Update on physician associates and anaesthesia associates

Classification: Official
Publication reference: PRN01707

To:

  • NHS trusts and integrated care boards
    • medical directors
    • chief people officers
  • Primary care networks

cc.

  • NHS trusts and integrated care boards
    • chief executives

Dear colleagues,

Update on physician associates and anaesthesia associates 

We are writing to update you following the Secretary of State for Health and Social Care’s announcement of an independent review of physician associates (PAs) and anaesthesia associates (AAs) and ahead of the General Medical Council (GMC) regulation of these roles from 13 December 2024.

Scope of the government’s evidence review

While we have always been clear that PA and AA roles are not replacements for doctors but are there to support doctors in their work, there are clear and ongoing concerns that we are listening to carefully and taking action to address. We welcome this independent review. It marks our pledge, together with the government, to getting this right.

It’s only correct that where there are concerns, they are investigated, and it’s essential that we establish and assert the evidence base. This is important so we learn from all the available evidence to protect patient safety and staff welfare, as well as maintain public and professional confidence.

We are pleased that this review will gather insight from across the NHS, hearing from hospital teams, patients, professional bodies and academics so that we have the evidence we need to find a way forward that is right for patients and our staff.

Support for colleagues working as PAs and AAs

We know that PAs and AAs come to work every day wanting to do their best for patients, just like any other staff member, and we see them as valued members of the NHS team who deserve support, care and respect.

We expect employers to continue to support their PA and AA workforce and to adhere to NHS England’s existing guidance on the deployment of medical associate professions in NHS healthcare settings.

Regulation by the GMC

We have been clear that regulation of healthcare professionals is fundamental to a safe and effective workforce. We welcome the progress that will see the General Medical Council (GMC) begin to regulate the AA and PA roles from 13 December this year, which will help to strengthen patient safety, professional standards and accountability.

We strongly encourage PAs and AAs currently practising in England to join the GMC register as soon as possible once regulation starts. This will underpin continued safe and effective practice.

The GMC has previously confirmed that a 2-year transition period will commence when regulation starts. This will enable already qualified PAs and AAs to continue to work while their registration applications are completed and processed.

From December 2024 onwards, anyone graduating and passing the necessary examinations to qualify as a PA or AA should join the GMC register prior to employment. Working with the GMC, we will provide clear and timely guidance on this requirement for current students and education institutions.

Future expansion of the use of AA and PA roles

There are over 3,500 PAs and around 100 AAs working alongside over 180,000 full-time equivalent doctors and GPs in the NHS in England.

The future of the NHS will need a larger medical workforce, supported by and working with multidisciplinary teams across a range of professions to deliver high-quality care for patients. This review has come at the right time as we look at how our workforce plans align with the delivery of the forthcoming 10 Year Health Plan.

NHS England will collaborate fully with Professor Leng as she carries out this important work, and we look forward to its conclusions.

Yours sincerely,

Professor Sir Stephen Powis, National Medical Director, NHS England
Dr Navina Evans CBE, Chief Workforce, Training and Education Officer, NHS England