The Royal College of Physicians (RCP) held an extraordinary general meeting earlier this month – for only the third time in its 505-year history – on the topic of physician associates.

After the meeting, nearly four fifths of RCP members who cast ballots voted to limit the scale and pace of the rollout of PAs across the NHS in the UK.

So what are physician associates and why are some unions worried?

FactCheck takes a look.

What are physician associates and why were they introduced?

PAs were first introduced in 2003 to support doctors diagnosing and managing patients, often in GP surgeries or hospitals.

Working under the supervision of a doctor, they are trained to perform a number of tasks, like taking medical histories from patients, performing physical examinations, diagnosing illnesses, seeing patients with long-term chronic conditions and analysing test results.

The role usually requires a bioscience-related first degree to get onto one of the training programmes, but if you’re a registered healthcare professional such as a nurse or midwife you can also apply to become a physician associate.

There’s also a level 7 apprenticeship for physician associates, which is equivalent to a master’s degree and typically takes two and a half years to complete.

A spokesperson for the RCP leadership told FactCheck: “There is a workforce crisis in the NHS and when employed appropriately we believe PAs can be useful supplementary members of the multidisciplinary team.”

How many physician associates are working in the NHS?

There are currently just over 4,400 physician associates listed on the Physician Associate Managed Voluntary Register, which is held by the Faculty of Physician Associates (FPA). Registering as a PA on this list is not a mandatory requirement.

Why are members of the Royal College of Physicians and unions worried about physician associates?

Five motions were discussed during the RCP extraordinary general meeting, during which doctors expressed concerns about the scope of practice of a PA, accountability and training opportunities.

The most eye-catching was the motion to limit the pace and scale of the PA rollout – which passed with 78.7 per cent of votes cast.

While the vote cannot force a change in NHS policy, the RCP says it will now work closely with its Council, Board of Trustees and key stakeholders “in response to this clear direction from the fellowship”.

The general secretary of the Hospital Consultants and Specialists Association, Dr Paul Donaldson, told FactCheck: “Associate roles are poorly defined and misnamed. They are assistants, not doctors, and they should be clearly labelled as such.

“It’s also appalling that no-one is taking overall responsibility for defining their scope of work, which is blurring boundaries and risking patient safety.”

Professor Phil Banfield, chair of the British Medical Association (BMA) council, said: “The need for guidance, implemented at a national level, about what a physician or anaesthesia associate can do safely and to be a valued member of a medical team, is paramount.”

The BMA has published its own guidance, which it encourages NHS organisations to adopt.

He said: “With the Government’s clear intent to expand the numbers of MAPs [medical associate professions, which includes PAs] in the medical workforce, but without the clarity on the scope of their skills and responsibilities, it is even more important that patients must know who is treating them and the skills and abilities that clinician has.”

NHS England sent out a letter on guidance for physician associates to trusts, which run local health services, on 12 March. It says it is “working collaboratively with partners”, including trade unions and others, to develop tools such as capability frameworks (which look at skills and knowledge) and supervision guidance for people in associate roles.

A Department of Health and Social Care spokesperson told FactCheck: “Physician associates and anaesthesia associates have worked in the NHS for over two decades and are an important part of the health service, providing support to thousands of patients every day under the supervision of doctors.

“Regulation by the General Medical Council will ensure they continue to meet the same high standards we expect of all healthcare professionals and support the safe expansion of these roles within the NHS, as set out in the Long Term Workforce Plan”.

(Image credit: Andy Rain/EPA-EFE/Shutterstock)