The Role of the Physician Associate | a Guide for Primary Care Network Leaders

At THC Primary Care, we support primary care leaders with a range of resources. We offer our take on all the latest policies and guidance with the aim of cutting through the small print to provide you with a summary of what you need to know.

With this in mind, and following both the recent controversy and confusion surrounding the role of physician associates in primary care, we have put together this blog to summarise the role’s fundamental elements and link you to related NHS guidance to support implementation.

This blog covers:

1️⃣ What is a Physician Associate (PA), and what can they cover?

2️⃣ What can’t they do?

3️⃣ Current controversies

4️⃣ The importance of supervision

5️⃣ The benefits of the role

6️⃣ The future of the role

7️⃣ Further reading and resources

We hope that this will enable you to make a more informed decision about whether a PA could add value to your PCN team.

A brief history…

The physician associate role (and that of the anaesthesia associate) was first introduced in the NHS in 2003 and currently, there are approximately 1149 PAs working within PCNs and primary care more broadly [NHS Digital, August 2022].

To support the delivery of the NHS Long Term Workforce Plan, NHS England are proposing to increase the number of Physician Associates (PAs) and Anaesthesia Associates.

In terms of primary care, these roles are accessible via the medium of the Additional Roles Reimbursement Scheme (ARRS) funding.

Qualifications and Training

PAs undertake specific and intensive postgraduate medical training in PA studies, which is completed over a two-year period.

The competence and curriculum framework for this training amounts to approximately 3,200 hours of study over 90 weeks, which is divided into 1,600 hours of theory and 1,600 hours of clinical practice. Theoretical learning is undertaken in medical sciences, pharmacology and clinical reasoning, complemented by clinical placement experience across a wide variety of settings.

In order to enrol on the postgraduate course, PAs are required to have already completed an undergraduate degree, usually in a biomedical or health/ life science field, with evidence of prior health or social care experience.

Regulation of PAs

Legislation has recently been passed to approve GMC regulation of the profession from December 2024.

Regulation will ensure that appropriate standards are set around:

• PA curriculum

• Training requirements

• Scope of practice

In addition, timelines will be stipulated regarding regular assessment of fitness to practice and the requirements for revalidation.

From the point of view of PAs themselves, regulation will mean that they have access to continuing professional development (and further education and training), as well as better defined progression routes and an adoption of a formally recognised appraisal process.

Regulation of the profession by the GMC, in particular, has proved to be somewhat controversial, as there are concerns that this could further blur the lines between doctors and PAs in relation to patients being clear about who is actually treating them. Whilst trained doctors complete a substantial medical degree and related intensive training, whereas PAs do not.

Now you have the background, let's jump in.....

1. What is a PA and what can they cover within the scope of their roles?

As per NHS Employers guidance:

"Physician associates (PAs) are healthcare professionals with a generalist healthcare education who work alongside doctors and surgeons, providing medical care as an integral part of the multidisciplinary team.

PAs work under the supervision of a named senior doctor (such as a named General Medical Council registered consultant or general practitioner) but can work autonomously with appropriate support.

PAs are part of the medical associate professions (MAPs) grouping in the health workforce and can be found working in primary and secondary care across 20 specialty areas in the UK such as internal medicine, general practice, surgery and emergency medicine”.

In short, PAs can work collaboratively within a team of health professionals but are not independent medical practitioners.

Scope of practice

We will repeat this throughout this article, but enabling your PA to thrive requires supervision by a senior, experienced clinician.

With the appropriate supervision in place, PAs can support with both clinical and administrative functions, as follows:

✅ Conducting rudimentary physical examinations for minor ailments

✅ Taking medical histories

✅ Managing routine and acute appointments (dependent on patient complexity)

✅ Developing appropriate treatment and management plans

✅ Seeing patients with long-term chronic conditions such as Type 2 diabetes and chronic pain (and potentially more chronic conditions, once established)

✅ Seeing patients with undifferentiated diagnoses

✅ Formulating differential diagnoses and management plans

✅ Carrying out diagnostic and therapeutic procedures

✅ Taking and ordering bloods (can also interpret results, subject to training and experience)

✅ Ordering ultrasound and MRI scans

✅ Providing health promotion and disease prevention advice for patients.

✅ Supporting receptionists with telephone triage

✅ Drafting referrals and fitness to work notes and prescriptions

✅ Conducting medication audits (similarly to that of the pharmacy teams) to identify potential cost savings, efficiencies and improvements in patient care.

Once trained and competent, as with any other healthcare professional, many PAs choose to pursue specialist interests, often in areas such as frailty / management of older people, which means they can take responsibility for management of the care home rounds and developing related treatment plans, e.g.

2. What PAs can’t manage

At present, PAs cannot:

⚠️ Order X-rays, CT or nuclear medicine scans

⚠️ Cannot work outside core hours or support with enhanced access, as they are not independent practitioners

⚠️ Until they are fully established, see young children and / or more complex patients

PAs are also unable to prescribe; however, this may be set to change with the introduction of regulation of the profession.

3. Current controversies

For some time now, there has been a general lack of clarity and widespread misunderstanding about the PA role, specifically around what they can and can’t do, and interpreting (and defining) the difference between PAs and doctors.

