Frequently Asked Questions

Prescribing

PAs are currently unable to prescribe medication in the UK. However, close work with supervising physicians and arrangements developed individually and supported by the trust or practice can allow for flexible ways of working and a continuation and expansion of quality patient care. For instance, many PAs working in general practice may propose medications, and have the ability to quickly interrupt their supervising physician for a signature and authorisation and then continue their work. If further advice on a case is required, the consultant/GP and PA take time out to discuss it and/or see the patient together to come to a decision on further treatment.  

Administering medications

PAs are currently unable to administer medication via a patient group direction (PGD) and this is unlikely to change post regulation, as it requires a change to the Human Medicines Regulations 2012, which is not planned at present. PAs can administer medications under a patient specific direction (PSD), which is a written instruction, signed by an authorised prescriber, for medicine(s) to be administered to a named person after the prescriber has assessed the patient. 

This has to be on an individual patient-by-patient basis. This process is more commonly referred to as a 'prescription' in clinical practice, but the legislation refers to this method as a patient specific direction.

Under the GMC’s Ethical guidance “Prescribing at the recommendation of a professional colleague” a registered doctor may delegate the assessment of a patient to another professional, so long as that doctor is satisfied that the person to whom they delegate to has the qualifications, experience, knowledge and skills to make the assessment. As such, it is possible for a PA to assess a patient and then recommend a medication to a doctor for prescription, so long as that doctor is happy with this process. The format that this takes is decided at the local level, between the PA, their supervising consultant/GP and the employing organisation.

The supervising consultant/GP needs to ensure the PA has the necessary knowledge and competency to administer a medication (including pre, during, post issues, complications and other necessary procedures). The PA needs to ensure that the patient has a patient specific direction (PSD) signed by a prescriber prior to the administration of the medication.

Additionally, each employing organisation will have a medicines policy which will dictate which healthcare professionals are authorised to administer medications to patients within that organisation. These policies must be followed by the physician associate, no different than other healthcare professionals.

Vaccinations

PAs should have been trained in administering a vaccination when studying to be a PA. There is a free online e-LfH course on immunisations and vaccines which PAs may wish to consider completing from e-LfH Immunisations/Vaccines.

All healthcare professionals advising on immunisation or administering vaccines must have received specific training in immunisation, including the recognition and treatment of anaphylaxis. They should maintain and update their professional knowledge and skills through appropriate training.

There is no mandatory need for PAs to complete the aforementioned course, unless your supervising consultant/GP wants to use the course as proof of competency or if you do not feel competent to safely administer vaccines, or recognise and treat complications such as, but not limited to, anaphylaxis. All PAs should be familiar with Immunisation against infectious disease - 'The Green Book' which details the requirements.

Vaccinations/immunisations would need to be prescribed via the patient specific direction method, as described above, and PAs cannot legally administer vaccinations/immunisations via patient group directions.

COVID-19 Vaccination

Health Education England e-Learning for Healthcare has worked in partnership with Public Health England and NHS England and NHS Improvement to develop the COVID-19 Vaccination e-learning programme.  The e-learning programme is designed to provide the health and care workforce involved in the national COVID-19 vaccination programme with the knowledge they need to confidently promote high uptake of the vaccine and deliver the vaccine programme effectively.

The programme currently consists of one core knowledge session, which covers subjects including vaccine eligibility and legal aspects, and an accompanying multiple-choice assessment session.  All those undertaking this e-learning should complete the core knowledge session as this is designed to provide essential knowledge about COVID-19 and the key principles of vaccination needed to deliver the vaccine.

This e-learning programme provides theoretical training.  Practical training in vaccine administration, and assessment and sign-off competency is also required before administering the COVID-19 vaccine.

Learners should also complete the vaccine specific session(s), when available, which will provide more detailed information about the vaccine(s). The assessment sessions should be completed after each knowledge session.  More vaccine-specific sessions will be added as and when more COVID-19 vaccines become available.

Additional, complementary, e-learning sessions including Basic Life Support, anaphylaxis and statutory and mandatory training are available to support vaccinators’ training and education.

For more information about the COVID-19 Vaccination programme, including details on how to access, visit the e-LfH website.

NHS England and NHS Improvement are also currently recruiting allied health professionals, including PAs, graduate PA students and those employed and eligible to be employed in the Assistant Practitioner role to undertake training to deliver the vaccine. For more information on getting involved in the vaccinator programme, please go to: https://www.england.nhs.uk/coronavirus/join-the-nhs-covid-19-vaccine-team/#i-am-currently-working-in-the-nhs

Minor surgery

Many PAs assist in the theatre environment and perform minor surgical procedures. It would not be necessary for a qualified PA to attend a course prior to entering the theatre environment or scrubbing in, as student PAs complete a surgical rotation during their pre-registration training. Once qualified, PAs are able to scrub in for procedures where their supervising surgical consultant deems this as appropriate.

Qualified PAs attending theatre for the first time as a qualified PA with their consultant should be supervised and a competency document (eg DOPS) completed to evidence competency in ‘scrubbing up/in’.   

Where a PA is authorised to perform a surgical procedure, this should be formally evidenced and agreed by both the surgical consultant and the PA. This authority and agreement should be reflected in a governance framework and recorded, usually in the form of a surgical log book and/or DOPS.

PAs should meet the same requirements for evidencing competency in performing the procedure to the same standard as that of colleagues performing the procedure. PAs performing surgical procedures should also be competent in managing potential complications of the surgical procedure. 

Supervision requirements

Supervision of a qualified physician associate is similar to that of a doctor in training or a trust grade doctor, in that the physician associate is responsible for their actions and decisions; however the consultant is the clinician who is ultimately responsible for the patient.

PAs have a named consultant/GP, who sets the scope of practice of the PA. However, day to day PAs may report to and discuss patients with other consultants, or nominated agreeing registrars. There is no legal requirement for the supervising consultant/GP to be on site, however they must be immediately contactable to discuss patients should the need arise and appropriate escalation plans/policies in place should an immediate physical review by a doctor be required.