The healthcare sector in the UK is constantly evolving, with regulatory updates shaping the practice landscape for professionals. One of these recent changes involves the regulation of Physician Associates (PAs) and Anaesthesia Associates (AAs) by the General Medical Council (GMC), that came into effect on the 13th December 2024. This development helps to bring clarity on the scope of practice for these professions but has also raised questions, particularly regarding prescribing rights.
The Role of Physician Associates (PAs)
Physician Associates play a critical role in the UK healthcare system, across both primary and secondary care settings. Their responsibilities include conducting patient assessments, diagnosing illnesses and developing management plans. Whilst PAs are trained to manage a wide range of medical conditions, they work under the supervision of a designated doctor to ensure patient safety and adherence to clinical standards.
According to the Care Quality Commission (CQC), PAs are invaluable in enhancing the capacity of healthcare teams, enabling doctors to focus on complex cases whilst ensuring that patients receive timely and effective care.
To qualify as a Physician Associate in the UK, individuals must have a relevant undergraduate degree, typically in biomedical or life sciences, and have completed an intensive two-year postgraduate diploma or master’s qualification in Physician Associate Studies. These courses are offered by accredited universities and combine theoretical learning with extensive clinical placements.
Understanding the GMC Regulatory Role
Historically, the regulatory landscape for PAs and AAs has been less well-defined compared to other healthcare professions. The inclusion of PAs and AAs under the GMC’s remit marks a significant step toward ensuring consistency in their education, training, and practice.
What will the GMC actually do?
The GMC’s regulatory responsibilities for PAs and AAs will include:
- Setting Standards: The GMC will define professional conduct and patient care standards that PAs and AAs must meet.
- Overseeing Training: Approval and oversight of training programmes will ensure that PAs and AAs are fully prepared for their roles.
- Maintaining a Register: The GMC will register qualified PAs and AAs, creating a clear record of who is authorised to practise.
- Providing Support: Guidance and resources will be available to help PAs and AAs navigate ethical challenges and understand their roles within the healthcare system.
- Addressing Concerns: The GMC will investigate and take action if significant concerns about a PA or AA’s practice arise.
The Big Issue: Prescribing
An area of ongoing debate and review concerning the role of PAs is their authority to prescribe medications. From December 13th 2024, once their roles are regulated by the GMC, PAs will not have the authority to prescribe medications, regardless of previous qualifications or experience in other healthcare roles. The Department of Health and Social Care (DHSC) has clarified that prescribing privileges are tied to the profession in which they were originally gained. This means once the role is regulated, PAs cannot carry over prescribing rights from previous roles, such as nursing or midwifery.
The Role of PAs in the Prescribing Process
Whilst PAs will not be able to prescribe medications, they continue to play a key role in supporting treatment decisions. They can recommend prescriptions for a general practitioner to review and approve. However, the responsibility and accountability for any prescribed medication remain with the supervising prescriber. By conducting detailed patient assessments, gathering comprehensive histories, and collaborating with supervising doctors, PAs can contribute to effective and efficient care delivery. This team-based approach ensures safety whilst maximising the unique strengths of each role.
The Benefits of Clearer Rules:
The introduction of GMC regulation offers multiple benefits:
- Enhanced patient safety: The clear definition of roles ensures that prescribing responsibilities rest with professionals specifically trained and regulated for this job.
- Higher standards: GMC regulation ensures consistency in the PA and AA professions, matching them with other medical professionals.
- Focus on what they do best: PAs and AAs can concentrate on their primary competencies, such as diagnosis and patient management.
The Future of Prescribing for Physician Associates
The regulation of PAs under the GMC has sparked discussions about the potential for future changes. Advocates argue that granting PAs limited or supervised prescribing rights could enhance their effectiveness within healthcare teams, particularly in primary care and urgent care settings where timely access to medication is crucial.
Key Considerations for Future Prescribing Rights:
- Training and Standards: Any extension of prescribing rights would require additional, rigorous training and assessment to ensure that PAs are equipped to prescribe safely and effectively.
- Patient Safety: Safeguards must be implemented to maintain high levels of patient safety, including close supervision and a phased introduction of prescribing responsibilities.
- Lessons from Other Roles: The experience of other healthcare professionals, such as nurse practitioners and pharmacists, who have successfully gained prescribing rights, could serve as a framework for PAs.
Whilst there is no immediate plan to introduce prescribing rights, the evolving role of PAs and the ongoing evaluation of their impact within healthcare teams may pave the way for future changes. Ensuring that PAs are supported by robust training and oversight will be critical in any such development.
Government Review
In November 2024, the UK government initiated an independent review of physician associates (PAs) and anaesthesia associates (AAs) to assess their impact and future role within the National Health Service (NHS). This review, commissioned by the Health and Social Care Secretary, will focus on several key areas, including patient safety related to these roles, how PAs and AAs contribute to and integrate with existing healthcare teams, and their overall effectiveness in delivering high-quality and efficient patient care.
Furthermore, the review will examine the current deployment of these roles within the NHS and provide recommendations for the optimal integration and utilisation of these and other new healthcare roles in the future, ensuring they effectively support the evolving needs of the healthcare system. The review is expected to report back to the government in the spring of 2025.
Looking Ahead
The CQC emphasises that healthcare providers must ensure that their workflows accommodate changes brought about by GMC regulation, allowing PAs to work effectively within their defined roles. Clear delegation protocols and communication channels will therefore be critical.
For healthcare professionals and organisations, the transition to GMC regulation is an opportunity to reinforce their commitment to patient care. By adapting to these changes, they can continue to deliver high-quality, patient-centred care whilst ensuring the safe and effective integration of PAs and AAs into the healthcare system.
