Physician Associate/Assistant (PA) Role – FAQ
Please note: In the light of the LENG report and the statement from NHSE, this page is in the process of being updated.
Page Contents
Royal College of General Practitioners
What is a Physician Associate?
What are the main duties of a PA in general practice?
What are the required training and development needs to undertake the PA role?
How does the role work in General Practice?
What does ‘supervision’ entail?
Can a PA request radiology investigation?
Should a PA wear a uniform in general practice?
How can we educate patients about the PA role?
What are the current concerns around the PA role?
Please note: given the significance of the RCGP’s position on Physician Associates in general practice , we have led with their statement as follows…
September 2024 – the RCGP voted to change their position on PAs in general practice. Read their current position here
The RCGP’s governing UK Council has today voted to oppose a role for Physician Associates working in general practice.
The outcome of the vote was 61% of Council Members agreeing to oppose the role of PAs working in general practice; 31% disagreeing; and 8% abstaining.
However, recognising that there are already around 2000 PAs working in general practice, RCGP Council did approve three sets of guidance to support GP practices already employing PAs. The guidance will cover the induction and preceptorship, supervision, and scope of practice of PAs currently working in general practice. This guidance has been informed by and reflects the results of the member consultation on the use of PAs in general practice conducted by the College in April and May this year, and the ‘red lines’ affirmed by UK Council in March 2024.
Council opposed inclusion of a paragraph in the draft scope of practice guidance that where existing PAs in general practice may currently be practising beyond the scope described in our guidance, it is the responsibility of their GP Clinical Supervisor and/or their employer, to determine that they are doing so safely. This paragraph will be removed to ensure it is clear that PAs must always work within the scope of practice the RCGP will set out.
The College will now undertake further work on these documents, taking on board comments made by Council Members, and publish them as soon as possible.
Given that there are PAs currently working in general practice, the principles set out in the College’s ‘red lines’, agreed in 2017 and strengthened at its Council meeting in March 2024, still stand.
It also remains the College’s position that the regulation of PAs must proceed as soon as possible. It is the RCGP’s position that a regulatory body other than the GMC would be more appropriate to take forward this crucial work – but recognising that GMC regulation is well advanced, and now in legislation, the College will continue to work with the GMC to ensure there is clarity over the differences between doctors and PAs.
Professor Kamila Hawthorne, Chair of the Royal College of GPs, said: “The role of PAs in general practice has dominated the medical agenda for well over a year now and we understand the strength of feeling amongst our members and their concerns for the safety of their patients.
“It became very clear at today’s Council discussion that we needed to speak out in opposition to the PA role within a general practice setting and I am pleased that our processes have enabled us to do this in a collegiate and democratic way.
“We recognise that this new policy position may be unsettling for Physician Associates who are already working in general practice and for their employers, and we hope that our upcoming documents to be published in the coming weeks will provide some clarity on how these roles could be managed where they are in place.”
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
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
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
What are the required training and development needs to undertake the PA role?
To enter the profession, all physician associates must have a:
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
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 – June 2024 updated their Mythbuster 82 (Physician Associates in general practice) guidance to include information on supervision and oversight and information about what physician associates can do. It is strongly recommend that you look at this in full as we understand it is an area that CQC are looking closely at when inspecting practices employing such roles.
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
How does the role work in General Practice?
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
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. |
Supervision top tips
Source- BSW training hub
All 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.
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.
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.
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.
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
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.
Should a PA wear a uniform in general practice?
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.
How can we educate patients about the PA role?
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. |
Position statements on the PA role in general practice
Updated guidance 1st August 2024:
Physician associates in general practice: making it safe for patients and GPs (bma.org.uk)
GPCE have published guidance to help standardise practice and reduce variation in how physician associates work within a general practice setting. It aims to provide a framework to support physician associates to work safely in general practice, for patients, their employers, and GP supervisors. It has been designed to complement the scope of practice and supervision guidance already published by the BMA and should also be read in conjunction with GPCE’s Focus on MAPs in general practice.
Content:
Recommendations for supervision of PAs seeing patients
Recommendations for doctors supervising PAs
Recommendations for doctors who are working with PAs in a non-supervisory role
Recommendations for employment of PAs
We recommend that you read the full guidance in its entirety, It has been designed to complement the scope of practice and supervision guidance already published by the BMA and should also be read in conjunction with GPCE’s Focus on MAPs in general practice.
Historic position statement from the BMA (March 2024), Full details can be found here
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:
- FPA Code of Conduct
- FPA letter to employers regarding the PA Managed Voluntary Register
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