Physician associates (PAs) are clinical graduates, trained in the medical model and intended to seamlessly integrate with the modern healthcare workforce. They have received 5 years of training, having completed an intensive 2-year university course at diploma or Masters’ level and a 3-year biomedical or healthcare-related degree. With 37 Higher Education Institutes providing PA training programmes, there is an increasing number of qualified PAs in the UK.

PAs are intended not as a substitute for GPs, but as a complementary role, to work alongside the wider practice team in providing continuity of care for patients, especially those with long-term conditions. PAs can diagnose illnesses, develop management plans, and perform physical examinations (see What is their scope of practice? for more). With support, PAs can conduct themselves autonomously; they require a named consultant for supervision purposes, but as they gain experience, the necessary level of supervision will decrease.

All PAs can:

• Access, manage, and treat patients with a variety of acute conditions
• Conduct telephone consultations
• Develop and deliver appropriate treatment and management plans
• Formulate differential diagnoses and management plans
• Perform diagnostic and therapeutic procedures
• Perform peak flow examinations
• Perform physical examinations
• Perform urine dip sticks
• Provide health promotion and disease prevention advice
• Request and interpret diagnostics studies
• Review laboratory test results
• See patients with undifferentiated diagnoses
• Send out referrals
• Take medical histories from patients
• Triage patients

Some PAs can:

• Carry out home visits (including to care homes)
• Offer specialised clinics, including family planning
• Run checks for COPD, asthma, diabetes, and anticoagulation

With more experience, PAs can:

• Provide service development and design, serve as clinical placement leads for students, and undertake minor operations

When identifying PAs to join their PCN, GPs should look for candidates whom:

• Are recognised and qualified by the Faculty of Physician Associates (FPA) register
• Are on the Managed Voluntary Register (click here to learn more)
• Have completed their postgraduate medical training in PA studies
• Have trained in the UK

A PA’s scope of practice covers:

• Taking medical histories from patients
• Carrying out physical examinations
• Seeing patients with long-term chronic conditions
• Formulating differential diagnoses and management plans
• Performing diagnostic and therapeutic procedures
• Developing and deliver appropriate treatment and management plans
• Requesting and interpreting diagnostic studies
• Providing health promotion and disease prevention advice for patients

PA students already have an undergraduate degree in life science, and / or a significant background in health care. To become a PA, students must complete a two-year, full-time, intensive postgraduate course at diploma or masters’ level in Physician Associate studies, which includes over 1,400 hours of clinical placement experience in both acute and community settings.

A new route to becoming a PA, via a four-year undergraduate Masters’ programme, is being considered.

Once qualified, PAs must maintain 50 hours of CPD per year and sit a re-certification exam every 6 years.

From April 2020, the PA role will be reimbursed at 100% of its actual salary plus defined on-costs, up to the maximum reimbursable amount of £53,724 over 12 months, via primary care networks.

As of 1 March, 2021, physician associates are on the list of healthcare professionals eligible to apply to the New to Partnership Payment Scheme (N2PP). This scheme offers participants up to £20,000, plus a contribution towards on-costs of up to £4,000 (for a full-time participant) and up to £3,000 as a training fund, all for PAs transferring into a partnership role.

Recommended guidelines:

• Ensure that your GP practice is clear on what role they need to fill, and the duties involved in primary care
• Write a clear job description* detailing the duties of the role / what is expected of the PA. Bear in mind that the PCN will need to grant the PA some variation in working hours when offering the job position
• Produce a clearly-defined and thorough job plan for the PA, taking into account CPD / career progression and a means by which to monitor their progress in primary care
• Remember that newly-qualified PAs will require regular supervision
• Allow for one dedicated GP / supervisor whom can get to know the PA, and vice versa

* Example job descriptions can be found in the ‘Any example job descriptions?’ section.

Click here to read HEE’s guide on recruiting PAs in general practice.

Click here to read An employers guide to physician associates.

This document was produced by the Royal College of Physicians’ Faculty of Physician Associates.

A PA should have:

• A post-graduate qualification consisting of 2 years of study, with 1,600 clinical hours and 1,600 hours of theory
• An undergraduate degree in biomedical science / life sciences

• What made you want to be a PA, not a doctor?
• Why do you want to be a PA in primary care?
• How do you see the role?
• How do you deal with stress / teamwork / decision making?
• What would you want to specialise or work towards in primary care?

• Questions based around safeguardingScenarios might include:
  • You have a patient with a high NEWS score whom you think needs admitting, and your supervisor says they are able to go home. What do you do?
  • You have concerns regarding domestic violence and the person has a child with them. What do you do?
  • You are asked to stay late and hold a clinic beyond your level of competencies. What do you do?

• You should provide one dedicated supervisor (a GP or otherwise) per PCN, whom the PA can get to know and form a bond with, and vice versa
• There should be a six-month probation period with a review
• The PA should be appraised on an annual basis

• Employers should meet with PAs in their first week of work
• Assess their skills and knowledge in and around general practice
• Create a structured programme of specific educational goals
• Establish a review process, with yearly appraisals and reviews every 3 – 6 months