give them cases that we feel are going to be straightforward for them and we review their cases afterwards as well.”

The limited scope of practice that had been advised by the BMA and RCGP does not seem to take into account the PA’s level of experience or training, she adds.

“It has been a reaction to bad practice – and there have been some awful stories so I understand that completely – but there have also been implications for areas where there is good practice,” she adds. “We’re doing our best to operate and support them until we get further advice.”

Dr Ryell has had colleagues make the point that the PA role is undermining the role of the doctor but she does not agree. “We make it clear they’re not doctors, and we have always had formal appraisal to set an individual scope and help them develop professionally.”

The limited scope advised by the RCGP has put the practice in a difficult situation, she notes. That “narrow” scope has to be balanced against the fact experienced members of the team are capable of more, she says.

“Practices should be able to use PAs in a way that aligns with their particular skillset,” Dr Ryell says.

“Uncertainty around the scope of practice has put significant additional pressure on a practice in a deprived area still struggling to cope with demand and recruitment.”

NHS England and the Department of Health and Social Care have been contacted for comment.

• Not her real name, at her request

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