Addressing your concerns about Physician Associates

The topic of Physician Associates (PAs) is of huge importance to us all. Not only is it a hotly debated issue among medical professionals, but it’s gaining profile in the public domain too.

Over the past month, PAs have been discussed on national TV, in Parliament, by influencers on social media and at Extraordinary General Meetings (EGMs) of other medical royal colleges. We’ve also discussed it during Question Time with the Officers, as many of you have written to me about your concerns.

It’s clear this is on many peoples’ minds, and I want you to know that it’s at the forefront of mine too.

Doctors across all specialties, including psychiatrists, have expressed concerns about the rapid expansion of the roles. I can see that much of the concern stems from the fact that there is no real clarity about the role of PAs – their scope of practice, training and supervision, and most recently around their regulation.

Currently, there are approximately 3,000 PAs working across all medical specialties in the UK. Around 180 of these work in mental healthcare. The Government has committed to growing the number of PAs in England by 10,000 alongside an additional 60,000 medical doctors by 2037. We expect to see a maximum of 350 of these PAs entering the mental health workforce.

In December, new legislation was introduced to designate the GMC as the new regulator of PAs. They will also hold a separate register, especially for PAs.  

EGMs to discuss this matter have been called by the membership at the Royal College of Anaesthetists and the Royal College of Physicians. The latter took place on 13 March, and a motion to slow the pace and scale of the roll-out of PA roles was passed with 78.7% of the vote.

Pausing the roll-out of these roles is beyond our gift as a College. However, we are doing everything in our power to help bring clarity, set the right standards and address your concerns:

• We have been carrying out a comprehensive review of the PA role and scope of practice within psychiatry. The review is being conducted by a Task and Finish Group led by the College Dean and the Chair of the Psychiatric Trainees' Committee (PTC). The recommendations will come to RCPsych Council in October and will include a period of consultation with members.

• At Council this April, there will be time dedicated to discussing members' concerns.

• During a recent forum meeting with Medical Directors, we highlighted concerns and reminded them about the importance of PAs being used appropriately.

• We have written to mental health employers in the NHS to provide advice on the way that PAs should/should not be working, to ensure the safety of patients. We advised the following:

  • PAs should not and cannot be used to replace psychiatrists.

  • PAs should not be on ‘on-call’ doctor rotas as this could compromise patients’ safety.

  • PAs acting in doctor roles could invalidate the employer's Crown indemnity.

  • PAs should be advised to take up personal indemnity and the risks of not having this should be clearly elucidated to them.

  • PAs should be used to support the doctors and the multidisciplinary team (MDT).

• We will feed into the GMC’s current consultation on the rules, standards and guidance by which it will regulate physician associates, due to close by 20 May.

• We have raised the concerns of members with decision makers at Downing Street, those in the Shadow Health Team, with civil servants at the highest level in the NHS and among Governments in the Devolved Nations.

Of course, this list of actions will continue to evolve as opportunities present themselves, and as our review develops. In addition, we have asked for examples of good practice and where PAs are working well as part of the MDT.

We are committed to having regular dialogue on the topic to ensure we are raising and addressing your concerns in the right way. Please continue to share your questions with me and the Officers, but also through your Devolved Councils, Divisions, Faculties and the PTC or Specialty and Specialist Doctors' Committee, who represent you and can bring your views to our discussions at Council – this April and throughout the year.

I really hope we can find a positive way forward.

Lade