Guidance

What is a Physician Associate?

Physician associates are healthcare professionals with a generalist medical education, who work alongside doctors providing medical care as an integral part of the multidisciplinary team. Physician associates are practitioners who can work autonomously, but always under the supervision of a fully trained and experienced doctor. They add new talent to the skill mix within teams, providing a stable, generalist section of the workforce which can help ease the workforce pressures that the NHS currently faces.

Faculty of Physician Associates

 

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What are the main duties of a PA in general practice?

This role complements that of a GP and includes:

  • managing patient lists
  • providing health promotion and disease prevention advice for patients
  • performing physical examinations
  • diagnosing illnesses
  • seeing patients with long-term conditions
  • undertaking residential, nursing and home visits
  • taking medical histories from patients
  • analysing test results
  • making referrals and
  • developing management plans. Healthcareers.nhs.uk

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The responsibilities held by a PA working within general practice vary depending on their experience, and their scope of practice will develop over time at the discretion of their named supervising GP, with many experienced PAs working at a semi-autonomous level. This means that supervision may be remote, such as when PAs are providing home visits or care home reviews. British Journal of General Practice

 

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What are the required training and development needs to undertake the PA role?

To enter the profession, all physician associates must have a:

  • relevant degree (for example bioscience or healthcare-related) and
  • postgraduate diploma which takes two years of full-time study to complete.

Physician associate courses in the UK follow a national curriculum and competence framework. All physician associates must pass a national examination of knowledge and skills. They must recertify in the knowledge component every six years. This is to ensure they keep up to date. Physician associate is the only clinical profession in the UK which has a national skills and knowledge test. CQC

 

Physician associate training usually lasts two years, with students studying for 46-48 weeks each year and involves many aspects of an undergraduate or postgraduate medical degree. The training focuses principally on general adult medicine in hospital and general practice, rather than specialty care.

There will also be 1,600 hours of clinical training, taking place in a range of settings, including 350 hours in general hospital medicine.  You’ll also spend a minimum of 90 hours in other settings including mental health, surgery, and paediatrics. You may be eligible to receive some funding but financial arrangements differ between universities so you’ll need to contact them to see what might be available.

Wherever you work, you’ll have direct contact with patients.

With further training and/or experience, you may be able to develop your career further and apply for vacancies in areas such as further specialisation, management, research, or teaching. Healthcareers.nhs.uk

Click here to view the full Physician Associate Curriculum Document – Sept 2023

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Is the role regulated?

Physician associates are not regulated at present. There are plans for this to change in the near future, with the General Medical Council (GMC) as the regulator. The Faculty of Physician Associates at the Royal College of Physicians keeps a Physician Associate voluntary register . This acts like a GMC or Nursing and Midwifery Council register It is not statutory. Practices should only employ physician associates who are on this register.

CQC

As this role awaits statutory regulation, employers are strongly advised to be diligent in their recruitment process. Any job description advertising for the role must state that it is essential for applicants to hold a PG Diploma or MSc in Physician Associate Studies from a recognised UK or US programme, and that they have passed the UK Physician Associate National Exam.

Faculty of Physician Associates

 

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How does the role work in General Practice?

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Physician associates can supplement and complement GPs, nursing staff and members of the practice team. With a doctor’s supervision, they can see a range of patients whose cases vary in complexity. The amount of supervision they need depends on their knowledge, skills, and experience. Governance obligations for physician associates are the same as for other staff employed (or deployed) in the practice.

Physician associates work under the ’delegation clause’. This means they are the responsibility of the supervising doctor. Practices need to ensure appropriate supervision arrangements are in place. According to GMC guidance on delegation and referral, doctors can delegate tasks to non-clinicians.  They must be sure that person is capable. Physician associates are indemnified under the General Practice Clinical Negligence indemnity scheme in the same way as the rest of the practice team.     CQC

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What does ‘supervision’ entail?

Physician associates’ ability to practice is enabled by collaboration and supportive working relationships with their clinical supervisor, meaning that there is always someone who can discuss cases, give advice, and attend to patients if necessary.

Supervision of a qualified Physician Associate is comparable to that of a doctor in training or a trust grade doctor, in that the physician associate is responsible for their actions and decisions; however, the consultant is the clinician who is ultimately responsible for the patient.

As a clinical supervisor there is also a responsibility for ongoing development of the PA including appraisal and development of a professional development plan (PDP).

Faculty of Physician Associates

               

The first-year post qualification / New specialty

Employers of newly qualified physician associates, or of those who have just moved to a new specialty, may wish to offer a one year “internship” so that the physician associate is able to consolidate their core knowledge and skills, and demonstrate their competence in practice.
During this period, they should be supervised more closely, have experiential leaning in the clinical area in which they are working, and should maintain a portfolio of cases and case discussions with clinicians which may also be reviewed with their clinical supervisor.
The  FPA Code of Conduct  may also be of use. As it sets out the key areas that the FPA deems of particular interest including, professionalism, knowledge, skills, risk analysis and communication.

