The RCP has published new interim guidance on the scope, supervision and employment of physician associates (PAs) working in the medical specialties (also known as the physician specialties).
Developed by the RCP oversight group for activity related to PAs (also known as the RCP PA oversight group, or PAOG), this new interim guidance has been approved by RCP Council and will act as a placeholder to ensure patient safety and support physicians and the wider healthcare team until the independent review of PA and anaesthesia associate professions (the Leng review) reports its findings in spring 2025.
The interim guidance covers scope of practice for general internal medicine, supervision and employment of PAs, and how PAs should describe their role to patients, employers, other healthcare professionals and the public. It will be reviewed in collaboration with stakeholders, including RCP fellows and members, following the publication of the report of the Leng review.
In the guidance, the RCP is clear that:
- PAs must support – not replace – doctors, have a nationally defined ceiling of practice, and have a clearly defined role in the multidisciplinary team (MDT).
- PAs must never function as a senior decision maker, nor should they decide whether a patient is admitted or discharged from hospital.
- Resident doctors are not, and must not be expected or asked to be, responsible for the clinical supervision of PAs. PAs should only be supervised by consultants, specialist or associate specialist doctors.
- PAs cannot prescribe medications regardless of any prior healthcare background while working as a PA.
- PAs must clearly explain their role to patients, their families and carers, as well as colleagues and supervisors, and provide details of their educational and clinical supervision when required.
In RCP's submission to the Leng review, it will be calling for the publication of a nationally agreed scope and ceiling of practice for PAs, a review of the projections for growth in the PA role in the NHS Long Term Workforce Plan, and a review of the way the PA role impacts training opportunities for resident doctors.
Dr Hilary Williams, RCP vice president for Wales, and chair of the PA oversight group said: "I want to thank everyone involved with the development of this interim guidance on scope and supervision for PAs, especially the authors and contributors who have put so much work into writing these documents. They have listened to the breadth and diversity of views of our fellows and members and learned from their expertise.
"It’s crucial that PAs are supported to understand the remit, scope and professional boundaries of their role so that they can contribute to safe patient care in the future. This guidance sets out a placeholder scope of practice for PAs and describes their role in the MDT while we await the findings and recommendations of the Leng review.
"The medical workforce remains under immense pressure, and it is time to refocus our attention on valuing our resident doctors. They deserve high quality training today to ensure they can become the expert physicians of tomorrow."
Dr Ben Chadwick, chair of the PA guidance writing sub-group said: "I hope that this new interim guidance offers clarity in how PAs can best be supervised and supported to work in multidisciplinary teams in the medical specialties. Employers must ensure that supervising doctors are resourced to provide clinical and educational oversight to PAs without compromising the training experience of resident doctors. Employers should also monitor the impact of the PA role on patient outcomes."
