Who are Physician Associates?
Physician associates are healthcare professionals who work as part of a multidisciplinary team with supervision from a named senior doctor (a General Medical Council registered consultant or general practitioner), providing care to patients in primary, secondary and community care environments. PAs are part of the government’s medical associate professions (MAPs) grouping in the health and care workforce and have been working in the UK since 2003.
Background to the Profession
Although the physician associate profession is still considered relatively ‘new’ in the UK, the first physician associates were formally introduced in 2003. The role of physician assistant first developed in the US in the 1960s, and equivalent or similar roles exist in many healthcare systems around the world.
In 2004, the Department of Health commissioned an evaluation of the impact of introducing physician associates, which pointed to great patient and physician satisfaction. In 2005, the UK Association of Physician Associates (UKAPA) was established, acting as a professional body for physician associates.
In 2006, the DH released the Competence and Curriculum Framework for the physician associate, developed in partnership with The Royal College of Physicians (RCP) and the Royal College of General Practitioners. Although the FPA has undertaken a review of the Competence and Curriculum Framework (CCF) and Matrix of Clinical Conditions (Matrix) in 2018, it has been decided that these documents will remain unchanged at the present time until the FPA can complete a more extensive review which it is working towards. The FPA can confirm that the CCF and matrix documents as published on the FPA website are current and relevant.
The profession has gone from strength to strength in the UK, with the adoption of the managed voluntary register for physician associates in 2011, and the launch of the Faculty of Physician Associates through collaboration with UKAPA and the RCP in 2015.
What do physician associates do?
Physician associates work within a defined scope of practice and limits of competence. They:
- take medical histories from patients
- carry out physical examinations
- see patients with undifferentiated diagnoses
- see patients with long-term chronic conditions
- formulate differential diagnoses and management plans
- perform diagnostic and therapeutic procedures
- develop and deliver appropriate treatment and management plans
- request and interpret diagnostic studies
- provide health promotion and disease prevention advice for patients.
Currently, physician associates are not able to:
- prescribe
- request ionising radiation (eg chest x-ray or CT scan).
For more information about the FPA or the physician associate role, please see our FAQ page . For FAQs relating specifically to PAs in primary care, visit the employers page .
How can they help physicians and the NHS?
Physician associates increase the numbers of the medical workforce and increase access to quality care for patients. They act in an enabling role, helping to reduce the healthcare team’s workload, and bring new talent to the NHS, adding to the skill mix within the teams.
While trainee doctors and surgeons rotate through different specialties, physician associates offer continuity and stability both for patients and for the team in which they work. Physician associate support also provides cover so that trainee doctors can attend training, clinic or theatre.
Physician associates (PAs) are healthcare professionals who work as part of a multidisciplinary team with supervision from a named senior doctor (General Medical Council registered consultant or general practitioner), providing care to patients in primary, secondary and community care environments. PAs are part of the government’s medical associate professions (MAPs) grouping in the health and care workforce and have been working in the UK since 2003.
Find out more about who physician associates are.
- take medical histories from patients
- carry out physical examinations
- see patients with undifferentiated diagnoses
- see patients with long-term chronic conditions
- formulate differential diagnoses and management plans
- perform diagnostic and therapeutic procedures
- develop and deliver appropriate treatment and management plans
- request and interpret diagnostic studies (except those involving ionising radiation)
- provide health promotion and disease prevention advice for patients.
Physician associates are not able to:
- prescribe
- request ionising radiation (eg chest x-ray or CT scan)
- provide care or treatments to patients in an unsupervised setting.
Physician associates are dependent practitioners working with a dedicated consultant or GP supervisor.
Supervision of a qualified physician associate is similar to that of a doctor in training or trust grade doctor in that the PA is responsible for their actions and decisions. However, who is ultimately responsible for the patient is the medical consultant or GP supervisor.
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).
Levels of supervision will vary somewhat from individual to individual and is dependent on a number of factors including, but not limited to, their past health care experience and years of experience as a physician associate. A new graduate will require much more intensive supervision compared to an experienced physician associate.
The RCP established the FPA in 2015 in conjunction with the UK Association of Physician Associates (UKAPA), Health Education England (HEE) and other medical royal colleges in order to strengthen and develop the close working relationship between doctors, across the specialties, and with physician associates.
The aim of the faculty is to support the professional development of physician associates, and thereby enhance patient safety, by providing access to the educational and professional development resources from the RCP, and our publications. the FPA is a national body, so standards apply across the UK.
The RCP also provides high quality administration for the faculty, which includes the running of the Physician Associate Managed Voluntary Register (PAMVR). The faculty and the RCP are also campaigning to achieve statutory regulation of the PA profession.
