The review into physician associates (PAs) launched by the Government will not cover a detailed scope of practice by setting, but will look at if and when an ‘enhanced’ scope of practice may be necessary.
The Government has unveiled more details about its review into PAs, detailing that it will also cover cost-effectiveness of the roles and supervision.
The independent review was launched last year by health secretary Wes Streeting in order to ‘establish the facts’ and ‘take the heat out of the issue’.
It will consider the scope of practice for PAs ‘at the start of their working career’, including where PAs and anaesthesia associates (AAs) might release time for doctors to focus on more specialist care, and if and when an ‘enhanced’ scope of practice ‘might be appropriate’.
The main question addressed in the review will be: ‘Are the roles of physician and anaesthesia associate safe and effective as members of a multidisciplinary team, across all tasks, roles and settings?’
It will evaluate the ‘cost-effectiveness of the role within multidisciplinary teams’ and the results will be presented by clinical setting, including primary care.
It will also consider supervision and oversight, including ‘best practice’ for PAs and ‘optimal’ staff ratios, and set out who should have responsibility in the health system in relation to setting out guidance and standards on training and working for the profession, to address ‘current confusion in leadership roles’.
The question of whether PAs and AAs should be regulated, or which body should carry it out, will not be covered as this regulation has already commenced, the Government added.
The review will also not produce ‘a detailed curriculum’ for PAs as ‘this is the role of the regulator’.
The Government pointed out that ‘wider engagement’ will be an ‘important’ component of the review, including:
- a ‘listening exercise’ with affected families, patients and staff
- visits to and conversations with GP practices and trusts that employ PAs
- workshops on topics such as scope of practice
- written evidence submissions from stakeholders
The evidence-gathering phase of the review will begin this month and conclude by the end of February.
The Government said: ‘It is important to note that this question about safety and effectiveness is a complex one, influenced by a large number of inter-related factors.
‘As with any complex question, there is unlikely to be a simple yes or no answer. Instead, there may be a spectrum of answers, potentially demonstrating some areas where practice is less safe, others where PAs and AAs are highly effective members of the team and, somewhere in the middle, areas where practice can be improved.
‘The debate around the roles of PA and AA is regularly described as “toxic”, with reports of bullying and harassment in the day-to-day working environment and leaders being unwilling to speak up.
‘While this behaviour is clearly unacceptable, the review must understand all concerns raised by the medical profession, by other healthcare practitioners and by the public, in addition to those directly related to safety and effectiveness.’
The conclusions of the review will help to inform the ‘refreshed’ workforce plan that the government has committed to publish in summer 2025 and ‘wider government policy’.
Pulse has recently looked in detail at conflicting views and advice on the scope of practice for PAs.
Doctors leaders have continued to raise safety concerns as regulation officially began in December.
Around 5,000 PAs across the UK will now be regulated by the GMC, as registration opened mid-December.
However, PAs have been given until December 2026 to register, after which it will become ‘an offence to practise as a PA’ or an anaesthesia associate (AA) in the UK without registration.
Last month, the GMC released a long-awaited report on findings from its consultation on the roles, which launched in March, with only minor tweaks made to its plans for PA regulation.
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Training involves learning through experience and improving one’s knowledge, skills and attitudes. So naturally scope of practice changes (almost daily). Of course PAs need a restrictive scope initially- so do new doctors and nurses too. Let’s move this debate on from keeping PAs chained to a restrictive scope, find compromises and so use their considerable talents to benefit our patients. If not we must impose restrictive scope of practice on all new clinicians-that is the inevitable outcome of BMA pronouncements. Ask your BMA rep how that will work in practices and hospital please.
When their work is not our responsibility clinically or medico legally their scope of practice can be less restrictive. Same as for medical students and doctors. While they are training they are supervised and while they are supervised their scope of practice is restricted. If they remain our responsibility and need supervision career long their scope remains restricted. Fairly simple.
Frankly they should all retrain onto any healthcare course of their choice, with government funding, that enables them to have completeness of training that allows them to work unsupervised.
The whole idea was some stupid copy of the US system and is ineffective cost and time wise and unsafe.
Phase them out, retrain them and move on.