Intended for healthcare professionals

Rapid response to:

Opinion Primary Colour

Helen Salisbury: Physician associates in general practice

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1596 (Published 11 July 2023) Cite this as: BMJ 2023;382:p1596

Rapid Response:

Re: Helen Salisbury: Physician associates in general practice

Dear Editor,

Dr Salisbury’s letter highlights important issues raised by the tragic death of a young woman recently debated in Parliament in reference to the role of Physician Associates (PAs). We hope we can all agree on the benefits of multidisciplinary practice in healthcare, recognising the importance of appropriate training, role boundaries and supervision.

Much to our disappointment, the Physician Associate profession is still awaiting regulation. The Faculty of Physician Associates (FPA) and Royal College of Physicians (RCP) have long called for the introduction of statutory regulation of PAs (https://www.fparcp.co.uk/file/image/media/633da06a23641_FPA_Regulate_PA_...) and this is finally on the horizon with the government consultation period ending last month (https://www.gov.uk/government/consultations/regulating-anaesthesia-assoc... ). If regulation by the General Medical Council (GMC) now proceeds at the pace promised, they are expected to open a register for PAs at the end of 2024.

In lieu of statutory regulation, the Faculty of Physician Associates introduced the PA Managed Voluntary Register (PAMVR), which allows employers to check whether an applicant or employee is a fully qualified physician associate. The FPA/RCP communicate at regular intervals with employers across the UK to strongly recommend that all PAs employed within a trust or GP practice are registered on the PAMVR (https://www.fparcp.co.uk/file/image/media/64674e0d24ec3_Letter_to_Employ...). The FPA recommends that PA registration is checked regularly in case a PA’s status changes, or they are removed from the register.

Regarding qualifications, we would like to clarify that student physician associates complete a two-year, postgraduate (level 7 i.e., master's level) qualification in physician associate studies, which involves teaching in medical science and clinical reasoning and consists of 50% theory and 50% practice. Developed in partnership with the RCP and Royal College of General Practitioners (RCGP), a national competency framework has been in existence since 2006, within which all student PAs in the UK are trained (reviewed and updated in 2012).

The FPA has also published several documents relating to supervision of PAs, an issue we see as pivotal in this tragic case. The Competency and Curriculum Framework (2012) clearly states that PAs "will always work under the supervision of a designated senior doctor (consultant, registrar or general practitioner)”. The FPA Code of Conduct additionally states that PAs "will always work under the supervision of a designated senior medical practitioner" (https://www.fparcp.co.uk/file/image/media/6310d927a4dab_FPA_Code_of_Cond...). Furthermore, Health Education England has also published guidance for PAs working in primary care which clearly states that PAs work under the supervision of a GP (https://www.hee.nhs.uk/sites/default/files/documents/PAPreceptorshipPC.pdf ), as has NHS England (https://www.england.nhs.uk/long-read/supervision-guidance-for-primary-ca...), and there are multiple resources on the FPA website (http://www.fparcp.co.uk/) which give examples of how supervision could work in general practice settings.

We agree with the author that in stressed clinical environments supervisory named GPs, or in the secondary care setting consultants and senior medical practitioners, may struggle to fulfil the required supervision of physician associates and other professionals. The time and the ability to oversee all healthcare practitioners requiring supervision in primary and in secondary care needs to be addressed with urgency at a national level, so that the value and skill of associate professionals can be deployed to their most safe and effective use.

Yours sincerely,

Jamie Saunders, BSc (Hons), MSc, FHEA,
President, Faculty of Physician Associates

Professor Cathryn Edwards, OBE, MA (Oxon), D.Phil, FRCP
Registrar, Royal College of Physicians

Competing interests: Jamie Saunders BSc (Hons) MSc FHEA: President, Faculty of Physician Associates Professor Cathryn Edwards OBE MA (Oxon) D.Phil FRCP: Registrar, Royal College of Physicians

22 July 2023
Jamie Saunders
Physician Associate
Cathryn Edwards
Faculty of Physician Associates