Why now?
The decision to oversee the FPA stemmed from the concerns related to the decision to increase the number of physician associates coming from the Department of Health, Health Education England (HEE) and universities, and to ensure that any expansion in numbers could be aided and evaluated over the period of growth. The FPA and the RCP aim to ensure that this expansion of a new clinical workforce was done as safely as possible pending formal regulation, which requires a change in the law. The RCP wants to support high national of standards physician associate training, and to campaign for effective regulation.
The RCP Council made this decision as it was seen as important to support, shape and understand the needs of the profession, in a manner that is complementary to the needs of physicians.
It also aligned with the RCP's aims to support the future clinical workforce as set out in the Future Hospital Commission report, published in 2013:
‘The roles of advanced nurse practitioner and physician’s associate should be evaluated, developed and incorporated into the future clinical team in a role and at a level of responsibility appropriate to their competencies.’ Future Hospital Commission Report – extract from Appendix 6; the medical workforce explained
As a new role in the UK, physician associates are still seeking statutory regulation, therefore the title ‘physician associate’ is currently not a protected title. The Faculty of Physician Associates, along with the universities involved in training physician associates, continues to work toward registration of the profession in order to protect the title.
To understand the journey towards achieving regualtion for the physician associate profession visit this webpage.
As a relatively new role in the UK, physician associates are still seeking statutory regulation, which the FPA is consistently campaigning for publically and behind the scenes. The government and the Department of Health are considering regulation in order to provide a legally accountable framework to ensure patient safety, set standards for the profession, education, protection of the title, fitness to practice, and continuing fitness to practice. Whilst these are already in place for physician associates nationally and overseen by the FPA, they cannot be legally enforced without statutory regulation.
The fact that physician associates are not a regulated profession means that they cannot prescribe medication or order ionising radiation (ie. order x-rays) and the title ‘physician associate’ is not protected.
At present there is a Physician Associate Managed Voluntary Register (PAMVR) housed at the FPA which keeps details of physician associates who meet all the required standards.The PAMVR does not currently have force of law, so is 'voluntary' as its name suggests. However, the FPA strongly encourages all qualified physician associates to join the register, and all trusts and practices to ensure that the physician associates they employ are registered. Employers should check this at appointment and at yearly appraisal; this will help ensure that only those properly trained are able to practice as physician associates. While work towards statutory regulation is underway, the overall decision regarding the eventual registering body for physician associates will be made by the government. All UK-based physician associates are therefore strongly encouraged to join the PAMVR as it will form the initial list of physician associates to enter a statutory register when established.
Physician associates are able to practice in the UK as a result of a clause within the British General Medical Council's guidance on Good Medical Practice.
Delegation is discussed within paragraph 44-45 as follows:
44. You must contribute to the safe transfer of patients between healthcare providers and between health and social care providers. This means you must:
a. share all relevant information with colleagues involved in your patients’ care within and outside the team, including when you hand over care as you go off duty, and when you delegate care or refer patients to other health or social care providers 8,14
b. check, where practical, that a named clinician or team has taken over responsibility when your role in providing a patient’s care has ended. This may be particularly important for patients with impaired capacity or who are vulnerable for other reasons.
45. When you do not provide your patients’ care yourself, for example when you are off duty, or you delegate the care of a patient to a colleague, you must be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for the patient.
Physician associates are currently unable to prescribe medication in the UK.
Close work with supervising physicians and arrangements developed individually allow for flexible ways of working and continuation and expansion of quality patient care. For instance, many physician associates working in general practice may propose prescriptions (which is no different to non-prescribing nurses) and have the ability to quickly interrupt their supervising physician for a signature and then continue their work. If further advice on a case is required, the GP and physician associate take time out to discuss it and/or see the patient together to come to a decision on further treatment.
Prescribing rights for physician associates may change once statutory regulation is introduced. At that time, decisions will be made regarding physician associates prescriptive rights. As physician associates are not yet licensed nor regulated, this limitation also applies to requests for x-rays and other ionising radiation requests.
PAs are currently not able to administer a medication via a Patient Group Direction (PGD) and this is unlikely to change post regulation, as it requires a change to the Human Medicines act which is not on the plans as present. PAs can administer medications under a PSD, which is a written instruction, signed by an authorised prescriber, for a medicines to be administered to a named person after the prescriber has assessed the patient. This has to be on an individual basis.
The supervising GP needs to ensure the PA has the necessary knowledge and competency to administer a medication (including pre/during/post issues/complications/procedures) and ensure that a patient has a Patient Specific Direction (PSD) signed by a prescriber prior to the administration of the vaccine.
