NHS Employers guidance warns of rapid expansion of PAs in GP practices

NHS Employers has set out guidance on employing physician associates (PAs), warning that expansion of the ‘poorly understood’ role is ‘particularly noticeable’ in GP practices. 

The guidance, published by the employers’ organisation for the NHS in England, advised those employing PAs to ‘review adverts and job descriptions’ for the role to ensure they do not ‘blur the lines’ between PAs and doctors.

It also recognised that there is currently ‘no single widely agreed’ scope of practice for PAs, despite several organisations – including the RCGP – having declared their own position on scope.

The NHS Employers advice also covered training opportunities, stating that the ‘specific impact’ of the PA roles on doctors’ training ‘needs to be explored further and tackled at a national as well as local level’. 

It encouraged GP partners and other employers to review all feedback ‘regarding missed education opportunities’, emphasising that ‘it is the responsibility of the employer’ to ensure training is ‘equitable’.

On the rapid expansion of the PA workforce – which is expected to climb to 10,000 by 2036 – the guidance said: ‘The NHS workforce is developing rapidly with new roles that are poorly understood by the public and many stakeholders. 

‘This expansion is particularly noticeable in primary care and ensuring these newer roles are easily identifiable is essential, especially for the public.’

NHS Employers also stressed the importance of all staff introducing themselves accurately, advising that PAs should ‘ideally’ state that they are not doctors when communicating with patients. 

‘The language used to describe the PA role in job adverts and in other promotional materials needs to accurately reflect what a PA is and not blur the lines between PAs and doctors,’ NHS Employers said.

Pulse recently reported on a GP practice which received a warning from the UK’s advertising regulator for its description of PAs, and was told to avoid ‘unduly conflating’ the role with GPs.

It comes as the BMA has threatened to move towards industrial action over the lack of a scope of practice for PAs.

NHS Employers suggested that the BMA’s national scope of practice, published earlier this year, included some standards which ‘diverge from those approved by the GMC for registration’ of PAs and it also referred to guidance from the Royal College of Physicians (RCP) which sets out ‘safe and effective practice’ for PAs as well as supervision requirements. 

The RCP consulted on this draft scope document over the summer with a limited number of stakeholders, including the BMA, who argued that it ‘does not sufficiently tackle the clear patient safety concerns of doctors’.

Unlike similar guidance from the BMA and the RCGP, the RCP document does not set out rules for specific clinical scenarios, such as whether PAs can see patients with suspected mental illness or paediatric patients.

The BMA said this new guidance from NHS Employers ‘fails to tackle the problem of unsafe local variation in scope of practice, fails to provide accurate guidance on supervision, and fails to ensure the prioritisation of medical student and doctor training’.

In a post on X, the union encouraged doctors to use its own scope of practice for PAs, saying that if ‘national bodies continue to fail to act to protect patient safety, doctors will’.

The GMC recently confirmed that regulation of PAs will begin on 13 December this year, but registration will not be legally required for another two years. 

This means that until the end of 2026 if a concern is raised about a PA who is not yet registered, the GMC will be unable to investigate. 

Earlier this month, the BMA’s GP Committee UK voted in favour of ‘phasing out’ the physician associate role in general practice, while the RCGP Council voted in September to completely oppose the role.