Ensuring safe and effective integration of physician associates into departmental multidisciplinary teams through good practice


  • chief people officers
  • medical directors
  • chief pharmacists


  • Integrated care boards: chief executive officers

Dear colleagues,

We are writing to bring your attention to guidance and actions for trusts on the implementation of medical associate roles as part of the delivery of the NHS Long Term Workforce Plan. Please ensure these steps are followed to secure the confidence, wellbeing and safety of our medical associate professionals and medical staff, as well as our patients.

Medical associate professions (MAPs), including physician associates (PAs) are an integral part of the multidisciplinary team and provide valuable support to patients and clinicians.

The NHS Long Term Workforce Plan commits to growing these roles alongside recruiting and training more doctors, nurses, allied health and other professionals and ensuring every team member can contribute their skills, experience and education.

It is essential that medical associate roles are introduced safely and in a supportive environment. This should include trust and primary care employers ensuring oversight of the supervision and tasks being carried out.

We are working collaboratively with partners, including the GMC, royal colleges, trade unions, doctors and medical associate professional groups to develop comprehensive curricula, core capability frameworks, standards for CPD, assessment and appraisal and supervision guidance for MAPs.

We are writing today to bring to your attention the latest guidance from these discussions.

Principles defining medical associate roles

As we implement the NHS Long Term Workforce Plan we are continuing the important work of setting out a consensus on work parameters for MAPs.

The High Level Principles Concerning Physician Associates Consensus Statement, released by the Academy of Medical Royal Colleges last week demonstrates how this collaborative working can support healthcare teams to integrate PAs safely to support patient care.

Alongside our partners, we are developing more detailed information for employers.


PAs are not able to prescribe; therefore in the context of electronic patient care records, every trust should have a comprehensive policy outlining access and restriction requirements for each professional group. This policy should cover aspects such as appropriate access to prescribing, laboratory reports, imaging results and patient clinical notes, whilst also implementing restrictions to prevent access to skills or responsibilities falling outside of a role scope of practice.


Trust policies, systems and permissions should ensure that PAs are appropriately supported, supervised and integrated into multidisciplinary teams so they can support these teams to provide excellent patient care.

It is important to emphasise that PAs are not substitutes for doctors; rather, they are specifically trained to work collaboratively with doctors and others as supplementary members of a multidisciplinary team.


PAs should not be used as replacements for doctors on a rota. Understanding the challenges faced by trusts in accurately reflecting multidisciplinary staffing within rota software constraints, we encourage you to:

  1. Assess the current capabilities of the rota software used to represent staffing within each department.
  2. Ensure each department has undertaken a department-specific assessment to establish safe minimum staffing levels, considering skillsets and scopes of practice, supported by a service evaluation of patient group needs.
  3. Ensure that the full name and job title of each healthcare professional, including physician associates, are prominently visible on any rota system.
  4. As part of the induction process, educate all staff members on how the rota is informed, operated and displayed to promote understanding and transparency.

Role clarity

It is important that all staff are able and supported to introduce themselves and their role clearly, to ensure that patients understand who is caring for them. The Faculty of Physician Associates has produced guidance to support staff which is available on their website.

Next steps

The steps above will help to protect the confidence and wellbeing of our medical associate professionals and our patients, and we are grateful to you for your leadership in supporting this valued part of the NHS workforce.

Further guidance on the use of MAPs in NHS teams has been set out previously on the NHS England website. As legislation to regulate the PA profession moves through parliament, we will continue to work together with stakeholders, doctors and MAPs to ensure that all members of the NHS workforce are supported to provide excellent patient care.

If you have any questions or would value further conversation about any issues related to MAPs, please contact us at england.maps@nhs.net.

Yours sincerely,

Dr Navina Evans CBE
Chief Workforce, Training and Education Officer, NHS England

Professor Sir Stephen Powis
National Medical Director, NHS England

Publishing reference: PRN01227