Large numbers of GPs think physician associates should do vaccinations and health checks

Exclusive Large numbers of GPs think physician associates (PAs) should be able to take on vaccinations and NHS health checks, a Pulse survey has revealed.

GPs were asked what tasks they think PAs should be able to perform in general practice, including vaccinations, health checks, initiating investigations, managing chronic disease and doing physical examinations and taking history on behalf of the GP.

The results of the poll of 732 GPs found that 57% think PAs should be able to take on NHS health checks, while 49% think they should be able to do vaccinations.

The survey also found only 2% of GPs thought PAs should be able to independently see acute non-triaged patients. And 28% did not think PAs should carry out any of these tasks (see box for the full results).  

There is currently no statutory or centrally-backed guidance outlining how physician associates should work in general practice, but earlier this year the RCGP – whose position in PAs is that they have ‘no role’ in general practice – set out a clear scope for the 2,000 PAs who currently work in practices which severely limited their roles.

The college guidance stipulated that PAs can ‘undertake annual NHS health checks and provide lifestyle support, according to protocolised pathways’. However, they must not see patients who have not been triaged by a GP, nor patients who present for a second time with an unresolved issue.

The BMA also set out a scope of practice, which said that PAs can do vaccinations ‘if trained to do so’ and argued that they should never see ‘undifferentiated’ patients in a GP setting.

GPs taking part in the survey told Pulse that there is still serious concern around the lack of a scope of practice for PAs. And some argued that PA tasks in general practice should be ‘dependent’ on the individual, and their training and competencies.

One GP said that PAs should take on vaccinations and NHS health checks, and added: ‘In general practice I think PAs can only safely work in areas which can be highly protocolled and leave little room for discretion.

‘Even where they can safely do this, it’s difficult to make a sensible economic argument. We previously used PAs – but they were significantly more expensive per patient contact than GPs.’

Another GP, who has experience working with PAs, agreed that they could do vaccinations and health checks, and told Pulse: ‘I would be happy for a PA to do either of these with the right training. We have health care assistants doing both health checks and vaccines. 

‘PAs are trained to degree level and HCAs are not. PAs are perfectly capable of delivering both of these items well. The keys are the right training and being assessed to be competent.  

‘My PA works across my practice and the PCN. All of her appointments are triaged so she is not seeing undifferentiated conditions and is only seeing patients we feel are within her competency. 

‘Of course, patients bring up other issues and she has a dedicated supervisor for each session to discuss the patients with and who can see the patients too if needed. 

‘We need to remember that PAs took on these roles in primary care planning to remain in this setting. They are stuck in their current roles with no opportunities to move to another area even if life circumstances change.

‘They did not create this situation and we need to ensure those who chose general practice are given the opportunity to be supported and to develop in this setting.’

Another GP responding to the survey said: ‘I do not think there is any place for PAs in general practice as their is no scope for them working independently dealing with undifferentiated illness.’

Pulse has recently looked in detail at conflicting views and advice on the scope of practice for PAs.

The Government-commissioned safety review of PAs, which is expected to be published by the end of the month, will reportedly conclude that their title should be changed to avoid patient confusion.

It will not cover a detailed scope of practice by setting, but will look at if and when an ‘enhanced’ scope of practice may be necessary, and it will also cover cost-effectiveness of the roles and supervision.

On scope of practice, the BMA urged Professor Gillian Leng, who is leading the review, to ‘set ceilings of practice for these dependent non-medical roles’. 

Throughout the review, GPs have been asked to provide both practice-level analysis or data on physician associates as well their own views and experiences of working with the role.

Professor Leng will take part in a Q&A with Pulse editor Sofia Lind at Pulse LIVE in Birmingham tomorrow.

In response to the survey results, RCGP chair Professor Kamila Hawthorne said: ‘The college’s position, as set by our governing Council, following consultation with members during which significant patient safety concerns were raised, is that physician associates do not have a role in a general practice setting.

‘Recognising that there are PAs already working in general practice, RCGP Council previously approved three sets of guidance to support GP practices already employing PAs, including a scope of practice of PAs, which can be found on our website.

‘We have engaged with the Leng Review to ensure that the voice of GPs is heard – we are now awaiting the outcome and will consider the report once published.’

This survey was open between 31 March and 14 April 2025, collating responses using the SurveyMonkey tool. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £200 John Lewis voucher as an incentive to complete the survey. We asked for GPs’ practice codes or practice names and postcodes, and asked them to confirm what kind of GP they were. We removed those with duplicate email addresses, and searched for duplicate IP addresses, removing obvious duplicate entries. The survey was unweighted, and we do not claim this to be scientific – only a snapshot of the GP population.