The day-to-day tasks of a PA and a doctor are not dissimilar which has led to confusion amongst patients (and other healthcare professionals) who assume they are one and the same.

The usefulness of employing a PA has also been called into question, based on the intensive supervision requirements, as well as their fitness to practice, following some highly publicised examples of missed diagnoses.

There is also some concern that PAs are seen to be taking away postgraduate training opportunities from junior doctors.

4. The importance of supervision

We will talk throughout this article about why supervision of the role is so crucial but what does this actually mean in practice?

NHS England offer detailed advice about clinical supervision more broadly and having met recently with Pauline Weir, a practising, primary care-based PA of 7 years, she offers the following advice to GPs and senior consultants:

🎯 Before you make the decision to recruit a PA, invest time in considering where they could fit and make a difference within your overall practice or PCN strategy.

Who would be best placed to act as their supervisor (bearing in mind that this should be someone who is patient, approachable and who has the appropriate seniority)?

Where do you need them most and what could they handle, once fully up to speed? Consider whether you want to work by list size or clinical area of need?

Does the culture within the PCN lend itself to providing stable and effective training and support for new roles?

🎯 Before you get to patient contact, ensure the basics are covered.

Although some PAs will have prior experience of working within other healthcare roles, many of them will be brand new to primary care and in their chosen profession.

This means they will require induction in not only clinical practice but also the day-to-day aspects of working in primary care; using EMIS or SystmOne, familiarising themselves with pathways, processes and the wider primary care ecosystem, PCN structure, etc.

You should always consider process mapping the patient journey to build clear and tangible guidance that all new (and seasoned) staff to reference, when required.

🎯 If possible, try to avoid spreading the role across practices.

This could potentially stifle momentum in their learning, cause confusion where processes differ between practices and means continuity of care for patients could be compromised.

In addition, there will be a heavy reliance on the supervisor to sign off everything they do within the first three months. The PA will also need to confidently feel able to approach their supervisor and ask questions at all times.

After the initial three months, it is expected that PAs spend the next three to six months building experience and training, with a view to being stable in their roles within one year.

🎯 Ensure PAs are allocated longer appointment times to manage their patients and seek sign-off of proposed outcomes

Particularly within the first three months, PAs should not see patients on a 121 basis. They should additionally not be tasked with seeing complex, heavily medicated patients or children in the early period.

This can be reviewed once the PA has been signed off as competent to do so (or on a case-by-case basis), however many areas maintain a policy of only assigning high risk patients to their GPs (and other senior clinical staff). Length of appointments can also be decreased as the PA progresses.

🎯 Focus on long-term investment

The PCN is ultimately responsible for the delivery of safe and effective care. Great supervision is the bedrock of this therefore keep in mind that you should not be too quick to advance your PA too quickly.

Investing more time at the outset in training and support will mean you are much more likely to nurture confident and capable professionals. Eventually, you should find that the balance tips in your favour, meaning that the number of GP supervision hours becomes outweighed by the number of patient appointments your PA can then cover in practice.

5. How PAs can make a positive impact

Patient Impact

🚀 As many PAs may already possess relevant healthcare experience prior to switching into the role, they are better able to adopt a more holistic approach to patient care, and offer a good level of wraparound care, too.

🚀 Once fully deployed, PAs can manage both routine and acute appointments, therefore improving patient access and reducing wait times.

🚀 In line with the above, PAs will also have a greater capacity for managing appropriate follow-ups, improving continuity of care.

🚀 A specific example of this is the management of the care home rounds, as discussed earlier. Enabling your PA to take responsibility for these means that they can build rapport with older patients, offer longer appointment times to discuss specific concerns, allow patients to better express their wishes and potentially pick up on smaller issues that they may not otherwise disclose.

Workforce Impact

🚀 In spite of the initial, onerous requirement of supervision, in the long-term, PAs can increase capacity in practice by taking on the lower risk caseload, freeing up GPs to manage the complex patient list.

🚀 PAs can additionally remove some of the administrative burden by managing things like foster care and DVLA reports.

🚀 With their generalist medical knowledge, PAs can also contribute positively at MDT meetings, offering guidance to other clinical staff members and supporting reception teams with telephone triage.

6. Looking to the future….

In spite of all the current concerns and controversies, it is hoped that, with the advent of regulation, more power will be given to PAs to be more effective in practice, including having the authority to prescribe, sign off fit notes and request all types of scans – and that an increase in awareness of the role will lead to a shift in culture when it comes to perception of PAs more generally.

7. Further reading and resources

All of the links from this article are also here, for ease of reference:

➡️ NHS Employers guide to the PA role

➡️ NHS England planned increase in PA numbers

➡️ Supervision guidance

➡️ BBC article on the PA role and current controversies

And in case this isn’t enough….

➡️ Health Education England’s case study covering the impact of Physician Associates in Primary Care also makes for useful reading.

➡️ The Faculty of Physician Associates also offer supportive guidance for PAs, supervisors, employers and organisations.

We hope this helps.🙂

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About the Author

I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast.

I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 120 PCNs by providing interim management, training and consultancy.

I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs.  

I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.

Find out more about THC Primary Care and follow us on Linkedin. 

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