Executive summary

The deanery met with Physician Associate (PA) students from the postgraduate entry programme at the University of Lancashire and trust PA leads as part of a rolling programme of visits to universities providing PA courses.

Verbal feedback was provided on the day to the Dean School of Medicine and Dentistry, Programme Director of the PA Programme and 2 Senior Lecturers, PA Programmes.

Positive findings included

• The MSc Physician Associate Practice provides a good mix of theory and practice.
• Dedicated university staff.
• Students are well prepared for their placements and supervised well whilst on placement.
• All students would recommend the course academically.  
• Passionate and enthusiastic cohort about their PA role and the difference it can make.

No mandatory requirements were identified; however, the following issues were identified

• Mixed experiences of PAs regarding the quality of some placements in primary care.
• Varying understanding at some trusts on the scope of PAs and student PA curriculum requirements.
• Perception of PAs and their skill set, negative social media attention has impacted some students interactions with staff on placement.
• Some students had experienced challenging behaviour from some colleagues questioning their role.
• Student morale has been impacted due to the current lack of career prospects, which is outside of the university’s control.

Review overview

Background to the review

The deanery are undertaking programme reviews across all universities providing PA courses. The University of Lancashire is the fourth of 5 universities providing the MSc in Physician Associate Studies to be visited.

The deanery has soft intelligence on the quality of the education and training provided at universities. Therefore, this quality intervention was planned to begin to establish a baseline on the quality of education and training provided and to understand the university’s quality assurance processes. The aims of the visit were to:

• Establish baseline information on the quality of the programme.
• Hear about the experiences of PAs going through the programme both in terms of education and placements.
• Gain feedback on the experience of clinical supervisors in trusts regarding the readiness of PAs placed on placement.
• Use the baseline information to identify any programme aspects that could be improved and/or support required by PAs/trusts and the university.
• Identify areas of best practice.
• Set recommendations for the future quality control of the course and placements.

This review involved speaking with Year 2 postgraduate entry PA students, PA leads, and trust clinical supervisors. High level verbal feedback was provided at the end of the review to the university’s PA course leads.

The deanery met with students face to face at the University of Lancashire and supervisors via Microsoft Teams.

We would like to thank the university for facilitating the deanery to meet with students and supervisors, and for making the visiting team feel very welcome.

Who we met with

Learners

• 15 student physician associates (Year 2)

Educators

• 5 trust clinical supervisors/PA leads

Education team

• Dean School of Medicine and Dentistry
• Programme Director, Physician Associate Programme
• 2 Senior Lecturers, Physician Associate Programme

Review Panel

• Associate Postgraduate Dean, Education. Quality Review Lead
• Deputy Postgraduate Dean, North West School of Foundation Training and Physician Associates.
• Programme Support Business Manager, North West School of Foundation Training and Physician Associates
• Quality Support Manager
• Quality Coordinator
• Quality Coordinator

Review findings

Physician Associate Students (Year 2)

Domain 1 Learning Environment and Culture

All learners said the university is a good place to study, they were happy with the facilities and told the panel they felt the university is a safe place to learn.

There were some technical issues with certain lectures streamed from Preston to students at the West Lakes campus.

Students said the course is very good with lots of content. All students commented that the MSc in Physician Associate (PA) Practice is an intense course with a good mix of theory and practice with 4/5 months of placement in each of the 2 years. One student said “it is the best 2 years of university you will get”

Learners said university staff are very dedicated and help them to get the best out of their education and said they have good pastoral support.

Domain 2 Educational Governance and Commitment to Quality

Equality, Diversity and Inclusion (EDI)

The panel heard that EDI teaching is through the academic elements of the course rather than being taught in the clinical environment.

The panel asked students about their working relationships whilst on placement. They described examples of anti-PA behaviour and said they have to regularly justify their role to other clinicians. The panel heard of an example whereby a registrar on a surgical assessment unit made their views about PAs very clear in front of a patient commenting that PAs are not doctors and there is a huge difference between the 2. This was raised with the consultant. Another example was a comment made towards a student PA “I don’t understand why you are doing this course; you won’t be able to do xyz”

The panel heard that some students have been told “they are playing at being doctors” and are “stupid” for doing the course. Other examples the panel heard included

• A student was asked “why are you doing the course, why didn’t you want to be a doctor instead”
• “At least I can say to my family I’m a doctor” this comment was made in front of other doctors who were supportive of the PA student.
• “Why do you want to be a PA, PAs shouldn’t exist”

Some students reported being left in tears at the comments made towards them.