 

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Supervision top tips

Source- BSW training hub

Speech bubbleAll new employees to your practice will need an induction. The new grad PA is no different. They may never have worked in a general practice and may be new to your area. They will need to see how the surgery works.

 

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For the first 3 months a new grad PA will probably need 30 minutes per patient appointment. They come out of PA training school with a lot of general knowledge and red flag information, but they need time to perfect their patient consultation skills. Being allowed generous appointment times reduces anxiety and allows the PA to naturally become quicker.

Ideally the supervising GP will audit a selection of the PAs notes at 3 months, 6 months and 12 months and have meetings scheduled for these times in the first year.

 

It would be good to have daily scheduled times in the supervising GP’s rota to have catch up discussions about patients seen that day. These could be 10-30 minutes at the end of morning and afternoon clinic sessions. This will help the supervising GP(s) to establish a relationship with the PA and will have more confidence in signing the prescriptions that the PA generates.

After 3 months the PA will most likely be able to reduce their appointment times to 20 minutes as they will be much quicker at assessing and examining many patients. At this time they should start dealing with pathology results and filing hospital correspondence if they have not started to do this yet. This is a fabulous way for them to learn about conditions and how specialists deal with patients.

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After 6 months most new grad PAs will be able to see patients in 15-minute appointments. This will depend on the PA being full-time and having a full clinic load.

 

 

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Can they prescribe?

Physician associate cannot prescribe or issue medication by Patient Group Direction (PGD). They can provide medicines by a Patient Specific Direction (PSD). It is likely that physician associates will gain prescribing privileges in the next few years.

CQC

Although PAs are currently unable to prescribe, they are trained in clinical therapeutics and are therefore able to prepare prescriptions for their supervising GP to sign, having devised an appropriate management plan.

British Journal of General Practice

 

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Can a PA request radiology investigation?

Availability of supervision is also critical because physician associates are unable to prescribe drugs or request radiology investigations. Supervising doctors, who carry legal responsibilities, cannot countersign these without having assurance that they are appropriate and in line with best practice.

 

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Should a PA wear a uniform in general practice?

medical uniform

It is important that PAs can identify themselves and be identified by patients and other staff groups. It is also important that PAs can identify with the medical teams with whom they work. In the UK the majority of PAs do not wear a uniform (unless working in ED or surgical specialities where their medical colleagues also wear uniforms) and there is no national or professional body requirement for PAs to wear a uniform.

It is recommended that members of the healthcare team should be clearly identified with a name badge which includes their role and should introduce themselves to the patient. Please refer to the FPA titles and introduciton guidance document.

 

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How can we educate patients about the PA role?

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What are the current concerns around the PA role?

In response to concerns raised across the profession, the BMA conducted a comprehensive survey to inform its position on physician and anaesthesia associates. The survey findings have been used in our ongoing engagement with central and devolved nation governments, NHS England and devolved nation health departments, the GMC, and other key stakeholders.

Amongst its findings, the survey found that:

55% of doctors have found that PAs increase their workloads, even though they were sold as a way of reducing them. 87% of doctors who took part said the way PAs and AAs currently work in the NHS was always or sometimes a risk to patient safety.
Nearly 80% of doctors stated that they were occasionally or frequently concerned that a PA or AA they worked alongside was working beyond their competence. 80% of doctors felt that PAs and AAs would be more appropriately named ‘assistants’ than ‘associates’, as they were in the past.
86% of doctors reported that they felt patients were not aware of the difference between these roles and those of fully qualified doctors, showing the immense scope for patient confusion about the level of care they are receiving. 72% of doctors do not support the future regulation of PAs and AAs by the GMC.

 

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Position statements on the PA role in general practice

March 2024-

Medical Associate Professionals (MAPs) can play an important role in the wider healthcare system, but they are not a substitute for a doctor who undergoes years of medical training to provide complex, highly skilled care to their patients. There must be no blurring of the lines between MAPs and doctors. Patient confusion about which type of clinician has treated them has tragically led to at least 3 deaths. We are calling for urgent changes to prevent this blurring of the professions and ensure patient safety:

  • The job title “physician assistant,” should be reintroduced. This is what physician associates were called until 2014. We believe it’s a clearer title that better reflects the role, and crucially, reduces any confusion for patients. AAs should be called physician assistants (Anaesthesia) – as they were previously- or anaesthesia assistants.
  • All recruitment of new MAPs must be halted until there is clarity and material assurances around their scope of practice.
  • The BMA has produced a safe scope of practice for the medical associate professions, which NHS employing organisations should adopt to help doctors and other staff to provide safe, high-quality care. You can read the document here.
  • MAPs should be regulated by the Health and Care Professions Council (HCPC), not by the GMC. The GMC has only ever regulated doctors and this change worryingly and unnecessarily undermines the distinctions between the professions.
  • MAPs must never, in person or on social media, describe themselves as doctors GPs or medical consultants.
  • MAPs cannot replace the expertise offered by a medically qualified practitioner, and this must be recognised in pay scales. All health professionals working in the NHS should be paid properly, but it is clearly wrong that a newly qualified doctor entering postgraduate training is paid over £11,000 less per year than a newly qualified PA, while the doctor’s role, remit and professional responsibility is far greater. We estimate that this is a 35% differential, which is manifestly unjust. We will continue our fight for fair pay for all doctors working in the NHS.

