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The role of GP assistants

The role of GP assistants

In October, the NHS announced plans to boost the GP workforce ahead of winter. A key part of this plan is the recruitment of over 1000 GP assistants to help GPs reduce the amount of time they spend on administrative tasks and basic clinical duties.

The move is supported by the Royal College of GPs (RCGP). However, the chair, Professor Martin Marshall, emphasised the importance of appropriate training for GP assistants and stressed that “they are not a substitute for GPs or other clinical staff, and they must not be expected to work beyond their levels of competence”.

GPs will be ultimately responsible for training GP assistants and for the work that they do, so appropriate indemnity cover is essential.

What is the role of a GP assistant?

The role of GP assistant (or Medical Assistant) was developed to relieve the administrative burden on GPs and enable them to focus on patients’ clinical needs.

The GP assistant job description may include:

  • Sorting and prioritising clinical post
  • Extracting information from clinical letters that needs coding
  • Arranging appointments, referrals, tests
  • Preparing patients for GP appointments
  • Dipping urine, taking blood pressure, electrocardiograms, phlebotomy
  • Completing basic (non-opinion) forms
  • Explaining treatment procedures to patients
  • Helping the GP liaise with outside agencies
  • Supporting immunisations and wound care.

Practices can choose how to deploy GP assistants within the outlines of the job description and competency framework. In some practices, the role is purely administrative; in others, it combines administrative and basic clinical tasks.

How do GP assistants benefit practices?

Following a successful pilot of the GP assistant role in the North West of England, Health Education England (HEE) implemented a national programme in 2019. By 2021, over 350 GP assistants had completed training. Feedback from GP practices and staff was positive, suggesting that adoption of the role may benefit practices by:

  • Improving patient access
  • Enabling highly qualified staff to focus on patients with more complex conditions
  • Improving patient flow, increasing efficiency, reducing waiting times
  • Supporting patient experiences by reiterating information from the GP
  • Enhancing GP retention and job satisfaction
  • Reducing the time spent by GPs on correspondence
  • Creating financial savings.

Feedback also showed benefits for the staff members who trained for the GP assistant role, with the new career pathway providing increased job satisfaction, a formal qualification, and sometimes a stepping stone to further clinical training.

Training for GP assistants

GP assistants receive on-job training and development led by GP mentors, in line with the national competency framework. Staff who undergo training may also seek accreditation, for which they must generate a portfolio of evidence.

A formal accreditation programme is available to provide guidance and support throughout the process, which is based on a framework of 5 clinical and non-clinical domains:

  • Care certificate (clinical)
  • Clinical (clinical)
  • Communications (non-clinical)
  • Administration (non-clinical)
  • Managing health records (non-clinical).

Trainees complete each training domain through an on-line learning portal, with support from a GP mentor who signs off the trainee’s evidence of competency. Training may be supplemented with external courses in topics such as phlebotomy if that is not delivered in the practice.

The training provider will verify the submitted evidence and give certification. Overall, the training should take 6–9 months to complete. HEE expects to expand the accredited programme with additional places in 2023.

The push to recruit GP assistants

The Additional Roles Reimbursement Scheme (ARRS) for 2022/23 now includes funding for four GP assistants per primary care network (PCN). PCNs can recruit to the role, predominantly through trainee positions, and claim reimbursement for salaries and some on-costs (maximum reimbursable amount at Agenda for Change band 4). Practices can also recruit GP assistant staff directly, either externally or from their existing staff team.

Dr Amanda Doyle, NHS England national directory of primary and community care, said: “Giving patients timely and convenient access to GPs and primary care is vital, especially during winter, which is why we are introducing brand new roles and giving GPs more flexibility to create teams that best meet the needs of their local population”.

GPs are responsible for overseeing the GP assistant role

GPs are responsible for the guidance and supervision of GP assistants and the services they perform under the NHS contract. In the document, Frequently Asked Questions: General Practice Assistants, HEE states that “the GP assistant’s primary mentor should always be a GP, who may draw on support from other health professionals in the practice/PCN.”

Other health professionals who support training must be appropriately trained and qualified themselves, with full endorsement by the GP practice team following a risk assessment, for indemnity/insurance purposes. A secondary mentor may also support and sign off training in the non-clinical domains of the accredited course. However, the GP mentor maintains overall accountability and any concerns must be relayed to them.

