Pulse’s investigation into physician associates looked into the growth of this role, and plans to extend it further. But do patients understand who they are and what they do? Louise Ansari, Chief Executive of Healthwatch England, reports what patients have told us about PAs and outlines lessons for the sector
Physicians associates (PAs) are not a new role. They have worked in England since the early 2000s, and the number employed in the NHS has grown quickly in recent years.
Despite this, there is little national data about people’s experiences of PAs, which services employ them, and in what capacity.
As the GMC is set to formally regulate PAs this winter, and with plans to recruit 10,000 by 2037, we have commissioned the first national poll of people’s views of PAs and worked with the Healthwatch network to understand people’s experiences with this role.
What patients and the public think
Our findings paint a somewhat mixed picture. While over half (52%) of the respondents agreed that they understood the difference between a doctor and a PA, nearly a quarter (23%) said they didn’t.
Younger people, aged 18-34, were more likely to agree they know the difference between a doctor and a PA (58%) compared with those in older age groups (47% of 34–54-year-olds, and 49% of those aged 55+).
Another takeaway from our research is that only 60% of respondents said that the person providing their care clearly explained their role during their last NHS appointment. People think it’s important to know who is treating them, and NHS staff are meant to identify themselves.
The need for clarity on the role of PAs came across strongly in reports from local Healthwatch services.
Some local Healthwatch services explained that while patients might have heard of PAs and understood that they were not doctors, people’s understanding of what they can and can’t do is more limited.
In many cases, patients needed to be made aware of the local presence of PAs, and often only found out about the role when given an appointment with a PA. In some instances, patients had specially asked to see a doctor but were instead assigned to see a PA instead.
The survey also found that where people knew they had received care from a PA, their experiences tended to be positive. People particularly valued that a PA could provide care when they needed it.
Five steps to improve clarity of PA role
Working with National Voices and the Patients Association, we have used our research to set out recommendations to policymakers and regulators on how they can better support the rollout of PAs. Our five calls to action highlight the need for clarity about the PA role:
- Clarity in direct patient care. Practising PAs and those in training must explain their role to new patients. Providers of education and training, including medical royal colleges, should make clear that informing patients about roles and responsibilities is core to providing high-quality care.
- Clarity on choice. PAs can offer high-quality care for simpler health issues, but patients should be informed that they have the option to see a fully qualified doctor. Before an appointment, patients should be told the types of clinician available, waiting times for different professionals, and that if a PA cannot address their issue, they may be referred to a GP or senior doctor.
- Clarity on training and regulation. National bodies, including the Faculty of Physician Associates and the GMC, should set the scope and content of PAs’ initial training and ongoing assessment and validation.
- Clarity of communication. Given the increasing use of new roles in the NHS, NHS England and other national bodies should adopt a proactive approach to communicating with the public in this area. Alongside broader awareness campaigns, ICBs should set up patient forums to explicitly examine the deployment of new workforce roles. Patients and their representatives must be centrally involved in all future discussions about the use of PAs and other new roles.
- Clarity on effectiveness. NHSE and the GMC should formally evaluate people’s experience of PAs in GP and hospital settings. This research would help to learn lessons to inform the expansion of this role and provide assurance that PAs are being used appropriately and are not substituting for fully qualified doctors.
*Healthwatch England commissioned Savanta to conduct a representative survey on public attitudes to Physician Associates. The poll ran as part of its weekly Omnibus survey. 1,677 people responded in total between 13 and 14 April 2024.
