The role of physician associates: what does the future hold?

The NHS is under significant and growing strain. According to the British Medical Association (BMA), more than six million patients are waiting for treatment in England.¹ Along with rising demand, workforce shortages, and struggles to recruit and retain staff are putting services under mounting pressure.

Physician associates (PAs) are part of the solution to addressing NHS workforce shortages outlined in the NHS People Plan.^2,3 PAs are included in the Government’s medical associate professions (MAPs) grouping in the health and care workforce, and have been working in the UK since 2003.⁴

However, in recent months discussion has centred around regulation of PAs and how to limit the pace and scale of the PA rollout. This article looks at the role, the benefits it brings and the challenges it faces.

What are physician associates?

PAs are healthcare professionals with a generalist healthcare education who work alongside doctors and surgeons providing medical care as part of the multidisciplinary team. They work under the supervision of a named senior doctor – such as a named General Medical Council registered consultant or general practitioner – but can work autonomously with appropriate support. They can be found working in primary and secondary care across 20 specialty areas in the UK such as internal medicine, general practice, surgery, and emergency medicine.⁴

Responsibilities include taking patients’ medical histories, performing physical examinations, diagnosing illnesses, and seeing patients with long-term chronic conditions.⁵

“Physician associates are an important part of clinical teams across the NHS, providing support to thousands of patients with appropriate supervision every day, while freeing up other clinicians to care for those patients who need their expertise the most,” says an NHS England spokesperson.

There are currently around 3,500 PAs on the managed voluntary register. However, there are plans to expand these numbers considerably. The NHS long term workforce plan published in June 2023 said that NHS England will incrementally expand the number of PA training places to over 1,500 per year by 2031/32, eventually establishing a workforce of 10,000 PAs by 2036/37.⁶

An NHS spokesperson says the NHS has been “working closely with the GMC on the development and regulation of these internationally recognised roles for many years, which will ensure the highest standards are met as thousands more are trained, alongside a near doubling of medical school and nursing training places over the next 15 years as part of the NHS Long Term Workforce Plan”.

Ross Raymond-Jones is a PA, based at an acute frailty unit in the University Hospitals Plymouth NHS Trust, and also a PA lecturer at the University of Plymouth Faculty of Health. He was a nurse before becoming a PA.

There are “multiple routes” to becoming a PA, he says. A standard PA entry route is an intensive two-year full-time Master’s programme, which requires students to already hold an undergraduate degree, usually in a biomedical or health/life science field. PAs may have had previous careers in healthcare. Other routes include a four-year MPAS, and more recently the introduction of a level 7 apprenticeship for physician associates.

Beyond their training, PAs will need additional support once they are in post. PAs are used as supplementary members of the multidisciplinary team in a wide range of clinical areas, and under the supervision of a named senior doctor. They operate within the limits of their competence and a defined scope of practice, which is decided locally by the supervising consultant or GP and may change over time as their knowledge, skills and experience develops.⁴

Currently, as an unregulated profession, PAs are not able to prescribe or request ionising radiation, such as a chest X-ray or CT scan.⁴ However, this could change.

GMC regulation of physician associates

This February, Parliament approved the regulation of PAs by the General Medical Council (GMC).⁷ This follows a consultation launched by the Government in December, which sought views on the legislative provisions that will give the GMC the necessary powers to regulate PAs in the UK.

The legislation provides a high-level regulatory framework and gives the GMC more autonomy to set out the details of its regulatory procedures in its rules. The draft legislation will also pave the way for full scale reform of the regulatory frameworks of all the healthcare professional regulators by providing a template upon which the GMC can build.

However, many doctors are concerned the move will present a significant risk to patient safety. The BMA has consistently spoken out against regulation by the GMC of PAs. It says it will blur the lines between medically qualified doctors and other professionals who are not doctors and have fewer years of training and experience.

Prior to Parliament preparing to approve regulation, the BMA took out an advert asking MPs to act on doctors’ very clear warnings and not wave through the “ill-thought through plans”.

Last December, A BMA survey found that 86% of doctors felt patients were not aware of the difference between these roles and those of doctors, showing the immense scope for patient confusion about the level of care they are receiving.

The BMA has also called on the health secretary to launch an independent inquiry, after reports that PAs are being used to fill medical rotas, despite Government ministers and leaders of NHS England making promises that PAs cannot and must not be used to replace doctors.

PAs want to support doctors

Ross Raymond-Jones says PAs “want to support doctors – it’s what our role is designed to do”. “However, the best way of holding that role to account is to have a statutory regulatory body. And while as individuals we don’t get to choose who that regulatory body is, it makes the most sense to be the GMC, given they regulate the very profession we are designed to support and work alongside.”

Recognising the title ‘physician associate’ can cause confusion among patients, who may not know the difference between PAs and doctors, he says: “While I may not have chosen this title, it is our responsibility as PAs to make sure patients and colleagues are aware of who we are.

