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Nigel's surgery 82: Physician associates in general practice
This mythbuster clarifies the role of the physician associate (PA) in general practice.
It has been written with involvement of Jim Parle, Emeritus Professor of Primary Care. Jim is former Course Director for the physician associate programme, University of Birmingham.
The role of the physician associate in general practice
Health Education England (HHE) defines the physician associate as a:
"healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision."
"Although physician associates are dependent practitioners, they can also practice independently and make independent decisions. This is enabled by collaboration and supportive working relationships with their clinical supervisors, meaning that there is always someone who can discuss cases, give advice and review patients if necessary."
Physician associates can supplement and complement GPs, nursing staff and members of the practice team. With a doctor’s supervision, they can see a range of patients whose cases vary in complexity. The amount of supervision they need depends on their knowledge, skills and experience. Governance obligations for physician associates are the same as for other staff employed (or deployed) in the practice. They apply where roles involve independent complex clinical decision making. Providers should be able to show how they assure themselves of the ongoing competence of physician associates.
Studies in England and Scotland show physician associates to be safe, effective and liked by patients. They are named as one of the 12 health care professionals (HCP) able to be recruited under the Additional Roles Reimbursement Scheme which is part of the Primary Care Network Designated Enhanced Service. The BMA has produced guidance in section 7 on roles included in the Additional Roles Reimbursement Scheme (ARRS) scheme.
On inspection this relates to staff having the skills, knowledge and experience to deliver effective care and treatment (key line of enquiry E3).
Qualifications and registration
To enter the profession, all physician associates must have a:
- relevant degree (for example bioscience or healthcare-related) and
- postgraduate diploma which takes two years of full-time study to complete.
Physician associate courses in the UK follow a national curriculum and competence framework. All physician associates must pass a national examination of knowledge and skills. They must recertify in the knowledge component every six years. This is to ensure they keep up to date. Physician associate is the only clinical profession in the UK which has a national skills and knowledge test.
Regulation and indemnity
Physician associates are not regulated at present. There are plans for this to change in the near future, with the General Medical Council (GMC) as the regulator. The Faculty of Physician Associates at the Royal College of Physicians keeps a Physician Associate Voluntary Register. This acts like a GMC or Nursing and Midwifery Council register It is not statutory. Practices should only employ physician associates who are on this register.
The register gives assurance that physician associates:
- have qualified from an appropriate UK or US programme
- have passed the national exams (and recertification exam if appropriate)
- maintain their continuing professional development (50 hours a year)
- do not have any code of conduct, scope of professional practice, or fitness to practise concerns.
Physician associates work under the ’delegation clause’. This means they are the responsibility of the supervising doctor. Practices need to ensure appropriate supervision arrangements are in place. According GMC guidance on delegation and referral, doctors can delegate tasks to non-clinicians. They must be sure that person is capable. Physician associates are indemnified under the General Practice Clinical Negligence indemnity scheme in the same way as the rest of the practice team.
Physician associate cannot prescribe or issue medication by Patient Group Direction (PGD). They can provide medicines by a Patient Specific Direction (PSD). It is likely that physician associates will gain prescribing privileges in the next few years.
When we inspect
We use these regulations when we review if the practice is safe, effective, responsive, caring and well-led. The role of physician associates relates to:
and key lines of enquiry (KLOEs). In particular:
- S2 Managing Risk
- S3 Safe care and treatment
- E3 Staff skills and knowledge
- WL3 Culture of the organisation
- WL4 Governance and management
- Employing Physician Associates in general practice (Faculty of Physician Associates)
- RCGP Templates, guides and advice for employers and supervisors of physician associates (Faculty of Physician Associates)
- Nigel's surgery 66: Advanced Nurse Practitioners (ANPs) in primary care
- Nigel's surgery 38: Care in advanced serious illness and end of life
- Last updated:
- 20 January 2021