One third of physician associates hired through PCNs

Around a third of physician associates (PAs) working in the NHS are hired through PCNs, the latest workforce data has shown.

The role was one of the first five jobs to be available via the additional roles reimbursement scheme (ARRS), which was established in 2019.

As of January 2024, there were 1,139 FTE physician associates working in PCNs in England and 772 FTE in practices. There are around 3,000 PAs in total working in the UK, according to the GMC.

Pharmacists (5,163), care coordinators (4,626), and social prescribing link workers (2,866) remain the top three ARRS roles within England’s 1,273 PCNs.

PAs have been around since 2003, however the role has expanded recently with NHS England committing to increasing the PA workforce. The number of PA training places is set to rise to over 1,500 by 2031, while NHS England is aiming for a total workforce of 10,000 by 2036/37.

There has been a debate around the role recently, with the BMA suggesting that the experience of doctors ‘has become more negative and patient safety concerns have dramatically increased’ due to the expansion in number of PAs.

The BMA last week set out guidance on the scope of the role of PAs and anaesthesia associates (AAs), which stated that GPs should triage patients first before deciding which ones a PA can see. 

The GMC is also set to regulate the role before the end of 2024 a move which the  RCGP  disagrees with having changed its stance on the regulation of PAs on Friday, following its UK council meeting debate. Members passed a vote that stated ‘another regulatory body would be more appropriate’.

Herne Bay PCN clinical director, Dr Jeremy Carter, who does not employ PAs, said: ‘On the whole, PAs are a newer role, and therefore many are coming into general practice earlier in their career pathway, often directly from training. This means their experience is less and the supervision requirements are possibly greater.

‘My understanding is the ideal would be for a PA to be working alongside one GP who would supervise them and build up a working relationship. Conceptually this is great, as building a working relationship and understanding of strengths and weaknesses will enhance the safety and effectiveness of the role, but it does mean that working in a PCN role, cross practice, does make that harder.’

He added that the supervision itself was also a barrier, as it costs GP time, responsibility and stress, and that there was no guarantee how long the PAs would remain in their role.

‘It can be frustrating to spend a lot of resource training and supervising staff to upskill and further their career, only for them to move on,’ he said.

Another PCN clinical director, who wished to remain anonymous, said: ‘Our PCN has employed PAs for a while. Our experience has been a positive one. They are quite junior roles and they do take regular supervision, but they have their place in primary care and if you invest in them, you could get rewarded with highly capable clinicians with significant potential.’

Breakdown of FTE ARRS roles employed in PCNs according to latest data

*While all the above roles are reimbursable under ARRS, NHS England has not confirmed whether the FTE numbers have been claimed for under the scheme.