Physician associates – background to the profession
The Faculty of Physician Associates (FPA) and Royal College of Physicians (RCP) recognise that there are many questions regarding the role of physician associates (PAs), a role established in the UK 2 decades ago.
These questions often relate to how PAs work as part of the multidisciplinary healthcare team, their scope of practice and supervision requirements, pay structure, and the future of the PA workforce.
The FPA and RCP are also aware of a motion in which the British Medical Association (BMA) is being urged to lobby for the PA profession to:
- become regulated by an alternative regulator to the General Medical Council
- change the PA title from ‘associate’ to ‘assistant’.
The BMA contacted the FPA in July 2023 to advise that an article regarding the PA profession will feature in its membership magazine, The Doctor. The FPA was asked to provide a response to the motion and to answer some of the common points of discussion raised by BMA members in relation to the PA profession.
We share that response below for wider readership. This outlines the background to the profession and several important workstreams currently in development at the FPA:
The background to PAs in the UK
Physician associates (PAs) are healthcare professionals who work as part of a multidisciplinary team with supervision from a named senior doctor (GMC registered consultant or general practitioner), providing care to patients in primary, secondary and community care environments. PAs are part of the government’s medical associate professions (MAPs) grouping in the health and care workforce and have been working in the UK for 20 years.
In order to qualify as a PA in the UK, students must complete a postgraduate (level 7, ie a master’s level) degree in physician associate studies. All programmes in the UK are run in accordance with the Competency and Curriculum Framework1 developed by the Department of Health and Social Care (DHSC), the Royal College of Physicians (RCP) and the Royal College of General Practitioners. In line with the planned statutory regulation of PAs, a new curriculum2 is being implemented for all PA schools from September 2023. Once they have completed a PA degree programme, all candidates must pass the PA National Examination, which is delivered by the RCP Assessment Unit, to be able to register as a PA in the UK.
Following the DHSC and Health Education England’s (HEE’s) ambition to grow the PA role in the UK, the Faculty of Physician Associates (FPA) was established by the RCP in 2015 to give PAs a professional home, set standards and importantly, oversee the PA managed voluntary register while lobbying of government continued for timely PA regulation.
The FPA was seen as important to support, shape and understand the needs of the PA profession and fundamentally, to provide clarity to the public on the different scope of practice of a doctor and a PA. Regulation has been slow to happen despite the RCP and FPA campaigning for many years. Following a DHSC public consultation earlier this year, this is now underway and we expect the PA profession to be regulated by the end of 2024.
The GMC as regulator
In 2018 the government announced that it would be pushing forward with legislation to regulate physician associates and anaesthesia associates (AAs). The DHSC explained that all four UK governments would work together to identify the preferred regulator and commence drafting the required secondary legislation.
In July 2019, the DHSC, together with the four UK governments, announced that the General Medical Council (GMC) was the chosen regulator of physician associates and anaesthesia associates (AAs). This came following the closure of a consultation by DHSC that sought the views on the regulation of medical associate professions in the UK. The consultation closed in December 2017 and received over 3,000 responses.3
The consultation report said that the majority of respondents supported the initial proposal that statutory regulation is proportionate for PAs.4 The GMC was then announced as the regulator for PAs and AAs in 2019. The GMC has since produced a range of guidance documents for PAs in support of the forthcoming regulation.5
The 2019 statement by Stephen Hammond – minister of state, Department of Health and Social Care
‘Today I am pleased to announce that we have asked the General Medical Council (GMC) to regulate physician associates (PAs) and anaesthesia associates (AAs) across the UK.
On 7 February 2019 the Government published its response to the consultation on the Regulation of Medical Associate Professions in the UK.
The response confirmed the decision announced on 12 October 2018 by the Secretary of State for Health and Social Care to introduce statutory regulation for physician associates (PAs) and anaesthesia associates (AAs) (formerly known as physicians’ assistants (anaesthesia)). However, we set out that further work was required to decide which regulator would take forward regulation of these roles.
Following the completion of this work, we believe that the GMC are best placed to regulate PAs and AAs. Regulation will enable these groups to work to their full potential and provide the very best care to patients as part of a multidisciplinary clinical team, contributing to the development of a safe and flexible workforce. This is an important step towards meeting workforce commitments in each of the four countries including the Interim NHS People Plan in England.
The UK and Devolved Governments will now work together alongside stakeholders to develop and then consult on draft legislation.’
The FPA, together with the RCP, have continued to campaign for timely regulation of the PA profession, but it is ultimately a process managed by government. In May 2022 we launched a #RegulatePAsNow survey. Over 300 PAs and PA students responded to the survey, detailing how the lack of regulation impacts their role. Following the analysis of the survey responses we published a short policy paper, Physician associates: the case for regulation.6
Why was the role renamed from ‘assistant’ to ‘associate’?
The name of the role changed from physician assistant to physician associate in 2013. At that time the UKAPA (UK Association of Physician Assistants) was the professional body for PAs. This change was backed by the government as it was strongly suggested from within the DHSC that the term ‘assistant’ would hold the profession back from becoming regulated, as it was perceived at that time that ‘assistants’ did not need to be regulated. The title change is also aligned with the establishment of a MAPs workforce group.