“We need to make it clear to patients when we introduce ourselves what our role is, and that while we are not doctors, we are working alongside them as part of their team,” he says.

He discovered the PA role eight years ago, while doing his nurse training. “I wanted to do some kind of advanced role that involved diagnosing and examining patients,” he says. “The PA role was the chance to join a new and growing profession, and all the opportunities that come with joining something early, and to take two years out of clinical work to focus on my studies.” Funding was made available from a local trust to do the PA course, and in response he agreed to work for them for a set period of time.

Since then, he says his career has “chopped and changed within the physician associate world”. He worked in secondary care for a year in endocrine and healthcare of the elderly wards, and joined the Health Education England PA ambassador scheme to promote and help educate people about the PA role. As part of that role, he moved around different general practices in the south west.

“We found one of the best ways to get people to understand the PA role, was to work with one. Going into it, people were not sure how a PA would fit into the team. But then, after experiencing the dynamics first hand, they would see how it worked,” he says.

Currently working back in secondary care and in part time lecturing, he will shortly be starting a PhD in medical education. “You have to very much make your own opportunities when joining this profession – there aren’t clear career ladders to climb and set pathways – you have to tread your own path,” he says.

How the PA role works in practice

In his PA role he sees himself generally as “an extension of a senior doctor”. “I’m there for that doctor to delegate tasks to me that they – and I – feel are within my scope of practice, with the hope that frees up time for the senior doctor to do other tasks more suited to their skill set and expertise.”

What a PA does will “vary significantly, depending on the area, and their experience, and who their supervisor is”, he says. “Currently, there is a lot of debate about defining the scope of practice for PAs so it’s clearer for patients and other staff members where the scope of practice starts and ends, and we welcome that,” he says.

A common scenario is for PAs to clerk patients, including taking a thorough medical history and requesting initial imaging – a potentially time-consuming process. The PA then presents that information to the consultant, who can add to it, rather than having to start afresh, he explains. “And the longer you spend with a consultant you get to know how they think and what they would and wouldn’t want.” he says.

“PAs can also provide continuity as they tend to be based in one area, and they will come to understand how a particular healthcare system works, which is something really valued by senior consultants,” he says.

He values “the privileged position” that comes with being a PA. “You are supporting patients who are very vulnerable who trust you with their health. And you get to have incredible conversations with strangers.”

A large part of his role is service provision, he says. “There’s a lot of enjoyment in providing that service and being able to care for people as part of your job.

“And there’s not many other roles where you get to work alongside such talented teams of not only doctors, but also other healthcare professionals. And we’re all working to the common good of improving patient standards and helping people. It’s an amazing role. It’s just a shame that the NHS environment is under such strain.”

A challenge is communicating the nuances of the role to the public, patients, and healthcare staff. But he believes “this will become easier as more people come into contact with PAs”. He also wants PAs to be able to prescribe and to request x-rays. “Not being able to do so creates a barrier in terms of delivering quick care to patients. It’s a challenge for PAs who have been qualified for some time in trying to be as efficient as they can.”

A major issue is the concerns being raised about PAs. “The frustrations surrounding physician associates are often shared by PAs themselves,” he says.

“PAs would rather you talk to them rather than about them, if someone doesn’t understand the role” he says. “There is a need – and a want – to educate people about the role, and hopefully inspire more people to consider becoming PAs – despite the current climate around them. The NHS is only going to become more diverse for professionals, and there’s room for many different types of people with different backgrounds to work in all these new roles.”

Resources

• NHS Employers has published guidance for employers on how physician associates fit into the NHS workforce: https://www.nhsemployers.org/articles/physician-associates
• The Royal College of Physicians and Faculty of Physician Associates have published guidance for employers: https://www.fparcp.co.uk/about-fpa/news/fpa-launches-an-employers-guide-to-physician-associates

References

1 BMA (2024) NHS backlog data analysis. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis

2 NHS England (n.d.) Medical Associate Professions. https://www.hee.nhs.uk/our-work/medical-associate-professions

3 NHS England (n.d.) NHS People Plan. https://www.england.nhs.uk/ournhspeople/

4 NHS Employers (2024) Physician associates. https://www.nhsemployers.org/articles/physician-associates

5 NHS health careers website NHS. (n.d.) Physician associate. https://www.healthcareers.nhs.uk/explore-roles/medical-associate-professions/roles-medical-associate-professions/physician-associate

6 UK Parliament (2024) Anaesthesia associates and physician associates.  [https://lordslibrary.parliament.uk/anaesthesia-associates-and-physician-associates/#:~:text=There%20are%20plans%20to%20expand,10%2C000%20Pas%20by%202036%2F37

7 Royal College of Physicians (2024) RCP welcomes legislation to regulate the role of physician associates.

https://www.rcplondon.ac.uk/news/rcp-welcomes-legislation-regulate-role-physician-associates#:~:text=The%20RCP%20welcomes%20news%20that,it%20can%20be%20made%20law.