RCP interim guidance limits PA scope of practice to ‘basic tasks’ during Leng review

The Royal College of Physicians has issued guidance limiting the scope of PA practice to ‘basic clinical and administrative tasks’, during the Government-commissioned safety review.

The RCP said that the guidance ‘will act as a placeholder’ to ensure patient safety until the independent review of PAs and anaesthesia associate professions, led by Professor Gillian Leng, reports its findings in spring next year.

It comes after the Government said it will not put in place interim safety measures regarding PAs ahead of the review, which was launched last month by health secretary Wes Streeting in order to ‘establish the facts’ and ‘take the heat out of the issue’.

The RCP guidance said that PAs must never act ‘as a senior decision maker’, nor should they decide whether a patient is admitted or discharged from hospital.

It stressed that PAs can only assess acute patients if this is followed ‘by prompt in-person review’ from their supervising clinician.

The document described a PA as someone who ‘carries out basic clinical and administrative tasks at the direction, and under the supervision, of a consultant physician or specialist doctor’.

It also makes clear that a PA should never undertake outpatient clinics ‘independently’ and must not undertake outpatient clinics alongside resident doctors or other healthcare professionals without their supervisor.

On PAs working in acute care, the guidance said: ‘PAs who contribute to the acute medical take require specific further supervision and support, due to the high volume, rapid turnover and undifferentiated nature of patients presenting in this setting.

‘A PA may be able to assess a patient presenting to the hospital, but only if this is followed by prompt in-person review by the SC to define the diagnosis and management plan.’

It also added that PAs cannot prescribe medications ‘regardless of any prior healthcare background’.

They must always use the full title ‘physician associate’ when they first interact with a patient or staff member, followed by the abbreviation PA, followed by the specialty in which they work.

‘This is to ensure that patients hear and understand their role, followed by the specialty they are working in,’ the guidance added.

The document covers scope of practice for general internal medicine, supervision and employment of PAs, and how PAs should describe their role.

The RCGP already set out a severely limiting scope of practice for PAs in October, stipulating that PAs must not see patients who have not been triaged by a GP; nor patients who present for a second time with an unresolved issue. 

The GMC has been clear that it will not itself set out a scope of practice for these professionals, but that it will ‘have reference’ to scopes set out by other bodies, such as the RCGP and the BMA.

In their submission to the Leng review, the RCP will be calling for the publication of ‘a nationally agreed scope and ceiling of practice’ for PAs, a review of the projections for growth in the PA role in the Long Term Workforce Plan, and a review of the way the PA role impacts training opportunities for resident doctors.

Chair of the RCP’s PA oversight group Dr Hilary Williams said: ‘It’s crucial that PAs are supported to understand the remit, scope and professional boundaries of their role so that they can contribute to safe patient care in the future.

‘This guidance sets out a placeholder scope of practice for PAs and describes their role in the MDT while we await the findings and recommendations of the Leng review. 

‘The medical workforce remains under immense pressure, and it is time to refocus our attention on valuing our resident doctors. They deserve high quality training today to ensure they can become the expert physicians of tomorrow.’

Earlier this month, the GMC released a long-awaited report on findings from its consultation, which launched in March, with only minor tweaks made to its plans for PA regulation. 

Doctors leaders have continued to raise safety concerns as regulation officially began on Friday last week. Around 5,000 PAs across the UK will now be regulated by the GMC, as registration opened yesterday. 

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.