Physician associates

What are physician associates (PAs)?

Physician associates (PAs) are healthcare professionals with a generalist healthcare education who work alongside doctors and surgeons providing medical care as an integral part of the multidisciplinary team. PAs work under the supervision of a named senior doctor (such as a named General Medical Council registered consultant or general practitioner) but can work autonomously with appropriate support.

Physician associates work alongside doctors and other healthcare professionals as part of the multi-disciplinary team (MDT).

PAs are part of the medical associate professions (MAPs) grouping in the health workforce and have been working in the UK since 2003.

PAs can be found working in primary and secondary care across 20 specialty areas in the UK such as internal medicine, general practice, surgery and emergency medicine.

What can a physician associate do?

PAs are trained to work within a defined scope of practice and limits of competence to perform the following duties:

• taking medical histories from patients
• carrying out physical examinations
• seeing patients with undifferentiated diagnoses
• seeing patients with long-term chronic conditions
• formulating differential diagnoses and management plans
• carrying out diagnostic and therapeutic procedures
• developing and delivering appropriate treatment and management plans
• requesting and interpreting diagnostic studies
• providing health promotion and disease prevention advice for patients.

Currently PAs are not able to:

• prescribe
• request ionising radiation (eg chest X-ray or CT scan)

• administer and/or supply medicines under a patient group direction.

  A patient group direction (PGD) is a written instruction for the supply and/or administration of medicines to groups of individuals who may not be individually identified before presenting for treatment.  Read further information on PGDs. 

  Subject to locally determined governance arrangements, a PA may administer medicines under a patient specific direction. A patient specific direction (PSD) is a written instruction, signed by an authorised prescriber, for medicine(s) to be administered to a named person after the prescriber has assessed the patient. Read further guidance on PSDs.

What training and qualifications do physician associates have?

PAs trained in the UK have undertaken postgraduate medical 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).

This 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 settings.

To enrol on a PA programme, students must already hold an undergraduate degree, usually in a biomedical or health/ life science field and have some prior health or social care experience.

How do physician associates fit into the NHS workforce?

PAs are utilised as supplementary members of the multidisciplinary team in a wide range of clinical areas, and under the supervision of a named senior doctor. The specific tasks performed are dependent upon the clinical area worked in and can vary between hospitals. 

PAs’ ability to practise independently and make independent decisions is enabled by collaboration and supportive working relationships with their supervising doctors, with whom they can discuss cases, seek advice and review patients.

PAs operate within the limits of their competence and a defined scope of practice, which is decided locally by the supervising consultant or GP and may change over time as their knowledge, skills and experience develops. 

PAs bring a helpful skillset as additional members of staff supporting services. A significant aspect of the PA role is supporting with ward rounds, reading and writing in patient notes and communicating across the MDT supporting departmental productivity. Their ability to consult with certain patients enables more clinics to be offered, reducing waiting times and the likelihood of cancelled lists.

NHS England has a series of impact case studies looking at ways in which PAs can support services.

Further information

We have produced a range of resources on physician associates including:

• a case study from The Royal Free London NHS Foundation Trust 
• a case study from Aintree University Hospital NHS Foundation Trust
• an infographic.
• The Faculty of Physician Associates, including a section of employer guidance
• Health Education England – physician associates