Physician Associates

The role Physician Associates (PAs) play in general practice is an area which is changing rapidly, with the anticipated introduction of new regulatory frameworks in the future and the presence of several position statements from the BMA, the RCGP and, as of 27/3/24, new guidance from NHS England.

Physician Associates are members of the healthcare team who work under the supervision of doctors, to assist with the management of patients.  They cannot prescribe medication as of the time of writing, nor request investigations involving ionising radiation.  Whilst there is currently a plan for them to be regulated by the GMC, at the present time their professional registration is voluntary.  PAs are trained to work within a defined scope of practice and limits of competence, and there are frameworks around this role created by the RCP and RCGP.

In General Practice, the majority of Physician Associates are employed via host practices under the terms of the PCN Network DES, as part of the Additional Roles Reimbursement Scheme.  NHS England states that it views PA roles as being integral to the multidisciplinary team, and the NHS Long Term Workforce Plan commits to developing this role. However, the BMA has expressed concerns about training limitations and patient safety incidents involving PAs and has produced guidance for supervising doctors as to what can, and cannot, be undertaken safely by them.

It has been recognised that the BMA guidance is in tension with the terms of the PCN Network DES, which specifically states that PAs should be seeing undifferentiated patients, and this has understandably created concern for practices.

NHS England has published guidance around the role.  Key statements from the guidance include:

• All work undertaken by PAs must be supervised and debriefed with their supervising GP.

• We ask that practices review their processes to ensure that they have appropriate supervision, supporting governance and systems in place.

• Underpinning this is the supervising GP’s confidence of the PA’s competence, based on the knowledge and skills gained through their training and development.

The document also lays out guidance on prescribing access and role clarity for practices.

Practices employing PAs will need to ensure that they are supervised in a safe, supportive manner, and assure themselves of the quality of their work as they would for any employee.