PAs work with the supervision of a consultant or GP. Each PA should have a named consultant or GP, who agrees on the scope of practice for that individual PA. In line with GMC guidance on delegation and referral, doctors can delegate tasks to others, but the doctor must be sure that person has the necessary knowledge, skills and training to take on the task. Once a task is delegated, the PA is accountable for the care they provide to patients, including acts and omissions in care.
Day to day, PAs can assess and agree on management plans with patients, but at all times it is clear they must be supervised by a specific consultant or GP. In a secondary care environment, this will usually be the on-call consultant for the area in which they are working, and in a primary care environment, a clearly identified GP. The consultant or GP providing clinical supervision must be available for advice, and/or guidance as appropriate – whether this means attending in person or giving advice through telecommunication. If the consultant or GP providing clinical supervision is not going to be immediately contactable, they must agree with another doctor (ST3 or above) to act as their deputy.
The FPA is currently working on supportive guidance for PAs, consultants, GPs, supervisors and other healthcare professionals who work with PAs. The guidance will give greater clarity on PA supervision. An FPA-led PA supervision survey will also launch in the coming months. This will be sent to all qualified members of the FPA in all four nations of the UK, who will be strongly encouraged to complete the survey. Analysis of the survey will further inform the FPA about the level of supervision PAs receive across a wide scope of specialties and areas.
Junior doctors’ training pathway
PAs were introduced into the NHS workforce to expand access to care for patients and support the workforce, which in turn should free up doctors’ time to fulfil their training requirements. Unfortunately, we do hear from doctors who feel that their training has been negatively impacted by the presence of PAs. Similarly, we hear of examples where PAs have been introduced and doctors have been better able to access training opportunities. We know there are huge capacity issues when it comes to NHS staffing, which are sadly creating some tensions.
The FPA is currently reviewing the PA employer guidance. This will provide best practice examples of where we know PAs have had a positive impact to support greater learning opportunities for all. It is important to recognise that all healthcare professionals require ongoing support, training and development to ensure evidence-based and high-quality care for patients.
The FPA does not set the pay structure for the PA profession, this is the role of the NHS centrally and its associated bodies (eg NHS Employers). Like the majority of healthcare professionals employed in secondary care, PAs are on NHS Agenda for Change (AfC) contracts. PAs working in primary care are employed on a locally agreed contract and salary.
NHS guidance advises that a newly qualified PA working in secondary care should typically start on AfC band 7. The NHS AfC approach uses a job evaluation and matching process to decide the pay bands for different healthcare roles.
Clarity for patients
It is very important that patients have clarity about exactly who is caring for them and the scope of practice of that type of healthcare professional. With PAs being a relatively new and small workforce constituency compared with other more established healthcare groups, the FPA has worked hard to inform and guide the profession, so they understand how to introduce themselves to patients and use the correct terminology.
We are also working closely with the RCP’s Patient and Carer Network to create a new suite of patient explainer materials. This will include leaflets, posters and infographics that will be distributed throughout the UK to clearly explain the role of a PA, how they can support patients, and their scope of practice.
Additionally, the FPA is developing supplementary guidance for PAs on how to introduce themselves, the titles they should and should not use, and a standardised way of documenting their role in clinical notes. The FPA will soon publish this guidance following consultation with stakeholders.
The future of the workforce
The FPA is working to develop a Career Development Framework for PAs. This will ensure that PA employers across all four nations of the UK have standardised guidance as to how to continue structuring the role of a PA and progress them through their careers within their scope of practice.
1 Department of Health and Social Care. The Competence and Curriculum Framework for the Physician Assistant. Department of Health and Social Care/PA working group, 2012. https://www.fparcp.co.uk/file/media/58dbecf8d81ef_CCF_for_the_physician_assistant_2012.pdf [Accessed 16 August 2023].
2 Faculty of Physician Associates/ General Medical Council. The draft Physician Associate Curriculum. FPA/GMC, 2022. https://www.fparcp.co.uk/about-fpa/news/the-faculty-of-physician-associates-launches-a-draft-physician-associate-curriculum [Accessed 16 August 2023].
3 Gov.UK. Consultation outcome – The regulation of medical associate professions in the UK. Department of Health and Social Care, 2017. https://www.gov.uk/government/consultations/regulating-medical-associate-professions-in-the-uk [Accessed 14 August 2023].
4 Department of Health and Social Care. The regulation of medical associate professionals in the UK, consultation response. DHSC, 2019 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/777130/maps-consultation-report.pdf [Accessed 14 August 2023].
5 General Medical Council. Bringing physician associates and anaesthesia associates into regulation. GMC, 2022 https://www.gmc-uk.org/pa-and-aa-regulation-hub/map-regulation [Accessed 14 August 2023].
6 Faculty of Physician Associates. #RegulatePAsNow campaign update and policy paper launched. FPA, 2022 https://www.fparcp.co.uk/about-fpa/news/regulatepasnow-campaign-update-and-policy-paper-launched/ [Accessed 14 August 2023].
7 Faculty of Physician Associates. #RegulatePAsNow campaign update and policy paper launched – continued updates on the road to regulation. FPA, 2022 https://www.fparcp.co.uk/about-fpa/news/regulatepasnow-campaign-update-and-policy-paper-launched/ [Accessed 14 August 2023].