The name has changed for several reasons. Currently the PA profession is not regulated in the UK and therefore the title Physician Assistant is not protected. This means that anyone can use the title. There are other groups of people in healthcare who use the title but who are trained to take bloods, ECGs and other technical tasks, they do not have the training or education expected of a PA, as defined above. This was leading to confusion regarding the role.

Physician associates work across a variety of medical and surgical specialties in England and Scotland.

PAs see patients of all ages for acute and chronic medical care.

They obtain:

• medical histories
• conduct comprehensive physical exams
• request and interpret tests
• diagnose and treat illnesses and injuries
• advise on preventive health care.

They are able to make referrals, discharge or admit patients and can arrange for intermediate care or community services as well. Experienced PAs help with teaching for the PA and medical students as well as qualified members of staff.

PA training is post-graduate in the UK. The programmes are a minimum of 90 weeks over two years (3,200 hours) and based on the Competence and Curriculum Framework for Physician Assistants (DH, 2006, Revised 2012). PAs then have to pass a national exam to enter into professional practice. They must re-certify every six years to continue to practice.

There are several organisations involved in the structure and overseeing of the profession: The UK and Ireland Universities Board for PA Education (UKIBPAE) and The Faculty of Physician Associates – professional body for PAs in the UK which has responsibility for the PA Managed Voluntary Register (PA MVR).

PAs are paid anywhere from £28,000 to £50,000, depending on experience. PAs are on the Agenda for Change pay scale in the NHS. US PAs would be banded in the same way but may be offered other incentives in their employment packages as PA salaries in the US are considerably higher than in the UK and most PAs coming to the UK tend to be very experienced in their specialty area.

As a new role in the UK, PAs are still seeking statutory registration, as current Government policy stipulates there will be no statutory regulation of new healthcare professional groups. However the Faculty of Physician Associates in conjunction with Health Education England, Department of Health and the Royal Colleges are working hard to gain statutory regulation of the profession in order to protect the title, secure standards for education and training of PAs and to provide an enhanced level of public protection and safety.

A managed voluntary register (MVR) for PAs has been established to mimic the registers of current statutory regulators, but it has no force of law. The MVR requires PAs to sign up to a code of conduct and scope of professional practice and gives clear guidance on standards required for continuing professional development and re-certification. It also provides some element of public protection and safety as it has a fitness to practice mechanism should anyone wish to raise a concern about a PA.

As this is a voluntary register PAs cannot be forced to join, however it is good practice and we would strongly recommend employers encourage PAs to join.

PAs are able to practice in the UK as a result of a clause in the British General Medical Council’s guidance on good medical practice.

Delegation is discussed in paragraph 54 as follows:

“Delegation involves asking a colleague to provide treatment or care on your behalf. Although you will not be accountable for the decisions and actions of those to whom you delegate, you will still be responsible for the overall management of the patient, and accountable for your decision to delegate. When you delegate care or treatment you must be satisfied that the person to whom you delegate has the qualifications, experience, knowledge and skills to provide the care or treatment involved. You must always pass on enough information about the patient and the treatment they need.”

For further information, see the General Medical Council’s website and statement on good medical practice.

PAs will require a certain amount of supervision in their medical practice. This will vary somewhat from individual to individual and is dependent on a number of factors including, but not limited to, their previous healthcare experience and years of experience as a physician associate.

PAs are currently unable to prescribe medications in the UK, due to the lack of statutory regulation. Legislative change is needed to enable this to happen. Therefore this is due to lack of legislation and not lack of competence. Despite this PAs can still provide an effective service and care for patients.

Close work with supervising physicians and arrangements developed locally allow for flexible ways of working and continuation and expansion of quality patient care. For instance, many PAs working in general practice have the ability to quickly interrupt their supervising physician for a prescription where required and then continue their work. If further advice on a case is required, the GP and physician assistant take time out to discuss it and/or see the patient together to come to a decision on further treatment.

In the hospital setting, PAs are able to write drug charts which require countersignature from a doctor, or propose medications on an electronic prescribing system.

At present PAs are also unable to request x-rays as the IRMER regulations stipulate that only registered healthcare professionals can do this. Most trusts work around this and have local policy/procedures to enable PAs to do their job as fully as possible.

Yes, PAs require professional indemnity coverage. The cost of this coverage is typically paid for by the employer. Currently, the Medical Protection Society (MPS), and Medical and Dental Defence Union of Scotland (MDDUS) will provide professional indemnity for PAs working in general practice. PAs and other hospital staff employed by a secondary care trust are indemnified by the NHS Litigation Authority but it is recommended that this is checked prior to commencing a role to ensure individual coverage is not also required for the specific task the PA is being recruited into. Independent providers should check the position with their indemnity provider but most major healthcare insurers now recognise PAs within their schemes.

PAs on the Managed Voluntary Register must complete 50 hours of CPD per year. Twenty five hours of type 1 CPD (formal training – recognised and certified courses ALS, Royal College courses) and 25 hours of type 2 CPD, online courses, teaching, journal articles and reflection pieces). Most employers will allocate study leave pro rata to enable PAs to meet the requirements of CPD to maintain their registration.

PAs on the MVR also have to recertify every six years to continue to practice. This involves a multiple choice, single best answer MQC paper covering all core areas of practice that a PA is expected to maintain knowledge in, regardless of where they are working.