GPs and physician associates disagree on tasks PAs can carry out, review shows
GPs and physician associates (PAs) strongly disagree on which activities PAs should carry out, according to new survey data which underpinned the review into their safety.
The survey asked respondents – including 1,141 PAs and 888 GPs – to say whether 17 activities were appropriate for PAs to conduct, including reviewing test results, performing physical examinations on patients and taking medical histories.
Its findings underpinned Professor Gillian Leng’s review into the safety and effectiveness of PAs, which did not set out a ‘scope’ of practice but suggested a severely limited job description in future, alongside a name change to physician assistant.
Upon joining general practice, PAs should ‘play a central role in all aspects of preventative care, including undertaking NHS health checks and provide lifestyle support, and support the administration of basic therapeutic procedure’, the report said.
In the survey, a higher proportion of PAs responded ‘yes’ than GPs for every listed activity, and there were only three activities which a majority of GPs thought were appropriate – ‘provide health promotion and disease prevention advice to patients’, ‘support innovation, audit and research’, and ‘deliver immunisations’.
‘In general, there was a very high level of confidence from PAs regarding whether they believed specific activities were, or would be in the future, appropriate to conduct,’ the Leng review said.
The largest disparities between PAs and GPs’ views were around whether PAs should review test results (97% of PAs compared to 27% of GPs) and performing diagnostic and therapeutic procedures (93% compared to 23%) – 70 percentage points.
Interpreting the survey results in the review, Professor Leng said the differences in GPs’ and PAs’ views were ‘influenced by a number of factors including negative media’.
She said: ‘In general, PAs were more confident in their abilities than any other healthcare professional, although this overconfidence might have arisen because of recent scrutiny and a feeling that PAs must “prove their worth”.
‘Reasons for the differences in perspectives are challenging to interpret and will be influenced by a number of factors including negative media. It is probably reasonable to expect that actual appropriateness of PA activities lies somewhere between the two extremes.’
In all, 99% of surveyed PAs said they should be able to:
- Provide health promotion and disease prevention advice to patients (73% of GPs said this should be the case)
- Perform physical examinations on patients (39% of GPs)
- Take medical histories from patients (49% of GPs)
- Provide clinical assessments on patients (36% of GPs).
Meanwhile, just 12% of GPs thought PAs should deliver antenatal care (compared to 61% of PAs).
Elsewhere in the survey, 61% of PAs agreed that patients understand the PA role compared to just 17% of GPs.
The review’s recommendations, including that the Government should consider a ‘fast-track training route’ for current physician associates (PAs) who want to become doctors, have now been accepted in full by the Government.
Last month, a Pulse survey of 732 GPs found 28% of GPs did not think PAs should complete any of the activities listed in the survey.
The most positive response rate was for PAs taking on NHS health checks (57% agreed) and carrying out vaccinations (49%), while only 2% thought PAs should be able to independently see acute non-triaged patients.
Following the review, the RCGP reaffirmed its opposition to the role of PAs in general practice.
Pulse July survey
Take our July 2025 survey to potentially win £1.000 worth of tokens
Related Articles
READERS' COMMENTS [2]
Please note, only GPs are permitted to add comments to articles
I feel the consensus comes from the responses from other roles which aligns with the GP responses.
Whilst we appreciate that PAs feel they are capable, it takes years of training as a junior doctor to see a lot of normal to be skilled to pick out the abnormal along with all the aggravation experienced when as a junior doctor patients felt you had missed a diagnosis and the litigation that follows .. it’s optimistic to think you know everything until a patient mishap, and this is why it takes 10 years to become a GP not 2 or 4 …..the title should change to clinical assistants not even physician as that implies some element of doctoring.
All GPs I know, worry about missing important diagnoses.
May be if we too all knew less, we would be less worried in our ignorance.
The Dunning–Kruger effect is a cognitive bias in which people with limited competence in a particular domain overestimate their abilities.