The General Medical Council (GMC) (the regulator of doctors in the UK) began its role as regulator of physician associates (PAs) and anaesthetic associates (AAs) in December 2024. A public consultation on the rules, standards and guidance to be put in place to implement the regulation of PAs and AAs was undertaken over March to May 2024. The consultation also allowed the GMC to collect feedback on draft principles that will inform the content of fitness to practise decision-making guidance, which will apply to PAs and AAs. All of this was against a backdrop of much concern regarding roles, responsibilities and patient safety, often played out on social media platforms. The report on the outcome of the public consultation has been published (GMC, 2024).
In recent years, the PA role has become increasingly important in addressing the growing demand for health professionals. The NHS Long Term Workforce Plan in England (NHS England, 2023) intimates that the roles of PA and AA will expand significantly. Despite their significant contribution and their proposed contribution to the NHS and patient care, the role of the PA has come under fire from many quarters, none more so than the British Medical Association (BMA). Its position statement (BMA, 2023) raised concerns that medical ‘associate’ roles unhelpfully blur the distinction between doctors and non-medically qualified professionals, potentially devaluating the doctor-patient relationship along with undermining the trust that patients place in doctors. The BMA argues that there is a high level of public misunderstanding, with patients and their families often unaware that they have not been seen or assessed by a doctor. Confusion is plausible, it says, as on social media there has been a proliferation of PAs who have described themselves as doctors, GPs or medical consultants. Before 2014, PAs were known as ‘physician assistants’. The BMA is of the opinion that the public find the title ‘physician associate’ highly misleading and confusing, adding that patients would be better protected and served by reverting to the original professional title.
The ongoing debate about the PA role's limitations and potential continues to shape how it is understood, misunderstood and integrated within the NHS. It is time to change the narrative and recognise that the PA is an integral part of the healthcare team. They are skilled in providing direct patient care across a variety of medical specialties and settings, adapting to the needs of the patient and the healthcare team in supporting the delivery of care. The NHS is under increasing pressure to meet relentless demand while maintaining safety and providing quality care outcomes. This is where the PA role becomes indispensable: by expanding the workforce and supporting doctors, PAs can help to alleviate some of the pressures on the healthcare system.
The role of the PA is still evolving and several challenges need to be addressed. One key issue is the recognition and understanding of the PA role. Although their education and responsibilities are robust, there can be confusion among patients as well as some health professionals about what PAs can do. A further challenge is ensuring the PA's role remains sustainable, ensuring sufficient funding for PA education and providing clear career progression opportunities.
The future of contemporary healthcare systems requires innovation, collaboration and flexibility in a diverse workforce. PAs represent a key part of that future, and it is time that we started talking about them in a more progressive way.