Dr Heidi Mounsey, Medicolegal Consultant at Medical Protection, answers some of the questions we have been receiving about supervising physician associates (PAs) and anaesthesia associates (AAs).
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Medical Protection has received a number of queries about supervision and the working arrangements of physician associates (PAs) and anaesthesia associates (AAs).
Some members will be familiar with working with PAs and AAs, and will be practising in environments where they are well integrated. Others will not however and could face working with people in such roles more over time if numbers increase as projected.
We know that this has been an area of concern for doctors and not just those who have contacted us proactively. We therefore thought that it would be helpful to summarise some of the key points in a brief article.
We are here to help
The first point we would like to emphasise is that if an issue arises in relation to the supervision of individuals working in a PA or AA role, you can as a Medical Protection member come to us to request support and assistance.
While this article provides an overview of the key considerations, we know some members will have specific concerns about your responsibilities in this area. We are very happy for you to contact us for tailored advice.
Delegation
GMC guidance sets out that when you delegate a task to a PA or AA, you should be confident that they have the necessary knowledge and skills to undertake the task, and that you have provided clear instructions about what is expected of them. You should encourage them to raise any questions or concerns they have about the task they are undertaking.
The GMC highlights that there is no one approach that would fit every circumstance, and supervision arrangements can range from “close personal supervision” to a “managed support system with clear escalation protocols”. The level of supervision should be tailored appropriately to the individual and subjected to regular review.
GMC guidance sets out that when delegating, such as requesting a PA to carry out a task or a review of a patient, you are accountable for the decision to delegate; the instructions you provide; the processes in place for ensuring patient safety; and the overall management of the patient if you are the clinician in charge.
You must be satisfied that the person you are delegating to is competent to carry out the task, or will be adequately supervised. The GMC considers that delegation would usually be to colleague registered with a statutory regulatory body – e.g. another doctor registered with the GMC, or a nurse registered with the Nursing and Midwifery Council – but does note that if the individual is not registered with a statutory registered body, registered on a managed voluntary register may give some assurance of their competence. For PAs, until statutory regulation is in place, this would be the Physicians Associate Managed Voluntary Register.
When delegating, you should check that your colleague understands what they are being asked to take responsibility for, and that they have the opportunity to ask questions or raise any concerns they may have about undertaking the task. In addition, you should check they know when they should be seeking input from a more senior colleague, and that they are aware of any escalation protocols in place.
It may seem concerning to read about your responsibilities, particularly that you may remain accountable for the overall management of the patient, but you are not accountable for the actions (or omissions) of those to whom you have delegated, as long as you have delegated in line with the principles set out by the GMC.
Some members have asked us whether it is their responsibility to ensure PAs or AAs have the right skills for the post they are in. Employers of PAs or AAs should ensure that the individual they are recruiting has the appropriate skills and competence for the role they are recruited to within a team, and set out the responsibilities and expectations within that role. However, when you are delegating a task to a PA or AA, you should still ensure you are following the guidance outlined above. If you hold concerns that a PA or AA is not appropriately skilled or qualified for the tasks they are undertaking, we recommend that you raise this with your clinical lead in the first instance.
Prescribing
When asked to prescribe on the recommendation of a PA, remember that you remain responsible for the prescription, and therefore you should be satisfied that the prescription is necessary and appropriate for the patient, and the medication is within your own competence to prescribe.
If you are uncertain whether the prescription is appropriate, you should take steps to assure yourself that the prescription is necessary and suitable for the patient – this may require you to examine or review the patient yourself.
You should be supported by your employer to carry out your supervisory role, including access to training where required. The scope and responsibilities of your role should be clearly defined, with time available to carry these out. If your individual responsibilities are unclear or you have any queries, we recommend you speak to your employer in the first instance.
Further information
As stated earlier, if you have any specific concerns about your responsibilities in this area, or if an issue arises in relation to the supervision of individuals working in a PA or AA role, we are very happy for you to contact us for further advice and support.