The Faculty of Physician Associates responds to the British Medical Journal's physician associates in general practice article
An article published in the British Medical Journal (BMJ) on 11 July 2023 addresses the role of physician associates (PAs) in general practice, following the tragic death of patient Emily Chesterton. FPA president Jamie Saunders and RCP registrar Professor Cathryn Edwards submitted a joint rapid response to the article.
Their rapid response can be read here or below.
Dr Salisbury’s letter1 highlights important issues raised by the tragic death of a young woman recently debated in Parliament in reference to the role of Physician Associates (PAs). We hope we can all agree on the benefits of multidisciplinary practice in healthcare, recognising the importance of appropriate training, role boundaries and supervision.
Much to our disappointment, the Physician Associate profession is still awaiting regulation. The Faculty of Physician Associates (FPA) and Royal College of Physicians (RCP) have long called for the introduction of statutory regulation of PAs3 and this is finally on the horizon with the government consultation period ending last month4. If regulation by the General Medical Council (GMC) now proceeds at the pace promised, they are expected to open a register for PAs at the end of 2024.
In lieu of statutory regulation, the Faculty of Physician Associates introduced the PA Managed Voluntary Register (PAMVR), which allows employers to check whether an applicant or employee is a fully qualified physician associate. The FPA/RCP communicate at regular intervals with employers across the UK to strongly recommend that all PAs employed within a trust or GP practice are registered on the PAMVR.5 The FPA recommends that PA registration is checked regularly in case a PA’s status changes, or they are removed from the register.
Regarding qualifications, we would like to clarify that student physician associates complete a two-year, postgraduate (level 7 i.e., master's level) qualification in physician associate studies, which involves teaching in medical science and clinical reasoning and consists of 50% theory and 50% practice. Developed in partnership with the RCP and Royal College of General Practitioners (RCGP), a national competency framework has been in existence since 2006, within which all student PAs in the UK are trained (reviewed and updated in 2012).
The FPA has also published several documents relating to supervision of PAs, an issue we see as pivotal in this tragic case. The Competency and Curriculum Framework (2012) clearly states that PAs "will always work under the supervision of a designated senior doctor (consultant, registrar or general practitioner)”. The FPA Code of Conduct additionally states that PAs "will always work under the supervision of a designated senior medical practitioner"6. Furthermore, Health Education England has also published guidance for PAs working in primary care which clearly states that PAs work under the supervision of a GP7, as has NHS England8, and there are multiple resources on the FPA website which give examples of how supervision could work in general practice settings.
We agree with the author that in stressed clinical environments supervisory named GPs, or in the secondary care setting consultants and senior medical practitioners, may struggle to fulfil the required supervision of physician associates and other professionals. The time and the ability to oversee all healthcare practitioners requiring supervision in primary and in secondary care needs to be addressed with urgency at a national level, so that the value and skill of associate professionals can be deployed to their most safe and effective use.
1. Salisbury S. Physician associates in general practice. British Medical Journal. 11 July 2023. https://www.bmj.com/content/382/bmj.p1596
2. Keeley B. Physician associates. Hansard. 6 July 2023, col 1025. https://hansard.parliament.uk/commons/2023-07-06/debates/D98F2ABE-7B33-4748-B88E-ED7243469131/PhysicianAssociates
3. Faculty of Physician Associates, Royal College of Physicians. Physician associates: the case for regulation. 29 July 2022. https://www.fparcp.co.uk/about-fpa/news/regulatepasnow-campaign-update-and-policy-paper-launched/
4. Department of Health and Social Care. Regulating anaesthesia associates and physician associates. 17 February 2023. https://www.gov.uk/government/consultations/regulating-anaesthesia-associates-and-physician-associates
5. Faculty of Physician Associates. Employing physician associates. May 2023. https://www.fparcp.co.uk/file/image/media/64674e0d24ec3_Letter_to_Employers_-_Employing_PAs_not_on_the_MVR_final_2023.pdf
6. Faculty of Physician Associates. Code of conduct for physician associates. July 2023. https://www.fparcp.co.uk/file/media/64cba37dcd431_FPA_code_of_conduct_July_2023.pdf
7. Health Education England. Preceptorship Year for Physician Associates (PAs) in Primary Care. March 2022. https://www.hee.nhs.uk/sites/default/files/documents/PAPreceptorshipPC.pdf
8. NHS England. Supervision guidance for primary care network multidisciplinary teams. 16 May 2023. https://www.england.nhs.uk/long-read/supervision-guidance-for-primary-care-network-multidisciplinary-teams/
Jamie Saunders BSc (Hons) MSc FHEA
Jamie is the current President of the Faculty of Physician Associates, and a physician associate in haematology.
Professor Cathryn Edwards OBE MA (Oxon) D.Phil FRCP
Cathryn is the current Registrar of the Royal College of Physicians, and a consultant physician and gastroenterologist.