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Education leaders push for statutory regulation of physician associates



Physician associates should be subject to statutory regulation, according to Health Education England, which is funding schemes to look at how this would work in practice. 

Health Education England is investing £185,000 in developing physician associate and other medical associate roles this year, including work to standardise training as a first step towards full statutory regulation.

HEE chief executive Professor Ian Cumming told Pulse regulation would give a ‘degree of certainty’ to the public, but said the final decision would be up to the Department of Health and the Professional Standards Authority (PSA).

Currently physician associates can join a voluntary register, operated by the Royal College of Physicians, and according to the GMC the DH backs the expansion of this voluntary list to incorporate greater numbers of PAs.

But Professor Cumming told Pulse: ‘HEE’s view is that PAs should be a regulated profession, and that will allow them to function appropriately across the spectrum of roles that they’re expected to undertake. It will also give that degree of security for the public who they’re interacting with.

‘But that’s not our decision, that’s a decision for others to be led by the Department of Health.’

The funding towards this aim was outlined in a HEE financial report this month, which announced the creation of an ‘oversight board’ for the development of a education and training programme that would support ’a route to statutory regulation for medical associate professions in England’.

It added that physician associates were one of four ’medical associate professions’ that had ‘been identified as important solutions to some of these workforce issues.’

The DH told Pulse they were committed to ’proportionate’ regulation of healthcare professionals and said that the PSA would be testing out possible approaches to the regulation of physician associate professions this summer.

Dr Krishna Kasaraneni, chair of the GPC’s workforce, education and training subcommittee told Pulse PAs were one option for tackling the workforce crisis, but wouldn’t be appropriate – or accepted – by all practices.

He added: ‘The concerns regarding regulation, indemnity and prescribing are all things which limit the role physician associates can play in any practice.

‘They need to be addressed in a way that makes it clear that these are independent professionals, working under the supervision of GPs. They do have responsibility for their own actions and prescriptions, but they work in an environment supported by expert generalists like GPs.’

Health secretary Jeremy Hunt tasked HEE with massively expanding the number of clinical support staff  working alongside GPs, including 1,000 new physician associates by 2020. 

Official data shows there were only 11 full-time-equivalent physician associates working in English GP practices in September 2015.

HEE has worked to massively expand the number of universities offering the two-year physician associate studies post-graduate courses, and commissioned places this year – an increase of 220% on last year.

What is a physician associate?

Physician associates – or physician assistants as they are known in other countries – are most widely employed by the USA health system but have more recently been adopted by Australia, Canada, the Netherlands, Germany and India.

They are trained to perform a number of duties, including taking medical histories, performing examinations, diagnosing illnesses, analysing test results and developing management plans, but work under the supervision of a qualified doctor.

The DH has said they would like to see PAs given prescribing powers, and research from Kingston University and St George’s University of London this year claimed that physician associates can take on some of GPs’ daily work without any harm to patients and at lesser cost to the NHS.

But a study this month said they would be unlikely to fill any ‘essential workforce gaps’ any time soon.