Physician Associates

 

Physician Associates (PAs) have been the subject of media attention over the last fortnight following the publication of the inquest findings of the tragic death last year of Emily Chesterton, a young woman as a result of substandard clinical care at a surgery in a local North London borough.

Here at Swiss Cottage Surgery, Physician Associates (PAs) have been valued members of our clinical team for nine years. Our PAs will always introduce themselves including their professional role. Many of you will be familiar with Physician Associate members of our practice team. In fact, we are proud to have been one of the first surgeries in London to employ PAs. Our PAs continue to have prominent education and leadership roles locally, at St George’s Medical School (the first PA training scheme in the country) and the Faculty of Physician Associates.

Our first thoughts when reflecting on the facts of this tragic case are with Emily’s family. It is right that we give serious consideration to what we might learn from the case to ensure that our patients can always have the highest confidence in the clinical care they receive at our surgery.

The surgery is a longstanding accredited learning environment. Throughout each year, we host medical, nursing, PA and pharmacist students. We also host GP trainees and other doctors in training, pharmacists training as independent prescribers and nurses studying for Advanced Practice. The majority of our GPs are GP trainers with many years of experience of teaching, training and supervision.

Our PAs have a named GP trainer as supervisor and have intensive further training upon joining the practice. PAs at the surgery join our weekly clinical and educational meetings and have ringfenced time each month for formal training. For the first 6-12 months PAs work very closely with their supervisor as they develop their skills and expertise. With time and experience and once assessed competent the PA is able to work autonomously with appropriate support. In addition to their routine roles each PA at the surgery is also provided with additional professional training to enable them to manage one or two long term conditions and develop specialist expertise in a particular field. Examples amongst our PAs include hypertension, anticoagulation, asthma, chronic obstructive pulmonary disease, teledermatology, geriatric medicine, cryotherapy, smoking cessation, ear canal microsuction, smear taking, spirometry, etc.  

We would like to emphasise that PAs have never been utilised at the surgery as a ‘replacement’ for a GP and are supervised and employed as part of our healthcare team appropriately. We have a full complement of GPs at the surgery and no vacancies. Our PAs contribute in many different ways to the high standards of clinical care we deliver at the surgery and also the class-leading access we know is so valued by our patients. 

Find out about our Physician Associates

 

Further information about Physician Associates

The Faculty of Physician Associates (FPA) at the Royal College of Physicians (RCP), who reviews and set standards for the education and training for PAs, has always maintained that PAs work under the supervision of a designated senior medical practitioner (usually a GP partner), and that an individual PA's scope of practice is an agreement of delegation between that senior doctor and the PA.

PAs are medically trained, generalist healthcare professionals, who work alongside doctors and provide medical care as an integral part of the multidisciplinary team. PAs are practitioners working with a dedicated medical supervisor, and with time and experience, are able to work autonomously with appropriate support.

PAs who have trained in the UK have undertaken postgraduate training in PA studies. These studies are spread over a period of at least 90 weeks (approximately 3,200 hours, divided into 1,600 hours of theory and 1,600 hours of clinical practice). The training is an intensive two-year course based on the Competence and Curriculum Framework for the PA, consisting of theoretical learning in medical sciences, pharmacology and clinical reasoning, as well as clinical placement experience in a wide variety of healthcare settings. To practice as a PA they must pass the Physician Associate National Examination (PANE) at the end of the two years. To enrol on a PA programme, students must already hold an undergraduate degree (3-4 years), usually in a biomedical or health/ life science field and have some prior health or social care experience.

PAs are able to see patients and are involved with taking medical histories, carrying out physical examinations, manage long-term chronic conditions, formulate differential diagnoses and carry out diagnostic and therapeutic procedures. PAs are also involved in developing and recommending appropriate treatment and management plans and are able to request and interpret diagnostic studies. PAs are currently not able to prescribe medication or request ionising radiation (e.g., x-ray or CT scan).
Currently, physician associates are not subject to any form of statutory regulation, however in 2019, the government asked the General Medical Council (GMC), which regulates medical practitioners (doctors), to regulate PAs. The GMC is best placed to regulate PAs as PAs form part of the medical team and are trained to the medical model. Regulation also paves the way for broadening their scope of practice, for example requesting ionising radiation where local governance allows and, in the future, the possibility of being able to prescribe. It is expected that this regulation will come into effect in Winter 2024 at the earliest.

Until regulation is in place, the Physician Associate Managed Voluntary Register (PAMVR), which is managed and overseen by the FPA, sets the professional standards for PAs and provides protection and safety to patients. The PAMVR currently has over 3,500 registered PAs. The FPA believes that holding a voluntary register for PAs remains a robust, fair and appropriate method to protect patient safety as an interim measure. Registration on the PAMVR involves strict membership criteria; PAs must: 

  • have completed a PA course at an approved UK university 
  • have passed both components of the PANE
  • agree to abide by the Faculty of Physician Associates’ code of conduct 
  • agree to undertake continuing professional development (CPD). 

PAs who have studied in the USA can be granted membership of the PAMVR if they have met the US equivalent qualifications and live or work as a PA in the UK. 

Published: Feb 27, 2024