Physician and Anaesthesia Associate roles in the NHS - fact sheet

*Updated 21 December*

This fact sheet sets out our position on the Physician and Anaesthesia Associate roles in the NHS.

What are physician associates and anaesthesia associates?

• Physician associates (PAs) and anaesthesia associates (AAs) are healthcare professionals, trained to the medical model. They have been practising in the NHS since 2002 and 2004, respectively.
• PAs work alongside doctors providing medical care as an integral part of the multi-disciplinary team. PAs can work autonomously, but always under the supervision of a fully trained and experienced doctor
• AAs are qualified to administer anaesthesia under the supervision of a medically qualified anaesthetist.

What sort of tasks do they carry out?

• Their role and clinical duties are very different to those of a doctor. Like Allied Health Professionals, Advanced Clinical Practitioners, Health Care Scientists, and other healthcare roles, PAs and AAs deliver specific aspects of patient care, increasing the capacity of clinical teams and reducing the workload of other clinicians, including doctors - increasing the capacity of the medical team to deliver care to patients.
• PAs are trained to do clinical duties such as taking medical histories, carrying out physical examinations, and developing and delivering treatment and management plans.
• AAs work within the anaesthetic team under the supervision of a consultant anaesthetist, with responsibilities such as reviewing patients before surgery, initiating and managing medications, administering fluid, and blood therapy during surgery and ensuring there is a plan for patients following their operation. AAs can therefore contribute to reducing operating theatre downtime, leading to more efficient use of operating lists.

Can they prescribe medication?

• PAs and AAs cannot currently prescribe medication as this is only considered for roles that are statutorily regulated.
• Alongside the work to regulate PAs and AAs, we are working with representatives from the professions, NHS England, the other UK countries and professional bodies to develop the case for extending prescribing responsibilities to these roles. The case will then need to be considered by the Commission on Human Medicines, an advisory non-departmental public body, which must recommend the change to Ministers before any amendments can be made to legislation.

What evidence is there of the benefits of this role?

• A study published by the National Institute of Health and Care Research in 2019 found that PAs positively contributed to the medical and surgical team, patient experience and flow, and to supporting the clinical teams' workload, and have potential to add further with an expansion of their role.
• The review also found that PAs undertook significant amounts of ward-based clinical administration related to patients' care and were reported to be safe.

What training do they have?

• PAs usually undergo a three-year undergraduate degree, in a health, biomedical science or life-sciences subject followed by two years postgraduate training, gaining significant clinical experience. Some universities now offer an undergraduate degree PA course that includes an integrated Master of Physician Associate Studies (MPAS). These courses take four years to complete.
• AAs also undertake a two-year postgraduate training programme.
• The course curriculums overlap with undergraduate medical degrees in certain areas but offers a more focused and less extensive training compared to what medical students receive.
• Their training involves supervised practice with real patients. The dedicated medical supervisor is responsible for the supervision and management of a student's educational progress throughout the clinical placements of the course.

How many are there in the NHS?

• As of June 2023, Electronic Staff Record (ESR) data suggests there are 73 full time equivalent (FTE) qualified Anaesthesia Associates and 1,508 FTE qualified Physician Associates working in NHS trusts and other core organisations in England. There are a further 1,707 FTE Physician Associates working in GP practices and primary care networks.
• This is relative to the almost 134,000 FTE doctors working in hospitals and other core organisation and the almost 36,000 FTE GPs at the same point in time.

Are they replacing doctors?

• No, the role of medical associates is to work with and support doctors and not to replace them.
• This supports the government's plans to grow the multidisciplinary NHS workforce, as set out in the first-ever NHS Long Term Workforce Plan. This means recruiting and training more doctors, nurses, allied health and other professionals and ensuring every team member can contribute their skills, experience and education.
• The plan sets out how we will grow the number of PAs to establish a workforce of 10,000 and increase the number of AAs to 2,000 by 2036/37.
• This is alongside the biggest training expansion in history which, taken with retention measures, could mean the health service has at least an extra 60,000 doctors, 170,000 more nurses and 71,000 more allied health professionals in place by 2036/37.

Do other countries have similar roles?

• The Physician Assistant/Associate movement began in North America and Africa in the mid-1960s. The adoption of PAs has spread globally across a variety of health systems and, as of 2022, at least sixteen countries including the Netherlands, Canada, Australia and New Zealand, have been in various stages of expansion of PA-like medical workers that function under the supervision of a doctor.
• The AA role is relatively new to the UK, but is common practice in Scandinavia, northern Europe and the United States.

Why are you legislating to regulate them?

• As we grow the PA and AA workforce, we plan to lay legislation before Parliament at the end of 2023, which will allow the General Medical Council (GMC) to start regulation by the end of 2024 at the latest.
• Regulation will give the GMC responsibility and oversight of doctors, PAs and AAs, allowing it to take a holistic approach to the education, training and standards of the roles. This will enable a more coherent and coordinated approach to regulation and, by making it easier for employers, patients and the public to understand the relationship between these roles and doctors, help to embed them in the workforce.
• Once regulation is in place, the GMC will ensure that PAs and AAs remain up-to-date and fit to practice through a process of revalidation. Both in training, and subsequently qualified practice, PAs must work with a dedicated medical supervisor which will be consultant, GP, or other senior medical personnel.

What are the current safeguards around PAs and AAs?

• The Faculty of Physician Associates at the Royal College of Physicians currently provides professional support to PAs across the UK. The Faculty reviews and sets standards for the education, training and national certification of PAs. The Faculty also oversees and administers the running of a Managed Voluntary Register. This is a register of fully qualified PAs who have been declared fit to practise in the UK. The majority of qualified PAs are on this register.
• Following successful completion of the AA training programme, a qualified AA can register and add their names on the AA Managed Voluntary Register (MVR) which is currently held with the Royal College of Anaesthetists (RCoA). The GMC encourages all qualified anaesthesia associates to join the register. The RCoA has written to all NHS Trusts advising them to employ only AAs on this voluntary register.
• We strongly recommend that employers only consider recruiting PAs and AAs who are on the Voluntary Registers. It enables supervisors and employers to check whether an individual is qualified and safe to work in the UK.

Is the Physician Associate job title misleading?

• No. PAs have been practising in the UK since 2002 and the title Physician Associate is therefore well-established among the NHS workforce.
• Regulation by the GMC will help to embed this further by making it easier for employers, patients and the public to understand the relationship between this role and that of doctors. Earlier this month, the Faculty of PAs issued guidance for PAs, supervisors, employers and organisations, which helps to provide a structured and standardised way of using the title.