Physician Associate

​PAs can:

• Take medical histories from patients

• Carry out physical examinations

• Look after patients with long-term conditions

• Develop treatment plans

• Propose medication for the GP to review and prescribe

• Develop and deliver appropriate treatment and management plans

• Request and interpret diagnostic studies such as blood tests and ECGs

• Provide health promotion and disease prevention advice

• Refer to social services and raise safeguarding concerns

• Refer to community services, social prescribing and hospital services

With adequate training and supervision PAs can perform:​

• Cervical smears​

• Respiratory diagnostic tests such as FeNO/Spirometry​

• Minor surgery​

• Ear micro suctioning​

• Family planning including inserting Long Acting Reversible Contraceptives (LARCs)​

• Cryotherapy​

• Tele dermatology ​

• Smoking cessation​

• Anticoagulation clinics​

Currently, PAs are not able to:​

• Prescribe medication​

• Request ionising radiation (e.g., chest x-ray or CT scan)

• Issue sicknotes or fit notes

Supervision:​

• PAs are always under the supervision of a designated named GP. During the initial 6-12 months, PAs work closely with their named supervisor to enhance their skills and knowledge. As they gain experience supervision requirements will develop accordingly

• Please note - PAs are not a substitute for a GP. Instead, PAs are integrated into the healthcare team, where they work under supervision and within their scope of practice

Regulation & Registration:​

• The Physician Associate Managed Voluntary Register (PAMVR) is held exclusively by the Faculty of Physician Associates (FPA) under the Royal College of Physicians (RCP), and only Physician Associates who are fully qualified and approved will be on this register. Physician associates will begin to be regulated by the General Medical Council (GMC) from December 2024.

The image below illustrates an example of a Physician Associate 5 day working week with +1 year experience:

The public must trust Physician Associates with their lives and health and to justify that the public can trust PAs, they must show respect for human life and make sure their practice meets the standards expected within the four domains of Good Medical Practice - outlined below. 

GMC Good Medical Practice: Interim standards for Physician Associates (NOT YET IN EFFECT) can be found on: https://www.gmc-uk.org/-/media/documents/good-medical-practice-for-maps-guidance-english_pdf-87860193.pdf

Domain 1: Knowledge, skills and performance  

• Develop and maintain your professional performance

• Apply knowledge and experience to practice

• Record your work clearly, accurately and legibly 

Domain 2: Safety and quality

• Contribute to and comply with systems to protect patients 

• Respond to risks to safety 

• Risks posed by your health

Domain 3: Communication, partnership and teamwork  

• Communicate effectively 

• Working collaboratively with colleagues

• Teaching, training, supporting and assessing

• Continuity and coordination of care  

• Establish and maintain partnerships with patients

Domain 4: Maintaining Trust 

• Show respect for patients

• Team patients and colleagues fairly and discrimintation  

• Act with honesty and integrity

NHSE offers a £5,000 preceptorship allowance which is paid to employers to support the supervision and educational needs for a newly qualified PA or a PA who is moving to General Practice within 3 years of qualifying.

NCL Is entitled to 11x Funded PA Preceptees per year. 

Further information can be found here: https://www.hee.nhs.uk/our-work/physician-associates.

Physician associates are healthcare professionals with a generalist medical education, who work alongside doctors as an integral part of the multidisciplinary team. Physician associates work under the supervision of a fully trained and experienced doctor.​

The below guide, published by the NHSE is for any general practice that has recently employed or considering employing a Physician Associate into their primary care team:​

• Download PA Supervisor resources.

The GMC and NHSE have released updated guidance regarding PA supervision

GMC update: An update: preparing for regulation of physician associates

NHSE updates: Summary of existing guidance on the deployment of medical associate professions in NHS healthcare settings

Key points:

• “Our guidance for doctors is clear that, as with other professionals that they supervise and work alongside, doctors are not accountable for the decisions and actions of PAs and AAs, provided they have delegated responsibility to them in line with the standards and guidance in Good medical practice, Leadership and management for all doctors, and Delegation and referral.”

• Supervision: MAPs must work under the supervision of a named senior doctor, ensuring tasks and responsibilities align with their competencies.

• Scope of Practice: MAPs should only perform tasks within their qualified scope, with clear job descriptions and defined roles.

• Safety and Accountability: Supervisors must have the capacity and capability to oversee MAPs, ensuring patient safety and clear role understanding among staff.

