Physician associates in general practice
Physician associates (PAs) are a relatively new member of the clinical team, seen as complementary to GPs rather than a substitute. In October 2018, the secretary of state for health and social care announced the introduction of statutory regulation for physician associates and physician assistants in anaesthesia, following direct engagement with the NHS workforce. Once this is in place, PAs will be able to prescribe and order radiology investigations.
The Physician Associate role is in no way a replacement for any other member of the general practice team. They work in conjunction with and are complementary to the existing team. GPs will continue to lead multi-disciplinary teams, adapting to the evolving primary care networks. (PCNs)
By employing a PA, it does not mitigate the need to address the shortage of GPs or reduce the need for other practice staff. They can help to broaden the capacity of the GP role and skill mix within the practice team to help address the needs of patients in response to the growing and ageing population.
It is strongly recommended that GP practices only consider recruiting physician associates who are registered on the Physician Associate Managed Voluntary Register (PAMVR).
There is a lot of general information in the employers section, that as a GP or practice manager you may find useful. You can also watch videos of physician associates talking about their work in general practice.
Your local Health Education England (HEE) area leads
Please get in touch if you need more national or local information, discuss ideas or help answer your questions.
- Kent, Surrey & Sussex. Professor Hilary Diack. Head of Primary and Community Care Education. [email protected]
- London. Emma Bailey. Associate Workforce Transformation Lead. [email protected]
- London. Lisa Hughes. Workforce Transformation Lead. [email protected]
- South London. Elaine Lancaster. Associate Workforce Transformation Lead. [email protected]
- Midlands & East. Christopher Lawson. Project Manager. [email protected]
- North. Judith McGregor. Physician Associate Programme Lead. [email protected]
- Wessex. Sue Hill. Workforce Transformation Lead Wessex. [email protected]
- South West. Marc Lyall. Transformation and Education Development Lead. [email protected]
- Thames Valley. Tessa Candy. Associate Workforce Transformation Lead. [email protected]
There has been some misunderstanding about what this means for individual practices. Under the new primary care network (PCN) arrangements, the directed enhanced service (DES) means each PCN (not every practice) may apply for 70% of funding for a qualified, experienced PA. PCNs eligible for funding must show that the role is providing additional services and must have been created after 31 March 2019. Please refer to section 4.5 of the Network Contract DES Specification 2019/20.
Networks should typically cover 30-50, 000 patients. Potentially that means funding would be apportioned between 4-6 practices. You can find more information on the BMA website.
Studies from general practice in both England and Scotland have shown physician associates to be safe, effective and liked by patients. The Faculty of Physician Associates run an annual census for all UK PAs and student PAs
Other examples include:
- Barriers and facilitators to integration of physician associates into the general practice workforce 2017
- RCGP position paper on physician associates working in general practice 2017
- Investigating the contribution of physician assistants to primary care in England: A mixed methods study updated 2016
- Physician associates and GPs in primary care: a comparison 2015
- BMA LMC Briefing on physician associate 2015
There's a short 3 step guide to recruiting a PA along with a job description and person specification template that you can download at the end of these FAQs. These resources are for guidance and may be adapted as required.
We strongly recommend that any employer looking to recruit a physician associate checks the applicant is registered on the Physician Associate Managed Voluntary Register (PAMVR).
We know there are not enough practice nurses or advanced nurse practitioners working in general practice. As an additional role, physician associates can supplement and complement the skill set of GPs, nursing and other clinical staff. It means that more clinicians are being trained, rather than ‘poaching’ from other professions – such as nursing that also have a shortage.
Over recent years there has been a steady increase in the number of large partnerships resulting in the consolidation and growth of a number of GP patient lists. In turn, the traditional staff roles have expanded and developed to meet the needs of the practice.
In addition to being supervised by and working with GPs, PAs may work alongside other professions including:
- General practice nurses including advanced nurse practitioners
- Healthcare assistants
- Clinical pharmacists
- Mental health therapists
- Practice managers
- Reception and clerical staff
In some parts of the country, it’s more difficult to recruit GP trainees. As an alternative clinical role, PAs can help a practice deliver a good service for patients and their work can be moulded to both fit the needs of the surgery and the interests of the individual PA. As an employee, rather than a trainee, they do tend to have a longer term commitment to the practice and can deal with many common conditions from day 1. It’s what they’re trained to do. As their experience increases, PAs are able to deal with a majority of patients who present at the surgery and the level of supervision naturally decreases.