If you are recruiting or mentoring a GP assistant and have questions about your medico-legal responsibilities or indemnity, please c

Automatic patient access to GP-held medical records: Roll out goes ahead

Automatic patient access to GP-held medical records: Roll out goes ahead

In November, NHS England’s plans on Accelerating Citizen Access to GP Data will be rolled out across England, in line with 2019/20 GP contract requirements. Patients aged 16 and over, whose GP practices use TPP and EMIS systems, and who have online accounts, will be able to view new entries to their own medical records using approved app services.

According to NHS Digital, 80% of NHS App users want easy access to their health information and research suggests potential benefits, such as empowering patients to manage their own health and reducing practices’ administrative burden. Indeed, the positive experiences of ‘early adopter sites’ are encouraging in terms of workload and safety.

Yet concerns over the implications for patient safety, GP workload and information governance led to considerable delays in implementation. NHS England has now provided further clarification and guidance for practices as the roll out goes ahead.

What records will patients see?

Patients will be able to access health records including free text, letters, and documents, but not administrative tasks or communications between practice staff.

Importantly, practices will be able to customise or remove individual patient access if online access is not appropriate. Furthermore, test results will be accessible only when checked and filed, so clinicians will be able to contact patients and discuss the results first.

Delays and concerns

NHS England originally planned to allow patients automatic access to prospective data entries from December 2021. However, concerns over safety and GP workloads meant that the plans were pushed back until April, then 1 November, 2022.

In October, the British Medical Association (BMA) and Royal College of General Practitioners (RCGP) raised concerns that not all practices would be able to uphold their obligations to patients in terms of information governance (as data controllers) as well as clinical safety if automatic access was enabled.

The BMA advised that practices could write to their system supplier and request a delay. In response, EMIS and TPP, the largest suppliers of patient online services, announced a pause to the scheme.

Roll out in November

NHS England subsequently released an update, confirming that prospective data entered into patient records from 1 November 2022 would automatically become visible to patients in a phased way.

However, EMIS and TPP were instructed to pause the scheme for practices that asked them, by 5pm on 4 November 2022, to not enable the change. NHS England asked those practices to engage with local commissioners for additional support and to agree plans to prepare for their systems to be automatically enabled to offer prospective records access from 30 November 2022.

The status of general practices as data controllers

The update makes it clear that patients will be offered digital access to their prospective health records through a ‘purely technical’ change in functionality to GP IT systems, and that:

“General practice retains full local rights, with a range of options to disable the new functionality and/or withhold patient access to some or all of their health information, to meet their obligations as data controllers and to ensure safe access.” The legal basis is now clarified on the NHS Digital website.

Are you ready? Action lists for practices and GPs

NHS England has provided resources to support general practice in preparing for the switch-on of prospective record access, including: RCGP patient online toolkit, ‘how to’ videos, and information governance guidance. In particular, GP staff should work through the GP readiness checklist.

Key actions include:

  • Ensure staff receive relevant training about data entry and safeguarding processes.
  • Identify patients who may be at risk of harm from automatic records access, such as those at risk of domestic violence or coercion; ensure that safeguarding processes are in place. It may be necessary to redact certain information or to prevent patient access.
  • Establish procedures to redact information that is unsuitable for patient view (such as confidential third-party data), in compliance with data protection legislation.
  • Correctly update the clinical system organisation (global) settings for online services to enable prospective patient records access.
  • Promote and offer prospective access to patients.

The RCGP patient online toolkit advises practices to establish a record-keeping policy.

What to do if your practice is not ready

For those practices not ready to proceed in November, NHS England provided guidance about how to locally disable the functionality or to deny individual patient access if necessary:

  • Before the technical change, practices can exclude individual patients by adding the appropriate SNOMED code to their records, or apply the code to groups of at-risk patients by using reports.
  • After the technical change, practices can amend the individual patient configuration or redact individual elements.
  • To disable the record access functionality, view the guidance on updating the organisational settings.
  • Practices may have the option to disable access to specific components of the record, depending on the clinical system.

Please contact us at Medical Defense Society if you have any medico-legal queries or concerns about the implementation of automatic patient records access.