Royal College of Physicians Issues New Supervision Guidelines for Physician Associates

The Royal College of Physicians (RCP), a prominent medical royal college, has released new guidance for its members, stipulating that physician associates (PAs) must be supervised exclusively by senior doctors, rather than doctors who are still in training. This announcement from the RCP comes amidst an intense and often contentious discussion within the medical community regarding the deployment of PAs, whose role is to support doctors and conduct certain health assessments. Concerns have been raised, alleging a lack of clarity regarding the precise scope of the PA role, instances where patients are reportedly unaware of a PA’s professional status, and a perceived blurring of the distinction between PAs and doctors. An independent review into this role, initiated by Health Secretary Wes Streeting, is scheduled to deliver its findings in the spring. Physician associates (PAs) and anaesthesia associates (AAs) are considered vital to the staffing of the health service, as outlined in the current NHS workforce plan for England. PAs are employed in both general practitioner surgeries and hospitals. While they lack the authority to prescribe medication, they are permitted to request specific scans, gather medical histories, and perform physical examinations. Anaesthesia associates (AAs) provide assistance to surgical teams and represent a considerably smaller group. Both PAs and AAs are required to complete a two-year master’s degree program. Although they commonly possess a prior degree in a bioscience-related field, this is not a mandatory requirement. The number of PAs and AAs has been steadily rising; however, a recent strategy proposed a significant increase in their numbers, from slightly over 3,000 to 12,000 by the year 2036. The Royal College of Physicians, whose membership spans the entire UK, asserts that the interim guidance, unveiled on Tuesday, should be implemented immediately, preceding the health secretary’s formal review. This guidance specifies that a supervising clinician must be “immediately available in the same clinical environment to provide advice to the PA and, if required, an immediate in-person review of a patient.” This requirement is more stringent than the broader directives from NHS England, which only mandate that PAs be directed and overseen by a senior doctor. The guidance issued by the Royal College serves an advisory purpose, aiming to provide its members with clear understanding regarding appropriate responsibilities for PAs and reasonable expectations from employers. Certain resident doctors, previously referred to as junior doctors, have voiced grievances, stating that they are tasked with overseeing PAs’ work and that PAs have assumed duties traditionally performed by doctors. Dr. Ben Chadwick, who chairs the group responsible for drafting the guidance, expressed his hope that the new interim recommendations “offers clarity in how PAs can best be supervised and supported.” The document pertains to hospital doctors who are members of the RCP, but it does not extend to those practicing in radiology, emergency medicine, general practice, and other specialized fields that have their own distinct Royal Colleges. The guidance additionally outlines existing policy, which includes the announcement made in November by Health and Social Care Secretary Wes Streeting regarding an independent review, slated to report in the spring of 2025. Streeting commented at that time that numerous PAs “are providing great care and freeing up doctors to do the things only doctors can do.” However, he also acknowledged “legitimate concerns over transparency for patients, scope of practice, and the substituting of doctors.” Streeting conveyed his expectation that the review would “take the heat out of the issue.”