No – PAs are qualified to work across a range of healthcare settings. In fact, if they commit to starting work in primary care, there’s a £5000 preceptorship allowance. The payment is from Health Education England (HEE) to help support the supervision and educational needs for any newly qualified PA working in general practice for their first year. The money can be used towards additional study, supervision, coacing or mentoring.
We have a list of active PA programmes with links to their websites and contact details. Most course directors are happy to speak with clinicians or practice managers about their students/graduates and the profession.
It’s easy. Advertise and interview. You can find more information and useful resources such as job description and person specification templates under the resources section. There are details of area contacts who can help advise you too. You might also team up with neighbouring practices, or approach your local training hub (community education provider network or advanced training practice) for support and advice.
PA graduates can be useful from the beginning of employment. As you would expect with any other new appointment, they will need regular supervision and further training to mould around practice needs and develop individual strengths. As with all clinicians, the team’s working relationship is the key to quality and efficiency. PAs are not likely to see large numbers of complicated patients at the start of their careers but this will develop over time and the level of supervision will naturally decrease. You can apply to Health Education England (HEE) for a £5000 preceptorship allowance to help support the supervision and educational needs for any qualified physician associate working in primary care for their first year. The money can be used towards additional study, supervision, coaching or mentoring.
It is strongly advised for GP practices to check that candidates appear on the Physician Associate Managed Voluntary Register (PAMVR). Anyone on this register has successfully completed the university programme and passed the PA National exam. It is advisable to only hire PAs who appear on this list, until such time that PAs gain statutory regulation.
Many GP surgeries are expanding their teams of non-doctor clinicians to include other groups such as pharmacists, paramedics, advanced nurse practitioners and physiotherapists as well as physician associates. These clinicians can all contribute to the overall running of the surgery to help provide safe and competent clinical care for patients.
In some parts of the country we know it can be near impossible to recruit enough general medically trained staff to cover practice needs. The introduction of the physician associate role means there is a chance to increase workforce numbers rather than ‘poaching’ from an under resourced pool.
Qualified PAs may develop specialist expertise that reflects the specialty of their supervising doctor. This will be gained through experiential learning and CPD. A PA is expected to maintain their broad clinical knowledge base through regular testing and maintenance of general clinical skills.
Anecdotally there have been some reports about a reluctance to adopt any sort of workforce change. This is an understandable concern and we know that views do alter over time with experience.
There are a number of simple guidance posters (GP Team explained under the FAQs) that can help explain how the PA role fits into a practice team.
The PA role in primary care varies and tends to develop according to the needs of each practice. Trained in the medical model, PAs are qualified to see the range of patients from infants to elderly people. PAs may effectively free up a GPs’ time.
In short they can take medical histories, perform examinations, develop differential diagnoses, analyse test results, develop management plans and refer patients as required.
Some examples of their activities could include:
- Patient consultations - same day acute illness and booked routine appointments
- Telephone triage
- Residential, nursing and home visits
- Managing chronic conditions lists (such as COPD or diabetes patients)
- Running clinics (sexual health, family planning or minor surgery for example)
- Reviewing, analysing and actioning diagnostic test results
- Support to meet clinical targets
- Providing health/disease promotion and prevention advice for patients
- Co-ordinating research activity
There’s more information including a short video under Who are physician associates?
Many new graduate PAs begin work at a salary of £31,696 (equivalent to an NHS Band 6/7 salary). Depending on the level of experience, a PA will be able to manage a proportion of a GPs workload acting in a supportive and complementary role, freeing up a GPs time rather than as a substitute.
A study by Drennan et al (2015) compared aspects of physician associate consultations with those of GPs. It found that processes and outcomes of PA and GP consultations for same day minor illness patients were similar, while the cost was cheaper. Anecdotal evidence from GPs suggests PAs can contribute to reducing GP workload and freeing up time.
As you might expect, GPs report different benefits according to the need of each practice. There are a number of short case studies that can help to give you a better idea of how PAs are most useful in ageneral practice setting. Or use the local contacts on this page to be put in touch with a practice who employ a PA in your area and can offer a first-hand practical point of view.
