GP mythbuster 82: Physician associates in general practice

Page last updated: 17 December 2024
Categories
Organisations we regulate

This mythbuster has been updated to reflect recently published external guidance.

This box only lists significant updates, for example where we are updating the factual content of our guidance. We do not include minor changes, such as editorial corrections.

This guidance clarifies the role of the physician associate (PA) in general practice.

The role of the physician associate in general practice

Physician associates are healthcare professionals who are trained to the medical model. They work alongside doctors and provide medical care as an integral part of the multidisciplinary team.

As practitioners, physician associates must always work under the supervision of doctors and under the direction of a named senior doctor. They must receive effective supervision, appropriate collaboration and supportive working relationships with their clinical supervisors.

Studies on physician associates working in primary care in England and those working in primary care and other NHS services in Scotland show that they are safe, effective and liked by patients. They are named as one of the 12 healthcare professionals (HCPs) able to be recruited under the Additional Roles Reimbursement Scheme (ARRS), which is part of the Primary Care Network Designated Enhanced Service.

Guidance from NHS England and NHS Improvement (section 7) includes roles included in ARRS.

Qualifications and registration

To enter the profession, all physician associates must have both of the following:

  • A relevant degree or master's degree. For example, in bioscience or a healthcare-related degree, or significant prior healthcare experience.
  • A postgraduate diploma that takes 2 years of full-time study to complete.

Physician associate courses in the UK follow a national curriculum and competence framework, which is set by the GMC and establishes their starting scope of practice. To begin working as a physician associate, a person is expected to have completed their degree and passed the Physician Associates National Exam.

The Faculty of Physician Associates (FPA) at the Royal College of Physicians is the national membership body representing physician associates in the UK. The FPA maintains a Physician Associate Managed Voluntary Register (PAMVR). This acts like a General Medical Council or Nursing and Midwifery Council register, but it is not statutory. The voluntary register is closed to new entrants following the start of regulation by the General Medical Council, but a static version of the PAMVR remains searchable online until 31 March 2025.

See:

Providers should be able to show how they assure themselves of the governance and ongoing competence of physician associates.

Regulation and indemnity

Following a consultation, the General Medical Council is now the professional regulator of physician associates from 13 December 2024. This means there are changes to the way in which physician associates will be required to show evidence of their ongoing competency and up-to-date knowledge in practice.

See Future regulation of physician associates (PAs) and anaesthesia associates (AAs).

Practices should only employ physician associates who maintain professional registration on the Physician Associate Managed Voluntary Register (PAMVR) or the General Medical Council, working within the latest code of professional conduct (from December 2024).

All physician associates are currently required to fulfil continuous professional development (CPD) requirements to remain on the register. This is audited by the FPA and the Royal College of Physicians using a CPD diary (requires a CPD diary user account). 

The register gives assurance that physician associates:

  • have qualified from an appropriate UK or US programme
  • have passed the national exams (and re-certification exam if appropriate)
  • maintain their continuing professional development (50 hours a year)
  • do not have any concerns about their:
    • code of conduct
    • scope of professional practice
    • fitness to practise.

Governance arrangements 

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. Governance arrangements should take account of the fact that these professionals are trained and registered on the basis that they should always work under supervision.

Organisations should identify an individual at GP partnership or integrated care board level who is responsible for the supervision and oversight of physician associates.

It is important to establish local processes to govern how these professionals are deployed and supervised. This is to ensure safe, high-quality care, and to support effective multi-disciplinary working.

Practices should also make sure that:

  • the supervisor is easily accessible
  • staff know who the supervising member of staff is
  • staff have enough capacity and capability to supervise.

The GMC states that doctors can delegate tasks to colleagues. This is where they are confident that the individual has the knowledge, skills and training to carry out the tasks. Or that they will be adequately supervised to ensure safe care.

See the General Medical Council’s Professional standards for doctors, in particular:

When doctors delegate care in line with the principles set out in GMC guidance, they are not accountable to the GMC for the actions (or omissions) of those to whom care is delegated. They will remain responsible for:

  • the overall management of the patient
  • decisions around transfer of care
  • the processes in place to ensure patient safety.

Physician associates are indemnified under the Clinical Negligence Scheme for General Practice (CNSGP) in the same way as the rest of the practice team.

Also see the GMC’s effective clinical governance handbook.

Supervision and oversight

Providers must make sure that staff are competent, and they must provide appropriate supervision and oversight.

A practice or primary care network (PCN) should nominate a qualified GP, who is on the GMC GP register, to provide day-to-day supervision of all clinical staff under their direction and control.

The consensus statement from the Academy of Royal Medical Colleges states that this should be a senior doctor.

See High level principles concerning physician associates.

Also see:

Guidance from the Royal College of General Practitioners recommends that:

  • physician associates working in general practice must always work under the supervision of qualified GPs
  • practices employing physician associates should ensure a clear governance structure. This includes approved guidance on induction and preceptorship, supervision and scope of practice of physician associates working in general practice.

The RCGP guidance includes:

Guidance from the United Medical Associate Professionals (UMAPs) and the College of Medical Associate Professionals (CMAPs) provides support for employers of physician associates. This recommends that supervision can be divided into 2 roles:

Clinical supervision

The ‘on-the-day’ point of contact is often the duty doctor but can be a GP assigned to supervise colleagues.

Educational supervisor

This is a named GMC registered doctor who takes overall responsibility for the line management and practice of an individual physician associate. They are most likely to work with the practice management team, which may include a lead physician associate. The educational supervisor is usually a partner or senior GP who is in a permanent lead position.

The guidance provides further information on:

  • employment and recruitment
  • clinical governance
  • supervision
  • scope of practice
  • preceptorships.

NHS England’s Supervision guidance for primary care network multidisciplinary teams supports GPs on effective supervision for their multidisciplinary teams.

A universally agreed scope of practice has not yet been established. However, the NHS England Directed Enhanced Service (DES) contract guidance may be helpful. It highlights key responsibilities.

See guidance from GMC on:

Prescribing and referral for other investigations

Ionising radiation

Physician associates can plan and suggest ongoing treatment. But they are restricted in what they can do. For example, they are not able to request diagnostic tests using ionising radiation (for instance, X rays or CT scans).

Any suggestions for further investigations would be discussed with and authorised by the accountable GP.

Prescriptions

Physician associates can propose prescriptions for signing by a GP. But the prescriber remains responsible and accountable for the prescription they issue.

The prescriber needs to be assured of the appropriateness of the consultation and the medicine being proposed prior to prescribing it.

See guidance on this from GMC.

Patient Group Directions

Physician associates cannot prescribe or issue medicines using Patient Group Directions (PGDs). However, they can administer medicines by a Patient Specific Direction (PSD).

There should be a standard operating procedure (SOP) in place to show how the prescription/PSD is raised and monitored. This would be considered best practice.

What we look at

We use these regulations when we assess if a practice is safe, effective, caring, responsive and well-led. The role of physician associates relates to:

We will assess how providers ensure that:

  • They complete safe recruitment processes.
  • There are enough qualified, skilled, and experienced people, who receive appropriate and effective support, supervision, and development.
  • These staff work together effectively to provide safe care that meets people’s individual needs.
  • There are clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support.
  • Information about risk, performance and outcomes is managed and shared securely with others when appropriate.
  • They value diversity in the workforce and work towards an inclusive and fair culture by improving equality and equity for people.

Further information

GP mythbusters