Medical associate professions

The first physician associate (PA) roles were introduced to the NHS in 2003. PAs must pass an intensive two-year university course at diploma or master’s level after completing a three-year biomedical or healthcare related degree. They train in both the acute sector and primary care to gain a broad base of patient-centred clinical knowledge and experience. 

Upon qualification, PAs work alongside doctors and form part of the multidisciplinary team, with supervision from a named senior doctor, such as GMC registered consultant or general practitioner. They work across a range of settings and specialties, operating within the limits of their competence and a defined scope of practice, which may change over time as their knowledge, skills and experience develops.

PAs have completed a generalist healthcare education. They work as part of a multidisciplinary team with supervision from a named senior doctor, such as GMC registered Consultant or General Practitioner) providing care to patients in primary, secondary and community care environments. PAs work within a defined scope of practice and limits of competence.

PAs are accountable for ensuring that the care of patients is of a high standard at all times. PAs work in hospitals, general practices and can also be deployed in mental health settings. The first physician associate roles were introduced to the NHS in 2003.

Employers might consider including PAs in their multi-disciplinary teams  to support increased continuity of patient care, with benefits for patient experience and service efficiency. 

AAs were first introduced in the NHS in 2004. AAs have undertaken a 2 year intensive university course at diploma or masters level, following a 3 year biomedical or healthcare related degree. Working across a broad range of surgical specialty areas these skilled practitioners can provide anaesthetic and perioperative patient care, under the supervision of an autonomously practising anaesthetist such as a Consultant or SAS doctor. Overall responsibility for the anaesthesia care of the patient remains with the named Consultant or SAS anaesthetist at all times.

Employers may utilise AA roles as part of the anaesthesia MDT to reduce operating theatre downtime, leading to increased throughput and theatre utilisation.

Surgical care practitioners are trained non-medical healthcare professionals who have undergone further masters level training. SCPs can perform surgical interventions and pre and post-operative care to patients to a pre-determined level of autonomy and supervision under the direction and supervision of the operating surgeon.

Surgical care practitioner undertake a wide range of roles within the multidisciplinary team including preoperative assessments, assist with preparation of patients for theatres and provide assistance with surgical procedures.

On top of assisting in operating theatres, SCPs help on wards and in clinics. Surgical care practitioners can prescribe medications relevant to their individual specialty following appropriate training for non-medically qualified prescribers. Employers might consider including SCPs as part of the extended surgical team, to enhance patient care and make surgical services more efficient.

Employers have an important role to play in ensuring that they have planned and modelled their workforce well at a strategic level, and that the incentive for introducing new or extended roles into the workforce is to improve service delivery and patient experience.

Medical Associates are optimally integrated where a detailed assessment of the capacity to train and supervise has taken place. Employers must also ensure that local training and clinical governance policies are utilised to ensure a competent workforce where patient safety remains paramount. 

Recruitment and employment policy and practice should support staff to ensure that their new recruits have qualified from recognised programmes, and that they have passed the relevant national exam within the UK (and recertification where necessary).

New staff should be well supported and integrated into the multidisciplinary teams they are working in and provided with appropriate supervision and continuous professional development.

The wellbeing of all staff should be paramount and reflected in their rotas and their training and development plans to enable flexibility and best use of professional and clinical skillsets to maximise outcomes for patients.

In October 2017, the Department of Health and Social Care (DHSC) sought views on the regulation of the medical associate professions (MAP) roles in the UK.

Following the consultation, DHSC has announced it will proceed with the statutory regulation of anaesthesia associates and physician associates. The General Medical Council (GMC) was deemed best placed to regulate AAs and PAs, and was invited to carry out this function in July 2019. 

The legislative provisions have been drafted on the basis of the detailed policy proposals consulted on in Regulating healthcare professionals, protecting the public, published in March 2021.

On the 11 December 2023, the government's response to this legislation was published, with the legislation being laid before parliament on the 13 December 2023. Statutory regulations for MAPs is intended to be in place by the end of 2024.

We welcome this news and fully support the regulation of these roles. It will provide a standardised framework of governance and assurance for clinical practice and professional conduct to enable these healthcare professionals to make a greater contribution to patient care.

In the meantime, anaesthesia associates and physician associates are able to apply for inclusion on managed voluntary registers held by the Royal College of Anaesthetists and the Royal College of Physicians respectively.

Although we acknowledge the benefits of voluntary registration for practitioners, patients and employers, it is also worth noting that where there are restrictions to gaining access to a managed voluntary register (such as requiring paid membership of a professional body), employers may not be able to ask for voluntary registration as an essential pre-requisite for employment.

Guidance for employers to support AA and PA colleagues during this process can be found here.

Read our AA and PA FAQs here.

Further information on the regulation process can be found on the GMC Hub.