Domain 3 Developing and Supporting Learners

Placements

The panel heard from all groups of PA students they met with that the university prepared them really well for their placements. They commented that the university placement lead is accessible. All said they had received good inductions when on placement.

Students described the university’s proof of attendance at placement process and felt this could be improved.

Students described varying levels of understanding at some trusts and within specialties/wards on the scope of their role and their educational needs. They confirmed that if the ward had existing PAs this made their experience better. When they are on placement at a trust that does not have qualified PAs, they are constantly explaining to other clinicians what level they are at and what their curriculum needs are. They said their placement experience also depended on staffing levels and individual’s attitudes towards PAs. For example, some students had no theatre time on their rota whilst on placement and were constantly on ward rounds.  

Students said as qualified PAs are aware of their competencies and of the current climate and negative social media attention regarding the role this takes away the anxiety of starting a new placement.

The panel heard of positive placement experiences at

• The Royal Preston Hospital including surgical placements as they have the opportunity to go to theatre as they have qualified PAs in the specialty.
• East Lancashire Hospitals NHS Trust as there are a large number of PAs at the hospitals and are good at supporting their learning.
• Blackpool Teaching Hospital NHS Foundation Trust – there were lots of opportunities, students got asked each day what they needed and said “they got to see life as a PA in various departments”

Supervision and feedback

The panel asked if students have been asked to act beyond their competency whilst on placement. Students felt well supervised with no reports of being pushed to act beyond their competencies. The panel heard of positive experiences in this respect with an example provided regarding placement on the respiratory ward at the Royal Preston Hospital, they were asked to take blood cultures which they said they did not know how to do and were shown how to do this.

One student described they were asked to undertake a medical procedure whilst at a GP placement but explained they were not qualified to do so.

When asked about feedback they receive on placement, students commented that foundation doctors are usually the most “honest” with their feedback.

The panel lead asked if their clinical supervisors on placement understand PA’s curriculum needs, some PAs said they have to present a list of what they need signing off. Students said that some clinical supervisors do not understand what sign off and meetings they require for their course. Many students said there is a lack of awareness of the scope of practice of PAs and sometimes they are treated like medical students. When asked if there was a clear scope of practice for PAs, students said they were unsure.

The panel heard of some difficulties experienced on placement at East Lancashire Hospitals on getting to see their supervisors and said this was due to large numbers of students.

Community Placements

The panel heard of variable experiences whilst on placement in primary care. A student explained that when on placement in primary care they see patients on their own and GPs are always debriefed afterwards and review the patient’s they have seen.

One student commented that there were no qualified PAs at either of the practices they were on placement at, but the practice were good at getting them involved.

Another example described was where there were 15 students at 1 practice, medical students were given priority, which resulted in them spending the day revising when on placement.

One student described difficulties in accessing language line whilst on placement in primary care. They explained they were placed in a practice where there were many non-English speaking patients therefore when they were shadowing the GP, they were unable to understand the consultation. They did ask if access to language line could be made available so they could learn from the consultations. This was declined and were told “to get on with it”. They did raise the issue with the university and despite this, other students were subsequently placed there.

There were mixed experiences of the quality of GP placements, the panel heard that some GP placements there was limited availability of educators, and they did not have as much direct patient contact as they should. Whereas at other practices students said they were their favourite placements because of the teams they worked with and the level of patient involvement.

Some students described communication between themselves, medical placements team at the university and the primary care training hub as “not great”

Some students felt there should be more consideration regarding the geography of where students live and where their placements are. For example, one student’s placement was 3 hours away from their home.

Raising Concerns

Students were aware of the Freedom to Speak Up Guardian at trusts and also informed the panel of the university’s process. The panel heard of an example from a student who had an issue with their supervisor, they raised this with the university placement lead and the issue was resolved with the trust.

Students also said if they had any patient safety concerns, they would contact their clinical supervisor, failing that they would contact the medical placements team at the university or lecturers.

