Physician Associate

Physician Associate
PA

How new is this role? [2,3,5]

Physician Associates (PAs) have been employed in the NHS since 2003.
The aim is to increase PA training places to over 1,500 by 2031/32. It is envisaged that this will lead to an overall workforce of 10,000 PAs by 2036/37. However, PAs are relatively new to mental health (MH) services. The NHS Long Term Workforce Plan emphasises the need to direct more PA roles towards both MH and primary care services.

Rationale [1,2,5,7]

PAs aim to make differential diagnoses and support the development and communication of multidisciplinary management plans. They cannot currently prescribe medication or request ionising radiation (e.g. x-rays/CT scans).

The rationale for the role is that they may a) enhance patients’ access to and continuity of care as they do not rotate in the same way as trainee doctors b) improve physical health care provision to service users with MH conditions c) support the skill development of students and members of the multidisciplinary team, particularly in terms of physical health and d) help ensure the effective use of consultant, speciality and associate specialist (SAS) doctors and trainee psychiatrists, undertaking work to allow others to deal with more complex cases.

Training [1-3,6,7]

Training can be accessed in more than one way:

The most common route is a Masters/PGDiP in PA Studies taken over two years of full-time study, with the entry requirement being a relevant first degree, usually in a life science subject. Most PA programmes require a minimum of a 2:1 honours degree for entry, together with some previous experience in health or social care.
Level 7 PA apprenticeships are being developed (to be held over 30 months) where apprentices are required to complete a Level 7 Diploma or MSc accredited by the Faculty of Physician Associates (FPA) at the Royal College of Physicians (RCP). Typically, entry requirements are a bioscience-related first degree or being a Nursing and Midwifery Council (NMC) Registered Nurse (RN) or Midwife, or a Health and Care Professions Council (HCPC) Registered Allied Healthcare Professional (AHP).
For non-graduates the option of a four-year full-time Integrated Master's in PA Studies is being developed.
Student PAs should have had 1600 hours of clinical placement with a minimum of 90 in MH.
Once qualified they should undertake an inceptorship programme with an MH focus, with a defined scope of practice in line with their competencies, undertake 50 hours of relevant CPD per year and undergo an annual appraisal. Access to a peer support network and ongoing training and development opportunities is also recommended.
A competency framework for PAs working in MH has been developed.

Expected pay band [1,4]

Agenda for Change band 6 or 7.

Is it registered/regulated and by whom? [1,3]

Registration is currently voluntary via the PA Managed Voluntary Register, accessed through the FPA at the RCP. The government is planning to regulate PAs through the GMC in December 2024. It is planned that post holders will be supervised by a doctor (in MH services, usually a consultant psychiatrist) and complete annual appraisals.

What our research found*

Numbers reported in practice

We received specific data for 24 Trusts (excluding estimates and trainees).
Fourteen Trusts reported employing PAs and 12 did not.
Numbers employed ranged from one to 12: three Trusts reported employing 12 PAs, most had between two and six PAs.

Insights from qualitative interviews and stakeholder reflection groups (i.e. what is reported to be happening in practice)

PAs were reported to be working in a range of MH settings including: medical, acute, rehabilitation, community and specialist services, learning disability, older adults and adolescent forensic services. They were most frequently described as working with medical teams in inpatient or older adult services.
There were mixed views of the role. For some Trusts PAs were “a really important part” of having sufficient medical cover [Interview Participant M1], however it was more common that Trusts expressed either ambivalence about the role: “we don’t really see the value of them in psychiatry” [Interview Participant E1], or active unwillingness to accept the role: “lots of resistance. That’s our biggest challenge” [interview Participant P1]. Trusts with more negative views of the PA role reported having sufficient other roles to cover services (particularly doctors and/or Advanced Practitioners):“we just can’t see where they fit in, particularly if we have our Advanced Practitioners, we have our medics on the ward. We don’t see a role for them really, at all, and I don’t think we’re gonna be progressing to PAs.” [Stakeholder Reflection Group Participant 1-C]. Other reasons for not employing PAs in MH were the inability to carry out Mental Health Act provisions and difficulties engaging medics in particular with the role.

Reported drivers for/advantages of implementing the role included:

- - bringing a physical health focus into MH services where it has traditionally been uncommon
  - helping to free up psychiatrist time for more complex work
  - helping to improve psychiatric trainees’ experience by providing cover to facilitate their CPD attendance.

Challenges to implementation included:

- - a potential lack of MH training which limits where PAs could be deployed
  - concerns around lack of registration for the role
  - difficulties with recruitment and retention
  - a lack of consultant supervisory capacity and/or backfill funding
  - some medic resistance to the role.

* Research findings are based on 1) interviews with heads of HR or workforce leads in English MH Trusts and 2) stakeholder reflection groups with experts on new roles in MH services. The ways in which new roles were reported to be working in practice could differ within and/or between MH Trusts.

Sources [1-7]

NHS England South West. Adult Community Mental Health Roles Guide v2.0 ((NHSE internal document accessed Sept 2023)
National Collaborating Centre for Mental Health (2022) Competence Framework for PAs in Mental Health, Supporting Document Competence Framework for PAs in Mental Health: Supporting Document
NHS England (2023) NHS Long Term Workforce Plan 2023 NHS Long Term Workforce Plan
NHS England South West. A brief guide to new roles and new ways of working in Mental Health 2023-2024 (NHSE internal document accessed Sept 2023)
Faculty of Physician Associates at the Royal College of Physicians (2024) Who are Physician Associates? Who are Physician Associates?
Health Education England and Royal College of Physicians (2019) Physician Associates working in mental health
Institute for Apprenticeships and Technical Education. Physician Associate: integrated degree Physician associate: integrated degree