New review to seek evidence from PA employers

A new review launched into the role of physician associates (PAs) is to seek evidence from employers to assess the safety of the role and how it supports wider health teams.

Announced yesterday by the health secretary, Wes Streeting, the review will be led by Professor Gillian Leng, president of the Royal Society of Medicine and a former consultant in public health medicine and chief executive of NICE.

It will look into the recruitment and training, scope of practice, supervision and regulation of PAs and anaesthesia associates, with results published in the Spring.

Currently there are over 3,500 PAs working in the NHS, according to the Department of Health and Social Care (DHSC), with over one third of those employed through PCNs.  

PAs have been around since 2003, however NHS England committed to increasing the number of PAs in the NHS to 10,000 by 2036/37 with training places for the role set to rise to over 1,500 by 2031.

But there has been controversy surrounding the role, which caught public and the profession’s attention after a handful of high-profile tragic cases, including Emily Chesterton, a 30-year-old patient who died at the end of 2022 after a pulmonary embolism. The coroner in the case concluded that the poor quality of care provided by the PA she saw contributed to her death.

In June, the RCGP urged that PCNs halt the recruitment of PAs, while in the same week, the BMA launched legal action over the regulation of the profession, which is set to begin on 13 December.

In October, the RCGP set out a scope of practice for PAs which limited their current practice. It suggested that they should not see patients who have not been triaged by a GP, nor patients who present for a second time with an unresolved issue.

However, the unofficial body representing PAs, the United Medical Associate Professionals (UMAPs), prepared to take legal action as a result of this at the end of October, as it said this scope had caused ‘harm’ and had adversely affected the careers of PAs.

At a Pulse PCN event in London last week, Dr Clare Sieber, GP in West Sussex and CEO of The Well-Led Practice, spoke of the guidance on employing PAs which was recently released by RCGP.

She said: ‘It is only guidance, but then you think about what people say to us about NICE guidance if we don’t adhere to that. People want to know why we’re not and if we’ve done a risk assessment to show why am I not adhering to the guidance.

‘Some bits in the scope of practice are difficult, paediatrics, gynaecology, obstetrics, what could be perceived as a major illness or disease is not in their scope, but how much can you really identify that when you’re triaging somebody?’

Dr Sieber added that CQC has taken more of an interest in supervision lately, which she sees in her role in The Well-Led Practice, which offers improvement tools for leadership and workforce development, and where she reads CQC reports.

‘We unpick reports that get published every month of practices that are being inspected and we see more and more scrutiny of supervision,’ said Dr Sieber.

‘Now in the governance quality statement on well led, they’re not just asking to see your supervision policy, but then wanting to make sure that it is effective and appropriate. So, going to your clinicians who need supervision and asking “are you getting it? Can you show me? Have you got a list of what you’ve been taking about?”,’ she said.

In response to a delegate saying they had risk assessed their PA due to the RCGP guidance limiting their scope of practice, she said: ‘I think you’re right to do all of those risk assessments’, but added it must feel ‘very personal’ for the PA having a risk assessment done against them.

On the review, Mr Streeting, said: ‘Many physician associates are providing great care and freeing up doctors to do the things only doctors can do.

‘But there are legitimate concerns over transparency for patients, scope of practice, and the substituting of doctors. These concerns have been ignored for too long, leading to a toxic debate where physicians feel ignored and PAs feel demoralised.

‘This independent review, led by one of the UK’s most experienced healthcare leaders will establish the facts, take the heat out of the issue, and make sure that we get the right people, in the right place, doing the right thing.’

Professor Leng added: ‘To promote patient safety and strengthen the NHS workforce, it’s crucial that we have a comprehensive review of the role of PAs and AAs. This will cover recruitment and training, scope of practice, supervision and professional regulation. 

‘As I conduct this review, I am looking forward to speaking to a broad range of stakeholders and to gathering evidence from the UK and abroad so that we can reach a shared understanding of these roles and their place in wider healthcare teams.’

Amanda Pritchard, chief executive of NHS England, said PAs are ‘important members of NHS staff’ who come to work to help care for patients.

‘They deserve to be treated with the same respect as anyone else coming to work in the NHS,’ she said.

‘While we have always been clear that they are not replacements for doctors, there are clear and ongoing concerns which we are listening to carefully and taking action to address – this independent review marks our pledge, together with the government, to getting this right.’

It comes as the Labour government has committed to developing a new long-term workforce plan for the NHS that will be published next summer.