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Physician Associates in Primary Care and the Latest Guidance
Updated: Dec 7
Here at THC Primary Care, we provide resources for PCN leaders, and this blog will focus on the recent guidance relating to Physician Associates.
Recent guidance from both the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) has sparked significant discussion about Physician Associates (PAs) in general practice. While headlines might seem concerning, this blog aims to break things down for PCN Managers as a starting point, but please read the guidance in partnership with your PCN.
Let's jump in!
Understanding the PA Role
PAs are skilled healthcare professionals who contribute significantly to primary care teams. They can:
✅ Take medical histories
✅ Perform physical examinations
✅ See patients with ongoing conditions
✅ Create management plans
✅ Perform certain procedures
✅ Order diagnostic tests (excluding radiation)
✅ Provide health promotion advice
It's equally important to understand their limitations. PAs cannot:
🛑 Prescribe medications
🛑 Request x-rays or CT scans
🛑 Work without supervision
🛑 Practice independently
A full breakdown can be found here: https://www.england.nhs.uk/long-read/nhs-englands-position-on-physician-associates-7-february-2024/
Multiple Perspectives
The GMC's Position
The General Medical Council (GMC) will start regulating physician associates (PAs) and anaesthesia associates (AAs) on December 13th, 2024.
Regulation is seen as a vital step towards strengthening both patient safety and public trust in these professions. It will help provide assurance to patients, employers and colleagues that PAs and AAs have the right level of education and training, meet the standards that we expect of the professions we regulate and that they can be held to account if serious concerns are raised.
More information can be found here: https://www.gmc-uk.org/news/news-archive/preparing-for-the-regulation-of-pas-and-aas-key-updates-ahead-of-december
RCGP's Position
While recently voting against future PA roles in general practice, the RCGP has taken a pragmatic approach by:
➡️ Providing development pathways for existing PAs
➡️ Supporting structured progression
➡️ Encouraging professional development
➡️ Creating comprehensive guidance for current roles
BMA's Perspective
➡️ The BMA emphasises strict operational controls:
➡️ Mandatory contemporaneous supervision
➡️ GP review of all patients
➡️ Limited independent activities
➡️ Enhanced safety measures
The Supervision Framework
The supervision framework for PAs consists of two key elements:
Clinical Supervision
➡️ Provides immediate oversight
➡️ Offers real-time advice
➡️ Ensures patient safety
➡️ Supports clinical decisions
➡️ Maintains quality standards
Educational Supervision
➡️ Guides professional development
➡️ Manages career progression
➡️ Ensures ongoing competency
➡️ Supports skill enhancement
➡️ Maintains professional standards
Uncomfortable conversations
In the current environment, it’s more important than ever to have open conversations about how all roles contribute to practice success.
While discussing the financial value of roles might feel uncomfortable, it's part of ensuring that practices and the primary care network can provide sustainable care.
If there is any doubt about the value of the physical associate, review their scope of practice and the supervision support in place.
Making It Work
For many networks, the guidance is nothing but an unnecessary distraction due to the robust supervision and support already within the practices and the PCN, but this isn't the case for all networks,
Success depends on several key factors, with all primary care network practices on the same page.
Clear Communication
| Effective Supervision
| Quality Assurance
|
· Transparent role definitions · Patient understanding · Team integration · Professional boundaries
| · Structured approach · Regular review · Clear accountability · Development support
| · Regular assessments · Performance monitoring · Patient feedback · Team evaluation
|
Moving Forward with Confidence
Support | Clarity | Patient Focused |
· Working within a defined scope · Receiving appropriate supervision · Maintaining professional development · Contributing to team-based care
| · Implement clear supervision structures · Define roles and responsibilities · Monitor performance and value · Support professional development
| · Understand scope limitations · Engage with supervision · Maintain professional standards · Focus on patient care
|
Next Steps
1️⃣ The United Medical Associate Professionals (UMAPs) was founded in November 2023 and aims to host the first MAP-specific trade unions for Physician Associates (PAs), Anaesthesia Associates (AAs), and Surgical Care Practitioners (SCPs).
UMAPs is a not-for-profit organisation that is closely aligned with the College of Medical Associate Professionals (CMAPs).
Jointly, the two organisations have published the MAP Employers’ Guidelines for General Practice 2024 for Physician Associates. Please read this to ensure you understand the scope of practice. There is also a huge library of further guidance and references within this document.
2️⃣ Speak with your clinical director and clinical leads to ensure you are all on the same page.
3️⃣ Speak with your practices.
4️⃣ Speak with your PAs, remembering working across multiple organisations in primary care networks creates unique challenges.
➡️ Multiple reporting lines
➡️ Different organisational cultures
➡️ Varied IT systems & processes
➡️ Working along-side colleagues with different terms and conditions
➡️ Inconsistent expectations
➡️ Unfair reporting in the media
➡️ Conflicting priorities between the practice and primary care network and so on.
It is our job as leaders to help focus on the fundamental needs staff want to feel at work, and I have slightly adapted Maslow’s hierarchy of needs to help me with this.
When staff feel frustrated, I’m reminded of this framework and the importance of being honest when a network cannot support staff to meet these needs.
5️⃣ Further reading. Whilst this particular resource is signposted at Physicians Associates, it's something to be aware of. Understanding the Current MAP Employment Crisis and how to Protect Yourself | UMAPs.org.uk
I hope this helps.
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