There is a £5,000 preceptorship allowance to support the supervision and educational needs for newly qualified physician associates working in primary care in England. Get in touch with your HEE area lead (details on this page) for more information including the process for application and payment.
As an initial guide the preceptorship programme eligibility criteria is listed below:
- The preceptorship programme will be undertaken for a minimum of a 1 year (WTE).
- Open to all PAs commencing a programme in the year after gaining registration on the national register.
- Normally the preceptorship programme will be wholly in primary care, but a minimum of 50% or 6 months’ full time equivalent in any rotation of placements should be in primary care.
- The weekly timetable should include at least 1 dedicated session for education.
- Placements should have an educationally approved primary care clinical supervisor.
- The programme should have a mentor available from an appropriate education organiser (e.g. HEI, HEE, Training Hub) and describe a process for preceptees to feed back on their programme.
- The preceptor should have an induction period – a meeting with their supervisor, with mid-point and an end of programme review.
- The preceptor should take part in the employer’s annual appraisal system.
- Access to a professional development programme from a local HEI or equivalent should be available which will include alumni activity.
- The preceptorship programme should enable the post–holder to engage in multi-professional learning activities.
- Where the post-holder’s objectives include a further course of study, this should usually be funded from the support payment. This could be up to the cost of a postgraduate certificate qualification if appropriate for the preceptor and the service context. This funding should be used flexibly to meet the needs of the preceptor.
- Individual post–holders will be expected to complete and maintain all the requirements of the UK PA managed voluntary register (PAMVR).
- Ideally the preceptorship programme will set out expected outcomes for the preceptor in the form of competence acquisition or a brief curriculum which may be locally derived but based on established national guidance, eg the FPA guidance.
If you’re thinking about taking a student physician associate on clinical placement it may be useful to know that across the UK most self -fund their tuition costs. Health Education England provides a support payment for each physician associate programme and clinical placement to help students gain experience in a good learning practice environment. Remuneration is available to support these learners based on an agreed national scale.
Course providers have been asked to increase clinical placement time for student PAs in primary care from 180 up to 510 hours in England.
When new roles are introduced there is bound to be an amount of speculation and misunderstanding until the benefits of the role are better understood and established. It’s worth remembering that the PA role does not replace a GP. There is significant evidence (see under research) that PAs are safe clinicians. They are trained in the medical model to consult, examine, understand the patient’s problems and plan care. They have to complete a rigorous, academically demanding programme to qualify.
Physician associate courses in the UK all follow the National Curriculum and Competence Framework.
All PAs must have completed a:
- relevant three-year undergraduate degree (for example bioscience or healthcare-related) and
- postgraduate qualification in PA studies (Diploma or MSc) which takes two years of full time study to complete.
The current curriculum framework specifies that a PA will have successfully completed a Masters level 1 academic programme of no less than 90 weeks leading to a Postgraduate Diploma in Physician Associate Studies. It also recommends that newly qualified PAs undergo a period of preceptorship to consolidate and practise learning.
All PAs must pass a national exit exam covering knowledge and skills developed and administered by the Faculty of Physician Associates. This includes a written assessment (multiple choice) and a practical component known as an OSCE (examination of consulting and procedural skills). Revalidation is required every six years by passing the written test along with an annual appraisal (recommended with a GP) and a requirement to complete 50 hours of CPD - to remain on the voluntary register.
At the moment, physician associates are not statutorily regulated, so they work under the ’delegation clause’. This means they are the responsibility of the supervising doctor. According to GMC guidance, doctors can delegate tasks to non-clinicians but must be sure that person is capable. PAs are indemnified in the same way as doctors.
PAs will be able to prescribe once Parliament enacts legislation granting them independent or supplementary prescribing rights. In October 2018 the Secretary of State for Health and Social Care announced the introduction of statutory regulation for physician associates and physician assistants in anaesthesia, following direct engagement with the NHS workforce. You can track progress of the bill through Parliament.
This will provide workforce groups with an important foundation, supporting them through a strong regulatory framework and reassuring patients that they are continuing to receive the highest quality of care from the NHS.
Many patients already have appointments with non-doctor clinicians. A small study focussing on acute GP visits published in the UK concluded that patients were happy with the service provided by PAs and would make future appointments.
There are some additional FAQ's on page 7 and 8 of An employers guide to physician associates.
The following resources are for guidance and may be adapted as required.