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

Classification: Official
Publication reference: PRN01246


  • All general practices
  • All primary care network clinical directors


  • Integrated care board CEOs
  • NHS England regional directors

Dear colleagues

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

We are writing to bring your attention to guidance and actions to support the practices that employ physician associates on the implementation of 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 physician associates and medical staff, as well as our patients.

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 physician associate roles are introduced safely and in a supportive environment, 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/physician associate professional groups to develop comprehensive curricula, core capability frameworks, standards for CPD, assessment and appraisal and supervision guidance for MAPs and PAs.

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


All work undertaken by PAs must be supervised and debriefed with their supervising GP.

We ask that practices review their processes to ensure that they have appropriate supervision, supporting governance and systems in place.

Underpinning this is the supervising GP’s confidence of the PA’s competence, based on the knowledge and skills gained through their training and development [1],[2],[3].

NHS England supports GP practices to provide a structured preceptorship for physician associates in their first primary care role.

It is important to emphasise that PAs are not substitutes for general practitioners or doctors in training; rather, they are specifically trained to work collaboratively with doctors and others as supplementary members of a multidisciplinary team alongside nursing and other ARRS colleagues.


PAs are not able to prescribe. Therefore, in the context of electronic patient care records, every practice 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, results, referrals, and patient clinical notes, and provide assurance that clinicians are not able to undertake activities falling outside of their role’s scope of practice (for example, by providing a smart card loaded with TPP or EMIS system role profiles for PAs that does not permit access to prescribing activities).

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. All clinical and administrative/clerical staff (for example, receptionists) must be educated on the PA role and make it clear to patients that they are seeing a PA. As part of good governance processes, all staff should be aware of how to triage patients so that they are seen appropriately by a clinician working within their level of competence. The same is true for all the ARRS colleagues that work within the practice.

Next steps

The steps above will help to protect the confidence and wellbeing of our physician associates 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 NHS England’s website. 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.

The Faculty of Physician Associates (professional body) is collaboratively working with the Royal College of Physicians to generate additional supportive guidance around the supervision and scope of practice of PAs. Existing guidance documents include:

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

Professor Sir Stephen Powis, National Medical Director NHS England

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

Dr Claire Fuller MBBS DRCOG MRCGP, National Medical Director for Primary Care  NHS England

[1] FPA Draft Physician associate Curriculum 2023

[2] GMC pre-qualification education framework for PAs and AAs 2022

[3] Physician associate registration assessment (PARA) content map 2022