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:

A response to criticism of Physician Associates

Dear Editor,

As a Physician Associate, it has been difficult to read some of the backlash precipitated by the tragic and avoidable death that was recently discussed in parliament(1). Some responses perpetuate misconceptions of PAs and highlight how poorly we are understood even by our healthcare colleagues.

Introducing ourselves by name and role is a fundamental approach taught from the start. There is never any intention to deceive by posing as doctors(2). The British Medical Association recently called for PAs to be renamed ‘physician assistants’(2). Our name has been criticised for being ‘grandiose’(1), and too similar to ‘associate specialist’(2). I disagree that a name change is needed. As the role becomes more widespread, awareness will improve. Employers can support this in many ways; at my trust we launched a QI project during PA Awareness Week in October 2022. As a PA who also has a PhD, I never introduce myself as 'Dr Glen' in my clinical role (even though that is my name), as this is an obvious precaution to avoid confusion(2).

PA training involves two years of intensive postgraduate study of medicine, in the medical model, after a relevant undergraduate degree. Dr Salisbury refers to our training as a ‘clinical skills course’ which significantly downplays the level of training. PAs are ‘medical practitioners’ under the Medical Act 1983 (4) and in 2019 the GMC were selected to regulate PAs(5). Is it really too much to expect doctors to acknowledge that PAs study medicine too?

PAs work across both primary and secondary care. All PAs have a named clinical supervisor, and the nature of supervision evolves over time, such that an experienced PA will require less support and can work more autonomously. The Faculty of Physician Associates has published many documents to support employers working with PAs, including those in the preceptorship year(6). There is no excuse for doctors to be ‘unfamiliar with PAs training and what competencies we should expect of them’(3).

Having a non-rotational permanent member of staff who has made an active choice to work in their specialty is valued by consultants, and means that PAs can develop advanced skills. However there is currently no recognition for this in the Agenda For Change model, which places PAs at Band 7. This means that many experienced PAs are working at a level well above their remuneration. There is certainly no justification for doctors to ‘feel aggrieved’ for working ‘longer hours for less pay’(3). Ironically PAs are simultaneously criticised for being overpaid, but also for being ‘doctors on the cheap’(3).

PA regulation is something that the FPA have been working tirelessly for since well before I joined the profession in 2016. Many criticisms would be addressed by regulation, including robust fitness to practice procedures when the performance or integrity of a PA is called into question. This would also prevent a PA from continuing to practice when they have been struck off.

Doctors, PAs want to work with you. We are a diverse group of people from a range of backgrounds bringing valuable skills to the mix. If you haven’t had the pleasure of working with a PA yet, find a colleague that has, and speak to them. There is plenty of information on the FPA website; educate yourselves. Respond to public consultations on PA regulation, of which there have been many so far; these are an appropriate platform to share any concerns, or indeed, your support. And please support the excellent work of the FPA to work towards GMC regulation, which will provide valuable protection to the patients who are at the heart of what we all do.

Emma Glen
Physician Associate in Forensic Psychiatry
BA (hons) Oxon, MSc, PGCE, PhD, PGDip

1. Keeley B. Physician Associates. Hansard. 6 July 2023. https://hansard.parliament.uk/commons/2023-07-06/debates/D98F2ABE-7B33-4...
2. Ireland B. Call for alternative regulator of - and to rename - physician associates. BMA. 6 July 2023. Call for alternative regulator of – and to rename – physician associates (bma.org.uk)
3. Salisbury H. Helen Salisbury: Physician associates in general practice. BMJ 2023; 382: p1596
4. Medical Act 1983 https://www.legislation.gov.uk/ukpga/1983/54/contents
5. GMC. PA and AA regulation. https://www.gmc-uk.org/pa-and-aa-regulation-hub#:~:text=In%20July%202019...(AAs).
6. Faculty of Physician Associates. Guidance for Employers and Supervisors. https://www.fparcp.co.uk/employers/guidance
7. Bascombe K. Real-life story – Kate Bascombe. https://www.healthcareers.nhs.uk/explore-roles/medical-associate-profess...
8. GMC. Bringing physician associates and anaesthesia associates into regulation. Bringing physician associates and anaesthesia associates into regulation - GMC (gmc-uk.org)

Competing interests: No competing interests

22 August 2023
Emma-Lee Glen
Physician Associate
Lancashire and South Cumbria Foundation Trust
Guild Lodge, Lancashire