As part of the nationally agreed funding model introduced in 2018, NHSE have invested a £5000 education support payment for Practices/PCNs if:​

• New PAs contract to work in Primary Care within the first 12 months of practice after becoming registered​

• Upon delivery of a Preceptorship Programme which meets NHSE Preceptorship Criteria ​

• This would also include the transition of PAs from secondary care with a maximum of 3 years’ experience​

For further information click here.

Please see below the guidance document for details.​

• NHSE Criteria – Physician Associate Preceptorship Guidance ​

• NHSE London Preceptorship Application Form​

• NHSE London Preceptorship Application – Mentorship Guidance ​

Once employed by the practice, Practice leads should complete the application form in accordance to the PA Preceptorship Guidance, along with the PA’s weekly timetable and induction programme. All applications should be sent to Carolyn Mathews, NCL Training Hub Workforce Development Lead at carolynmatthews@nhs.net.​

If you have any queries, please contact Chaima Hale, Physician Associate Ambassador for North Central London, NHSE at chaima.hale1@nhs.net.

The image below illustrates the Preceptorship Timeline for newly qualified PAs or PAs new to General Practice:​

Physician associates require professional indemnity coverage in order to practice in the UK and the cost of this coverage is typically paid for by the employer. 

With the introduction of the state-based indemnity scheme for primary care (GMPI), the cost to practices indemnity has dropped substantially.

However, dependant of the clinical scope of practice of a primary care PA, a ‘top-up’ policy from one the clinical indemnity organisations is required. 

Clinical indemnity organisation  providers for PAs include:

• MPS

• MDU

• MDDUS 

For further information click here.

Prescribing: 

Physician associates (PAs) cannot currently prescribe. Prescribing responsibilities aren’t included in the legislation that will bring in regulation. Additional legislation will be required.

While this is not the GMC decision, the GMC are contributing to a DHSC working group on prescribing for PAs, alongside the Faculty of Physician Associates (FPA) and others. 

The GMC have set out some principles and expectations, including around patient safety, education, and assessment and the GMC  understand the importance of future prescribing to the PA professions. Statutory regulation needs to be implemented before prescribing responsibilities can be extended to PAs.

For further guidance: Physician Associates and prescribing in general practice

Immunisations and Patient Specific Direction (PSD):

A PSD is a written instruction, signed by a doctor, dentist, or independent (non-medical) prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis.

The prescriber who signs the PSD is accountable for the assessment of the patient and determining the suitability of the patient to receive the vaccine. The healthcare worker who supplies or administers the vaccine under a PSD is accountable for their own practice and must be trained and competent to undertake such tasks They must act according to their level of competence and in accordance with the directions of the prescriber.

All Physician Associates are currently required to fulfill CPD requirement to remain on the PAMVR which is audited by the FPA in conjunction with the Royal College of Physicians. 

All PAs are required to complete 50 hours of documented CPD per year using the RCP CPD diary.

https://cpd.rcplondon.ac.uk/Login.aspx 

The user friendly RCP Physicians’ CPD App is also available to PAs to document their CPD 

For information on education events: 

• https://www.fparcp.co.uk/professional-development/events

• https://gps.northcentrallondon.icb.nhs.uk/education/events

The NCL PA Forum is a dedicated PA group providing monthly PA teaching for NCL Primary Care PAs.

Teaching occurs on the last Wednesday of every month from 2.30 - 4pm.

If you are interested in joining our dedicated Whatsapp group, please email Chaima Hale, chaima.hale1@nhs.net.

Subscribe to the London Affiliation of Physician Associates newsletter:

Click here to subscribe

To stay up to date with GMC regulation:

https://www.gmc-uk.org/pa-and-aa-regulation-hub

Faculty of Physician Associate news: 

https://www.fparcp.co.uk/ 

This is a role that is included in the Additional Roles Reimbursement Scheme from April 2020. Primary Care Networks may therefore be able to access funding via the ICB to cover salary and on-costs. You can find out more about the scheme and workforce planning by contacting the GP Forward View Leads who work with the ICB's Primary Care Team and by referring to the Useful Resources tab on the right of this page.

Physician Associate Ambassadors support and enable the development and integration of the local PA workforce working alongside key stakeholders. 

NCL’s Current NHSE ambassador is Chaima Hale: chaima.hale1@nhs.net.

Appointment term: October 2022 - December 2025.