PAs should have been trained in administering a vaccination when studying to be a PA. There is a free online e-LfH course on Immunisations/Vaccines: https://www.e-lfh.org.uk/programmes/immunisation/
But to clarify, there is no need for PAs to complete the aforementioned course unless your supervising GP wants to use the course as proof of competency. Again, all PAs should be familiar with Immunisations and vaccinations and the administration of these medicines as the supervising GP could delegate without the need for a formalised course.
Please also refer to The Competency and Curriculum Framework for Physician Assistants (Department of Health, 2012)
"The following is a list of procedural skills which the Physician Assistant should be able to perform on completion of the educational programme. This section is designed to be read in conjunction with the competences (2.3) and for the sake of brevity we do not repeat the vitally important skills of routine examination, communication with the patient, seeking informed consent, ensuring safety, avoiding infection etc - Draw up and give intramuscular, subcutaneous, intra-dermal and intravenous injections."
Yes, physician associates require professional indemnity coverage. The Medical Protection Society (MPS), Medical Defence Union (MDU) and Medical and Dental Defence Union of Scotland (MDDUS) all provide professional indemnity for qualified physician associates.
Within trusts the practice of physician associates is covered by the Department of Health 2012 Clinical Negligence Scheme for Trusts (CNST). However, qualified physician associates are strongly encouraged to have their own personal professional negligence insurance from one of the medical defence organisations listed.
In primary care, it is imperative that physician associates have their own indemnity. The annual physician associate census shows that in the majority of cases the cost of physician associate indemnity in primary care is covered by the employer and we recommend GP employers contact their own indemnity provider for guidance.
International Medical Graduates have not completed an approved physician associate training programme, and so are not eligible to work as a physician associate. Anyone wishing to become a physician associate must apply to and complete the entire physician associate programme, and pass the national examinations.
At this time the FPA have three categories of membership:
- Physician associate member: A graduate from a recognised UK physician associate programme or from an accredited US physician associate programme
- Student physician associate member: A student enrolled on an accredited UK or US physician associate programme
- Friend of the faculty: Individuals who are interested in joining the faculty as a non-physician associate member.
In addition, a PA:
- applying for PA membership must have completed either a UK/US PA programme, passed the national PA exam in either UK/US, and either live or work in the UK
- student applying for PA student membership must be enrolled in a PA programme in the UK.
We are not in a position to allow non-UK or non-US physician associates to join as student or physician associate members. Presently we are looking at other existing European physician associate programmes to determine how to include them and how to evaluate the equivalency of these programmes. Until that happens we can only allow these individuals to join as a friend of the faculty.
If you have any further queries or would like more information about the physician associate profession, please contact us.
In certain areas of the UK, there are organisations which employ people to do technical tasks in the hospital such as phlebotomy, arterial blood gases, and administrative duties. While they are also called 'physician associates' or ‘physician assistants’, they have not undertaken the training required for physician associates in the UK at one of the recognised universities (listed on our website), have not passed the UK PA National Certification Examination, and do not have the training of National Commission on Certification of Physician Assistants (NCCPA) certified American physician assistants. These are nationally set standards that enable the use of the title.
There is a clear distinction in the level of medical training, and for this reason, the Faculty of Physician Associates along with the universities involved in training physician associates continue to work toward regulation of the profession in order to protect the title.
There is also a separate profession called physicians’ assistant (anaesthesia). This is a separate profession with a different set of competencies which enable them to work under the supervision of anaesthetists within the operating theatre environment.
The newly qualified physician associate post has been evaluated under Agenda for Change at Band 7. Higher level physician associates (usually requiring a minimum of five years’ experience and a relevant Master’s degree) have been banded at 8a.
Physician associates have a responsibility to keep up to date. Continuing medical education (CME) or continuing professional development (CPD) is key to a physician associates on-going clinical practice, thus the majority of physician associates are provided with some form of study leave. This is to be determined through discussions with the physician associate and their supervising physician as well as their employer.
All physician associates are currently required to fulfil CPD requirements to remain on the Physician Associate Managed Voluntary Register (PAMVR) which is to be audited by the FPA in conjunction with the Royal College of Physicians using the CPD diary.
The Faculty of Physician Associates requires documented evidence of members CPD as an essential component of the information needed to remain on the PAMVR. This evidence is required, under membership of the FPA, to be documented in the members' RCP CPD diary. All physician associates are currently required to complete 50 hours of CPD per year. Further information can be found in the CPD guidance for physician associates.
