NHS England’s position on physician associates, 7 February 2024 letter to Royal College of Physicians

Sarah Clarke
President, Royal College of Physicians
11 St Andrews Place, Regent’s Park
London, NW1 4LE

7 February 2024

Dear Sarah,

Thank you for the opportunity to meet with elected councillors of the Royal College of Physicians (RCP) on the 18 of January to discuss our ambitions for Medical Associate Professions (MAPs), specifically physician associate (PA) roles, in the NHS Long Term Workforce Plan (LTWP).

We are aware that there is considerable discussion about these roles and we continue to work with partners, including MAPs and doctors, to agree how we deliver the NHS LTWP and address the concerns raised around how Medical Associates can play their role safely and effectively.

Physician associates (PAs) work as valued members of the wider multidisciplinary team (MDT) to deliver effective and efficient healthcare, helping to improve continuity of care and expand patient access to health services. PAs are trained to examine, diagnose and treat patients under the supervision of doctors. With careful workforce and service planning based on local needs, PAs can support the delivery of effective and efficient medical services across the wider health system.

PAs are not doctors, and cannot and must not replace doctors.

PAs are not a substitute for doctors; they are trained to work collaboratively with other health professionals as supplementary members of a multidisciplinary team.

PAs must always work within a defined scope of competence; they are not independent medical practitioners and must be supervised appropriately by doctors. Employers must ensure that the supervision of PAs is never to the detriment of doctors, and patients must always receive clear and accurate information about who is treating them and making decisions about their care.

NHS England’s commitment to double the number of medical school places over the next decade will contribute to the sustainable implementation of this multidisciplinary model by ensuring an extra 60,000—74,000 doctors and a total of 10,000 PAs in the NHS by 2036/37.

NHS England’s position, that MAPs are not a replacement for doctors; and our commitment to the medical profession, is shared by the Government, as set out by Andrew Stephenson, Minister for Health and Secondary Care, on 17 January 2024 at the Delegated Legislation Committee debate on the draft Anaesthesia Associates and Physician Associates Order 2024. 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.

We look forward to working with you and other partners over the coming weeks and months to deliver the NHS LTWP we worked so hard to create together.

Kind regards

Professor Sir Steve Powis FRCP, National Medical Director, NHS England.
Dr Navina Evans CBE MRCPsych, Chief Workforce, Training and Education Officer, NHS England.
Professor Sheona MacLeod FRCP, Director of Education and Training, NHS England.


Statement, in full, from The Rt Hon Andrew Stephenson, Minister for Health and Secondary Care, 17 January 2024 at the Delegated Legislation Committee debate on the draft Anaesthesia Associates and Physician Associates Order 2024

I beg to move,

That the Committee has considered the draft Anaesthesia Associates and Physician Associates Order 2024.

It is a pleasure to serve under your chairmanship, Dame Caroline. I will begin by setting out the policy context behind the draft order. Strengthening the future of the NHS workforce remains one of the Government’s top priorities. Anaesthesia associates, AAs, and physician associates, PAs, are already a valued and integral part of the multidisciplinary healthcare team, but they have the potential to make an even greater contribution. Regulating those professions will increase the contribution that AAs and PAs can make to the UK healthcare sector, while improving patient safety and professional accountability.

As well as bringing AAs and PAs into regulation by the General Medical Council, the draft order paves the way for full-scale reform of the regulatory frameworks for all the healthcare professional regulators. This is a rare and significant opportunity to deliver a large-scale programme of reform that will implement improvements to patient and public safety, the system of professional regulation, and the health and care workforce. We are introducing the regulation of AAs and PAs under a new legislative framework without at this stage changing the GMC’s regulatory framework for doctors. That means that the GMC’s overall governance and its regulation of doctors will continue under the Medical Act 1983 after the order comes into effect.

The draft order will give the GMC powers to register AAs and PAs whom it assesses to be appropriately qualified and competent, and to set standards of practice, education and training, and requirements for continual professional development and the conduct of AAs and PAs. It gives the GMC the powers to approve AAs and PAs’ education and training programmes, to operate fitness-to-practice procedures, to investigate concerns and, if necessary, to prevent or restrict an associate from practising.

The legislation provides a high-level framework for the GMC to regulate AAs and PAs, and importantly gives the GMC autonomy to set out the details of its regulatory procedures in rules. The GMC has committed to developing rules and processes for regulating AAs and PAs, which will be subject to public consultation, to enable regulation to begin by the end of this year.

We recognise some concerns about the deployment and planned expansion of the AA and PA roles within the NHS. Let me be clear: the role of associates is to work with doctors and not to replace them. AAs and PAs are distinct, complementary and valued professionals who can enrich the workforce skills mix, freeing up doctors and consultants to spend more time using their specialist skills and training to focus on complex clinical duties and decisions on patient care.

It is important to note that the NHS long-term workforce plan sets out an aim to double the number of medical places in England to 15,000 a year by 2031-32, and to work towards expansion by increasing places by a third to 10,000 a year by 2028-29. We have accelerated that expansion by allocating 205 additional medical school places for the 2024-25 academic year, with the process for allocating 350 additional places for the 2025-26 academic year under way. That demonstrates our commitment to the medical profession and that we do not see PAs or AAs as replacements for doctors.

Currently, more than 139,200 full-time equivalent doctors work in the NHS in England. That is more than 42,100—or 43%—more than in 2010. There are fewer than 3,500 PAs and AAs. Patient safety remains of the utmost importance, and regulation will help to bring further clarity to patients and healthcare professionals on the nature of the roles and their respective remits. Regulation will give the GMC responsibility and oversight of AAs and PAs, in addition to doctors, allowing the council to take a holistic approach to education, training and standards. That will enable a more coherent and co-ordinated approach to regulation, and make it easier for employers, patients and the public to understand the relationship between the roles of associates and doctors. Each nation is considering the operational deployment of those roles within their respective workforces.

In England, the long-term workforce plan reaffirms the commitment to PAs and AAs, and commits to increase the PA workforce to 10,000, and the AA workforce to 2,000, by 2036-37. Over the same period of the long-term workforce plan, we will deliver an additional 60,000 doctors. That is a factor of 5:1 in favour of doctors, which I hope addresses the mistaken belief that PAs and AAs will replace doctors within our NHS. It is vital that this expansion is delivered safely. NHS England is working through partners, including the GMC, the Royal Colleges and other stakeholders, to ensure that associates can be effectively trained and integrated into teams across a range of specialities.

To summarise, the draft order will provide a standardised framework of governance and assurance for clinical practice and professional conduct to enhance patient safety and enable AAs and PAs to make a greater contribution to patient care. I commend the order to the Committee.