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The Council confirmed the College’s existing ‘red lines’ on PAs, and voted to add two more, explicitly stating that the training and retention of GPs must be prioritised and that the responsibilities and skills required by GPs to supervise PAs must be recognised and resourced.

The RCGP’s updated position now stipulates:

  • PAs working in general practice must always work under the supervision of qualified GPs.
  • PAs must be considered additional members of the team, rather than substitutes for GPs.
  • PAs do not replace GPs or mitigate the need to urgently address the shortage of GPs.
  • PAs must be regulated as soon as possible.
  • Public awareness and understanding of the PA role must be improved.
  • Training, induction and supervision of PAs within general practice must be properly designed and resourced.
  • At a time of significant GP workforce challenges, funding allocations, resources and learning opportunities within general practice must be prioritised for the training and retention of GPs.
  • The significant responsibility and skills required for supervision must be recognised and resourced, with GPs able to choose whether they are willing to undertake supervision of PAs. PAs should not be employed unless sufficient supervision can be provided.

Whilst continuing to recognise that regulation of PAs is vital and must happen as soon as possible, Council members raised significant concerns that PA regulation by the General Medical Council could increase confusion amongst patients about the differences between doctors and PAs. It was therefore passed by Council vote that the RCGP should change its stance on this issue and that another regulatory body would be more appropriate to take this crucial work forward to regulate PAs. Regardless of the regulatory body, as previously stated, it is also important that any costs of the regulation of PAs must not be transferred to doctors. Given legislation was passed through the House of Lords last week, the RCGP will need to enter into discussion with the GMC and other key stakeholders to look at how these concerns can be addressed.

Council also agreed that the RCGP should consult with members on the role of PAs in general practice settings, including their scope of practice and supervision arrangements. This consultation will commence in the coming weeks and will inform the development of college guidance.

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March 2024

Ensuring safe and effective integration of physician associates into general practice teams through good practice

It is essential that physician associate roles are introduced safely and in a supportive environment, ensuring oversight of the supervision and tasks being carried out.

We are working collaboratively with partners, including the GMC, royal colleges, trade unions, doctors and medical associate/physician associate professional groups to develop comprehensive curricula, core capability frameworks, standards for CPD, assessment and appraisal and supervision guidance for MAPs and PAs.

We are writing today to bring to your attention the latest guidance from these discussions.

Supervision

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 [1],[2],[3].

NHS England supports GP practices to provide a structured preceptorship for physician associates in their first primary care role.

It is important to emphasise that PAs are not substitutes for general practitioners or doctors in training; rather, they are specifically trained to work collaboratively with doctors and others as supplementary members of a multidisciplinary team alongside nursing and other ARRS colleagues.

Prescribing

PAs are not able to prescribe. Therefore, in the context of electronic patient care records, every practice should have a comprehensive policy outlining access and restriction requirements for each professional group. This policy should cover aspects such as appropriate access to prescribing, results, referrals, and patient clinical notes, and provide assurance that clinicians are not able to undertake activities falling outside of their role’s scope of practice (for example, by providing a smart card loaded with TPP or EMIS system role profiles for PAs that does not permit access to prescribing activities).

Role clarity

It is important that all staff are able and supported to introduce themselves and their role clearly, to ensure that patients understand who is caring for them. The Faculty of Physician Associates has produced guidance to support staff which is available on their website. All clinical and administrative/clerical staff (for example, receptionists) must be educated on the PA role and make it clear to patients that they are seeing a PA. As part of good governance processes, all staff should be aware of how to triage patients so that they are seen appropriately by a clinician working within their level of competence. The same is true for all the ARRS colleagues that work within the practice.

Next steps

The steps above will help to protect the confidence and wellbeing of our physician associates and our patients, and we are grateful to you for your leadership in supporting this valued part of the NHS workforce.

Further guidance on the use of MAPs in NHS teams has been set out previously on NHS England’s website. We will continue to work together with stakeholders, doctors and MAPs to ensure that all members of the NHS workforce are supported to provide excellent patient care.

The Faculty of Physician Associates (professional body) is collaboratively working with the Royal College of Physicians to generate additional supportive guidance around the supervision and scope of practice of PAs. Existing guidance documents include:

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Summary of common themes

  • Effective Supervision
  • Review of title for clarity of role
  • Regulation of the role but not by GMC
  • Priority training and retention of GPs
  • Increased public awareness of role.
  • Clear defined, safe scope of practice

More information on the PA role with links to useful information can be found on our ARRS Roles webpage

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Last Reviewed Date
02/05/2024