Sessional GPs should not be expected to supervise ARRS staff, says BMA

Supervising non-doctors should not form part of a sessional GP’s job description ‘unless expressly and mutually agreed’, according to new advice from the BMA.

The union said that with the ‘expansion’ of the additional roles reimbursement scheme (ARRS) and the ‘diversification of the workforce’, GPs have seen a ‘dramatic increase’ in supervision responsibilities expected of them.

The BMA has previously recommended that physician associates (PAs) – who are usually employed by practices through ARRS – must have a named supervisor ‘immediately’ available ‘at all times’ while working at GP practices.

Now the union has released new guidance for sessional GPs, clarifying their supervision responsibilities of ARRS roles, including PAs.

GPs also ‘should not be expected’ to sign prescriptions, request investigations or make referrals based ‘solely’ on the clinical assessments made by ARRS staff, the BMA said.

The guidance pointed out that if investigations, referrals or prescriptions are deemed required after initial assessment by ARRS staff, patients ‘should be allowed the opportunity to consult a qualified GP’, and GPs should be ‘given the time’ and opportunity to make ‘their own full and proper assessment’ of the patient.

The BMA also said that supervision should not be included in a salaried GP’s job plan or locum agreement ‘unless expressly and mutually agreed’ and that provision of supervision is the responsibility of the employer.

‘With the personal liabilities and the potential risks to a GP’s professional licence that come with such responsibilities the clinical supervision of ARRS roles remains the responsibility of the employer,’ the guidance added.

It also pointed out that if additional supervision responsibilities are agreed, these need to be ‘remunerated with supplementary pay’.

The union added: ‘Should a sessional GP agree to supervise multidisciplinary team/ARRS roles as part of their agreed job plan, they must be allocated sufficient time to safely perform this role.’

Last week, Pulse’s major investigation into the rise of PAs published last week looked what clinical responsibilities they are being given, and the potential risks in their practice, including a lack of guidance and regulations, meaning that GPs are having to decide themselves how to use PAs in general practice.

Pulse has looked at how effective PAs are and if they reduce GP workload, with some GP partners arguing that ‘heavy’ supervision is ‘the biggest downside’ of the role.

The BMA previously published a national scope of practice detailing that MAPs – including PAs – should never see ‘undifferentiated’ patients in a GP setting.

The ‘scope’ document was met with criticism by PA representatives, with one body threatening legal action against GPs who implement it in their practice.

And NHS England said last week that PAs are a ‘small but important’ part of the NHS workforce plan and ‘crucially’ need to be ‘well-supported as colleagues’.