New review of Physician and Anaesthesia Associates launched

An independent review of Physician Associates (PAs) and Anaesthesia Associates (AAs) has been launched by the Health and Social Care Secretary Wes Streeting today (Wednesday 20 November 2024) to consider how these roles are deployed across the health system, in order to ensure that patients get the highest standards of care.

The review will look into the safety of these roles, how they support wider health teams, and their place in providing patients with good quality and efficient care. It will also look at how effectively these roles are deployed in the NHS, while offering recommendations on how new roles should work in the future.

The review will seek evidence from a range of voices - including patients, employers within the NHS, professional bodies, and academics.

Professor Gillian Leng CBE will independently lead the review. She is an experienced leader in the UK health care system who has championed patient safety and has a deep understanding of the British medical system.

Health and Social Care Secretary, Wes Streeting, said:

Many physician associates are providing great care and freeing up doctors to do the things only doctors can do.

But there are legitimate concerns over transparency for patients, scope of practice, and the substituting of doctors. These concerns have been ignored for too long, leading to a toxic debate where physicians feel ignored and PAs feel demoralised.

This independent review, led by one of the UK's most experienced healthcare leaders will establish the facts, take the heat out of the issue, and make sure that we get the right people, in the right place, doing the right thing.

The review will consider the scope of PA and AA roles, which currently include gathering medical histories, performing initial examinations, organising tests to support doctors and reviewing patients before surgery.

To increase transparency in these roles, the review will also look into measures to ensure patients know when they are interacting with PAs or AAs, so they are clear on the type of clinician they are seeing and for what reason.

Professor Gillian Leng CBE said:

To promote patient safety and strengthen the NHS workforce, it's crucial that we have a comprehensive review of the role of PAs and AAs. This will cover recruitment and training, scope of practice, supervision and professional regulation.

As I conduct this review, I am looking forward to speaking to a broad range of stakeholders and to gathering evidence from the UK and abroad so that we can reach a shared understanding of these roles and their place in wider healthcare teams.

Amanda Pritchard, chief executive of NHS England, said:

Physician associates and anaesthesia associates are important members of NHS staff - they come to work every day to help care for patients and so they deserve to be treated with the same respect as anyone else coming to work in the NHS.

While we have always been clear that they are not replacements for doctors, there are clear and ongoing concerns which we are listening to carefully and taking action to address - this independent review marks our pledge, together with the government, to getting this right.

The 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 tackle this head on and find a way forward that is the right one for patients and our staff.

Currently, 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.

NHS England has issued guidance on the roles that PAs and AAs play. Regulation of PAs and AAs by the General Medical Council will begin in December 2024 to help to ensure that all PAs and AAs meet the high standards expected of every healthcare professional.

Professor Sir Stephen Powis, NHS national medical director said:

Like all healthcare professionals in the NHS, physician and anaesthesia associates come to work every day wanting to do their best for patients and I have seen how well they can work as part of clinical teams, but it is essential that they are properly supported and supervised in their roles, and where there continue to be concerns that this is not always happening, we must investigate further.

It is absolutely right that we have the confidence of the public and the medical community as we develop the future NHS workforce, and we will collaborate fully with Professor Leng and the review team to carry out this important work over the coming months.

The review and next steps will be published in the Spring.

Dr Navina Evans, NHS England's chief workforce, training, and education officer, said:

We know that having a diverse set of skills and roles within the NHS workforce helps to improve care for patients and the efficiency of our teams, including staff in associate roles who work under supervision to deliver specific tasks they are trained to do alongside a wider team.

But we must also listen to the concerns people have about these roles and I fully support this review to ensure we get the right evidence-based answers for patients, doctors, associates and the NHS as we develop our future workforce.

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