The clinical pathways delivered under Pharmacy First are a 'good starting point' to define the scope of practice for Physician Associates (PAs), the Royal College of GPs (RCGP) has said.

Pharmacists must undertake additional training to deliver minor ailments consultations under Pharmacy First.

But the RCGP suggested that 'first point of contact presentations' of over 16s with suspected minor or common conditions, 'with clear clinical pathways and escalation processes' would be within the scope of practice for PAs without any extra training.

It suggested this could include conditions such as otitis media, urinary tract infections (UTIs) and sore throats.

This comes as part of three new documents issued by the RCGP which set out guidance on preceptorship and induction of PAs, supervision arrangements, and detailed descriptions of what a PA can and cannot do in clinical practice.

On clinical scope, the RCGP said: 'The seven common minor illnesses used in the Pharmacy First programme in England are a good starting point.

'The list of minor conditions a PA can see must be agreed and documented, with clinical protocols for diagnosis and management.'

The RCGP stressed that PAs 'must not see patients who have not been triaged by a GP' and must only undertake work 'delegated to them by, and agreed with, their GP CS [clinical supervisor]'.

And it said the triage process must 'incorporate patient preferences about the healthcare professional they see'.

The RCGP also advised practices that they should only employ PAs that appear on the Physician Associate Managed Voluntary Register - meaning that they have successfully completed the two-year postgraduate programme and passed the PA national exam, or, once the profession is regulated by the general medical council (GMC), physicians who appear on the GMC’s Register of PAs.

The Royal College of Physicians' Faculty of Physician Associates notes that 'PAs are dependent practitioners working with a dedicated medical supervisor'.

And the RCGP has called for a national preceptorship programme to fund the supervision and ongoing education of PAs in GP practices in England.

The RCGP also suggested that other clinicians working in general practices might be involved in supervising some teaching sessions with the PA preceptee, although the GP clinical supervisor and GP educational supervisor would be 'ultimately responsible for these teaching sessions'.

While the RCGP said it was not within its remit to 'enforce this guidance', it noted that it 'may be taken into account by NHS Resolution and the Medical Defence Organisations in a case of alleged negligence or clinical or professional mistakes'.

‘Ultimately, it is the decision of employers whether to follow this guidance, and the employer’s responsibility to ensure the appropriate treatment and handling of existing PA contracts,’ it added.