Physician Associates

The role Physician Assistants (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 15/8/25 new guidance from NHS England.

Physician Assistants 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.  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 has committed to developing this role. However, the BMA has expressed concerns about training limitations and patient safety incidents involving PAs.

These concerns fed into wider issues around the role, and as such the Leng Review was commissioned to agree recommendations for the future of the physician assistants, the safety of the roles and their contribution to multidisciplinary healthcare teams.  The Review was published in July 2025, and was followed by NHS England and BMA guidance.

NHSE recommends, and the BMA supports the position that PAs currently working in primary care must:

• not triage patients
• not see undifferentiated patients

Whilst current PCN DES specifications do not explicitly state this, they refer to PAs doing so only if a supervising practice is confident of their ability to do so, and the view of GPC England is that a PCN would be unlikely to have clinical practice unsupported by the Leng Review challenged.

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.  Issues around PA contracts with these changes should be discussed with the BMA or practice HR adviser, and the LMC is happy to support such queries.