Recommendation of Course  

Students were asked what the best things were about their course, responses included

• University staff, as a small cohort they felt very supported.
• Structure of the course.
• Closeness with their cohort.
• Good placement experience at the Royal Blackburn Hospital.
• Good placement experience at the Royal Preston Hospital.  
• Challenges experienced on placements has enabled them to become good clinicians and allowed them to build resilience.

Students were asked what they would change about their course. Responses included

• Career prospects
• Perception of PAs and their skill set

All PAs explained that at the end of their course they have not got employment as PAs in the NHS. Some said they will be unemployed, some were returning to their previous occupations and others said they will be working part time, examples included as health care assistant and a delivery job.

The panel heard that the previous cohort had also not secured PA roles, and some qualified PAs are being made redundant, so they are competing with more experienced qualified PAs for jobs.

It was very evident to the panel how passionate and enthusiastic all students are about being a PA and the difference they can make to patients. The panel heard how excited they were at the beginning of their 2 year course, and they thought at the end they would have a job and career, however they are now “broke and unemployed” as it is a postgraduate course, they self-fund.

Some students said they will not be taking their Physician Associate Registration Assessment (PARA) following qualification as it costs almost £1,000 to sit and only lasts for 2 years. If they do not have a job as a PA in that time period they will have to sit it again.

It was clear that student morale had been impacted due to the lack of career prospects. Students said The Leng Review – an independent review into the roles of PAs and Anaesthesia Associates in the NHS, published by the Department of Health and Social Care, July 2025 and vacancy freezes had impacted their prospects.

All students said they would recommend the university as a place to study. They said they would recommend the course academically as it is very good but would not recommend it currently due to the limited employment opportunities which are outside of the university’s control.  

Domain 4 Developing and Supporting Supervisors

The panel heard that trust PA leads receive good information from the university including the curriculum and learning objectives and meet with them regularly. The trust PA leads the panel met with described the clinical experience of students whilst on placement at their trust and heard that quarterly quality assurance meetings take place with the university.

Good relationships were described with the university overall with an example heard of a PA leaving the trust to lecture at the university. Good relationships were described with the university’s medical placement team.

The panel heard that trusts try to place students where there are already qualified PAs and/or are familiar with PA students. They acknowledged that when students are on wards without qualified PAs, they can find it harder to transition. Some trusts commented that their biggest challenge is supervisor time as they only have a few students and are therefore unable to job plan. Some PA leads explained that PA time is not in consultant’s job plans.

Some trusts described being low on supervisor time as they have a high number of medical students, so can only offer small numbers of PA placements.

The panel heard that trusts are not actively recruiting PAs largely due to the current climate, and some said they are not recruiting at the moment as they recruited the number of PAs they needed 2 years ago and are establishing those that are already in post. They commented that The Leng Review has not provided any certainty regarding the future of the PA role.  

Trusts that have qualified PAs described them as a “stable workforce” and therefore have low turnover, which means there are limited vacancies for newly qualified PAs to move into.

The panel also heard there are recruitment freezes at some trusts.

Equality, Diversity and Inclusion

The supervisor/PA leads were asked if they had any students approach them regarding any negative comments they may have had about studying to be a PA. Some leads explained that they have heard of some negative/challenging behaviours but were unable to act without any formal complaint or escalation. The panel heard that some students are reluctant to raise the issues, and some PA leads have heard about challenging behaviours 2^nd or 3^rd hand.

A PA lead told the panel that they had dealt with passive aggressive staff which has impacted on the student experience.

The panel heard that some students feel nervous that they may face challenging behaviours as a student PA and subsequently the way that they interact with people has changed. Some PAs have a fear of potential difficult interactions due to the “toxic” debates on social media rather than lived experience.

Areas that are working well

Areas for improvement

None identified and therefore no requirements or action plans required.

Report approval

Report completed by: Paula Fletcher, Quality Support Manager
Review lead: Professor Simon Carley, Associate Postgraduate Dean
Date approved by review lead: 3 October 2025

NHS England authorised signature: Dr Raghu Paranthaman, Deputy Postgraduate Dean
Date authorised: 13 October 2025

Final report submitted to organisation: 13 October 2025