To help meet the evolving needs and complexities there are a growing number of registered and non-registered practitioners who hold dual roles within Primary Care. Whilst this can enhance flexibility and efficiency, it may also raise challenges and has the potential risk of staff working outside of their scope and competencies within a session. As a result of this, we have developed this guidance to support both employers and individuals in navigating these challenges safely

Potential issue

Where employees are currently working in dual roles for example:

  • Health Care Assistant (HCA)/ General Practice Assistant (GPA)
  • Receptionist/ General Practice Assistant (GPA)
  • Physician Associate (PA) /Nurse/other professional 

When individuals work across multiple roles, there can be uncertainty around which tasks are appropriate in any given session.  This can increase the risk of staff inadvertently working outside of their scope of practice, which may impact patient safety and indemnity cover.

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It is obligatory that all parties concerned with allocating and giving care, to fully understand the law surrounding roles, accountability and delegation. Examples of where roles can be blurred: Individuals working as both a General Practitioner Assistant (GPA) and a Health Care Assistant (HCA) within the same practice. GPAs cannot give Vitamin B12 injections or perform anticoagulation monitoring assessments. However, HCA’s can do these tasks if they have received the appropriate training, and it is within their scope to do so.

  • Individuals working as an HCA and is a Student Nursing Associate. Both elements have different scopes of practice, and employers need to be aware of the professional scope Standards of proficiency for registered nursing associates – The Nursing and Midwifery Council
  • Individuals working as both a Registered Nurse and another role e.g. a Physician Associate (PA). Where one role is legally able to prescribe, and the PA role is currently not.
  • Receptionists and Phlebotomists. Receptionists arenot indemnified to perform venepuncture unless trained and working in a phlebotomy appropriate clinical setting
  • NB This is not an exhaustive list

Recommendations

  • Ensure job descriptions accurately reflect the responsibilities and scope of each role. These should be reviewed and updated as roles evolve
  • Individuals must work within their scope of practice as defined in their job description and contract of employment
  • There should be robust processes in place to ensure appointments and tasks are allocated appropriately
  • Individuals have a responsibility to decline tasks allocated to them that is outside of their scope
  • Employers and individuals are encouraged to familiarise themselves with the scope of cover provided by the Clinical Negligence Scheme for General Practice (CNSGP), and to understand when additional or alternative indemnity arrangements may be required: What’s covered by CNSGP? – NHS Resolution

We hope that you found this guidance helpful however if you have any further queries, please do not hesitate the Training Hub Team kmicb.kmpcth@nhs.net

who will be happy to advise.

For any specific concerns or questions around Employment Contracts and Dual Roles, Clarkson Wright and Jakes Ltd can be contacted as per the information on the Kent LMC website.

Useful Links:

Physician Associate Role:  Physician associates

General Practice Assistant Role: General Practice Assistants | NHS England | Workforce, training and education

Health Care Professions Council:  Scope of practice | The HCPC

NMC: The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates – The Nursing and Midwifery Council

delegation-and-accountability-supplementary-information-to-the-nmc-code.pdf

Nurses Accountability and Delegation to Nursing Associates Nurses Defence Service – UK.

British Journal of Nursing – The nurse’s legal duty to safely delegate tasks and to follow up the outcome