Intended for healthcare professionals


Medical associate professionals: we need calm heads and a pause

BMJ 2023; 383 doi: (Published 27 November 2023) Cite this as: BMJ 2023;383:p2789
  1. David Nicholl, consultant neurologist
  1. City Hospital, Birmingham, UK
  1. David.nicholl{at}

Recruitment of medical associate professionals should be paused to allow time for problems around regulation, scope of practice, and supervision to be resolved, writes David Nicholl

As Partha Kar said in his recent column, the whole situation around medical associate professionals, including physician associates and anaesthetic associates, is “an unqualified mess.”1 The latest development in the debate is that the BMA has called for a pause in the recruitment of medical associate professionals to allow time to resolve the matters of scope of practice, the level of supervision, and statutory regulation.2 Expansion of medical associate professionals was a key part of the NHS Workforce Plan, which proposed introducing 10 000 physician associates in total by 2036.3 But doctors have voiced their concerns about the risks of medical associate professionals performing tasks that they haven’t been trained for, the extra workload it will put on doctors supervising them, and the lack of clear regulatory oversight of their role. It’s time to pause the recruitment of more medical associate professionals until doubts around regulation and supervision are worked out.

Government drafted legislation would give the General Medical Council (GMC) powers to regulate physician associates and anaesthesia associates but has been repeatedly delayed. Frustration about the delay is understandable, given that physician associates as a profession have been waiting 20 years to be regulated like any other healthcare professional.

Now is the time for the royal colleges to speak out. Medical associate professionals are spread across 46 medical and surgical specialties, so it would be a challenge to solve all the problems before the government plans to present legislation around their regulation o at the end of 2023. The Academy of Medical Royal Colleges has already written to the GMC expressing concern about the lack of a separate second register for medical associate professionals.4 Medical defence organisations like the Medical Protection Society are concerned about the “disparities” between the proposed regulation of medical associate professionals and that of doctors.5

The royal colleges are ideally placed to settle the matters of scope of practice and the level of supervision required by virtue of the range of specialty societies they represent. The Royal College of Physicians, which has hosted the Faculty of Physician Associates since its establishment in 2015, in response to the BMA’s request for a pause, has urged the “government to maintain its commitment to lay legislation on anaesthesia associates and physician associates regulation by the end of 2023 as planned.”6

If regulated and supervised appropriately with a clear scope of practice, physician associates could be a valuable part of the health workforce.7 They are non-rotational staff so can provide continuity of care. But the risks of physician associates making mistakes or not being overseen by supervisors are greatest in areas that involve unselected patients, such as emergency medicine and primary care—and 38% of physician associates are currently practising in primary care.8 When an adverse outcome occurs, NHS trusts are quick to point out that “it is the responsibility of the supervising consultant to ensure that the level of supervision is appropriate to the knowledge and skills of each individual physician associate.”9 But many doctors are still unfamiliar with the training and competencies that can be expected of physician associates.

Patient safety and trust must remain our top priorities. We must avoid creating a two tier healthcare system between patients who receive care from regulated healthcare professionals versus unregulated physician associates. I’m not arguing that only doctors can deliver healthcare—there are numerous essential members of a healthcare team—but these allied health professionals should be subject to regulation.

Finally, the appropriate processes of revalidation for physician associates and establishing time for their clinical supervisors to manage this additional workforce still need to be determined. Given the importance of these matters, and despite the delays there have already been, the BMA’s request for a pause is the most sensible way forward. The royal colleges should resist political pressure, such as from NHS England, which rejects any suggestion of a pause on recruitment.10 These concerns around supervision, revalidation, and scope must be tackled before the government passes legislation to regulate physician associates and anaesthesia associates, which could be by the end of the year. Our patients, colleagues, and medical associate professionals deserve a safer, regulated, supervised, and fully scoped healthcare system—nothing less will suffice.


  • Provenance and peer review: Not commissioned; not externally peer reviewed.

  • Competing interests: DNis a former elected council member to the Royal College of Physicians and one of the main instigators of the open letter to the Royal College of Physicians that led to last month’s Emergency RCP Council meeting.