New guidance on the use of physician assistants

Physician associates (PAs) should only be supervised by senior doctors and not doctors in training, a leading medical Royal College says in guidance issued to members.

The Royal College of Physicians (RCP) announcement follows fierce debate over the use of PAs in the medical profession, which aim to assist doctors and can carry out some health tests.

Claims have been made that the scope of the role is unclear, patients are not always aware of PA status, and their discrimination against doctors is becoming blurred.

An independent review of the role, announced by Health Secretary Wes Streeting, will report in the spring.

According to the current NHS workforce plan for England, PAs and AAs (Anesthesia Associates) are seen as an important component of staffing in the health service.

PAs can work in GP surgeries and hospitals. They are not authorized to prescribe medications, but they can order certain scans, take a medical history, and perform a physical examination.

Anesthesia Associates (AA) support the surgery teams and are a very small group.

Both PAs and AAs must complete a two-year master’s degree. Typically they will have held a previous degree related to bioscience, but this is not a requirement.

Numbers are increasing slowly, but a recent plan calls for a rapid expansion in the number of PAs and AAs – from 3,000 to 12,000 by 2036.

The Royal College of Physicians, which has members across Britain, says the interim guidance announced on Tuesday should take effect immediately ahead of an official review by the Health Secretary.

It states that a supervising physician should be “immediately available in the same clinical environment to advise the PA and, if necessary, carry out immediate individual review of the patient”.

This also goes beyond the more general guidelines of NHS England, which require PAs to be instructed and supervised only by a senior doctor.

The Royal College guidance is advisory, and designed to give members clarity about what is appropriate for their role and what employers can reasonably ask of them.

Some resident doctors (formerly known as junior doctors) have complained that they are expected to supervise the work of PAs, and that these physicians have taken on tasks traditionally performed by doctors. Have taken.

Dr. Ben Chadwick, chair of the group that wrote the guidance, said he expected new interim guidance “This provides clarity on how PAs can best be monitored and supported”.

The document includes hospital doctors who are members of the RCP – but not those who work in radiology, emergency medicine, general practice and other specialist areas with their own Royal Colleges.

The guidance also sets out current policy which states:

• PAs should support – not replace – doctors, and they should have a clearly defined role in the multidisciplinary team.
• PAs should never act as senior decision-makers, nor should they decide whether a patient is admitted or discharged from the hospital.
• Resident doctors (junior doctors) are not responsible for the clinical supervision of PAs and should not be expected or asked to do so. PA should only be monitored by consultants, specialist or associate specialist doctors.
• PAs cannot prescribe medications regardless of any prior health care background while working as a PA.
• PAs must clearly explain their role to patients, their families and caregivers, as well as to colleagues and supervisors.

In November, the Health and Social Care Secretary Wes Streeting announces an independent review To report in spring 2025.

He said at the time that many PAs were “providing very good care and freeing up doctors to do things that only doctors can do”.

But he said there were “legitimate concerns over transparency for patients, scope of practice and replacement of doctors”.

Streeting said he hoped the review would “take down the heat of the issue”.