Physician associates need new job title, says review

Physician associates (PAs) and anaesthesia associates (AAs), who assist doctors in GP surgeries and hospitals, should be known as “assistants” to avoid confusing patients, an independent review says.

It recommends PAs and AAs wear standardised clothing and badges to distinguish them from doctors and should only see patients in limited circumstances.

Health Secretary Wes Streeting said the government would accept all the recommendations of the review which was announced last year, following a heated debate.

The doctor’s union, the BMA, said it should have gone further but the union representing PAs and AAs warned the plans could make waiting lists longer.

Review author Prof Gillian Leng talked to doctors, patients and the public to collect evidence on the safety and effectiveness of the roles of PAs and AAs.

She said a clear vision “was largely missing” when they were introduced in 2000 and there was no national plan for how the new roles would fit into existing teams, resulting in growing “confusion about the roles’ purpose and remit”.

“Where capacity was limited in local services, gaps in medical posts were sometimes covered by PAs, without taking into account their more limited training or ensuring that supervisors had the necessary understanding of the roles and the time and skills required to provide appropriate oversight,” Prof Leng added.

Prof Leng also listened to families of relatives who died after being treated by PAs, believing them to be qualified doctors.

“Safety concerns raised in relation to PAs were almost always about making a diagnosis and deciding the initial treatment,” says the review.

“It is here that the risk of missing an unusual disease or condition is highest.”

Emily Chesterton was told the calf pain she was experiencing in October 2022 was a sprain but it was in fact a blood clot. She died, aged 30, after being seen twice by a physician associate.

Susan Pollitt, 77, was being treated by a PA in hospital two years ago after a drain was left in her abdomen for 15 hours longer than it should have been. She died from an infection two days later.

Her daughter Kate says the family have never blamed the PA involved but want more clarity.

“As a family, when you’ve got someone in hospital, you don’t think straight because you’re just worried about your relative,” she says.

“Even though people are telling you who they are, you’re not registering it. So I do think it needs to be made clear, with the uniform and the badges and the name. So we do welcome that,” Kate says.

In other cases, patients said they were satisfied after seeing a PA and felt listened to, the review says.

The review recommends physician associates should:

• be renamed “physician assistants” to reflect their supportive role in medical teams
• not see new patients in primary or emergency care until they have been triaged and deemed to have a minor ailment
• have at least two years’ hospital experience before working in a GP surgery or mental health trust
• be part of a team led by a senior doctor
• wear badges, lanyards and clothing to set them apart from doctors

Anaesthesia associates should be renamed “physician assistants in anaesthesia” or PAAs.

In addition, patients should be given clear information about the role of a PA and there should be a faculty to represent PAs and set standards for training.

Accepting all the recommendations, Mr Streeting said patients could “be confident those who treat them are qualified to do so”.

“Physician Assistants, as they will now be known, will continue to play an important role in the NHS. They should assist doctors but they should never be used to replace doctors.”

Physician associates (PAs) and anaesthesia associates (AAs) were introduced into the NHS in the early 2000s to ease doctors’ workload.

As their numbers grew, concerns were raised about the safety of the roles, the lack of clarity around their responsibilities and the impact they had on junior medics’ work and training.

PAs are not authorised to prescribe medication but they can order certain scans, take medical histories and conduct physical examinations.

Anaesthesia associates (AAs) support surgery teams and are a much smaller group.

There are now more than 3,000 PAs and AAs in England but the NHS workforce plan envisages that increasing to 12,000 by 2036.

Both PAs and AAs have to complete a two-year postgraduate course. To be eligible they need to have either a science-related undergraduate degree or be a registered healthcare professional already.

The Academy of Medical Royal Colleges said there was a growing campaign against their use, fuelled by unsubstantiated claims on social media. It requested an independent review to set out the jobs they can safely do.

PAs and AAs have been regulated by the General Medical Council, the body which also regulates doctors, since December 2024.

Doctors’ training takes many years longer, and anti-social hours and exams are a regular occurrence.

The British Medical Association has said PAs and AAs were being asked to do tasks they were not meant to do and the lines with doctors were getting blurred.

Dr Emma Runswick, from the BMA, says the name change to physician assistants is “positive” but doctors haven’t got everything they wanted and more still needs to be done.

“Patients can know who they are seeing, but it does not make the key changes that we are looking for in terms of setting out what they can and cannot do.”

“But we would be a fool to say that it wasn’t some progress.”

United Medical Associate Professionals (UMAPs) which represents PAs and AAs broadly welcomes the findings but has concerns, particularly over PAs only treating patients who have already had a diagnosis.

“We believe this will only compound the backlog for appointments with GPs and consultants and entirely negates the benefit of having such highly trained medical professionals available on wards and in local surgeries,” said general secretary Stephen Nash.

Dr Hilary Williams, incoming vice president of the Royal College of Physicians, said the review was “thoughtful” and “thorough”, and showed that “reform is urgently needed” to ensure safe teamworking in the NHS.