The Royal College of Physicians (RCP) has just released interim guidelines for Physician Associates (PAs). The aim of the guidelines is to guarantee patient safety whilst supporting the healthcare team as effectively as possible. A full review of this topic is due in spring 2025.

To summarise, the key points of guidance are:

The PA must work within their own scope of practice. This group of healthcare professionals must have a clear role within the MDT.
The PA must be supervised by consultants and/or specialist doctors. Importantly, resident doctors should not be responsible for clinical supervision.
With regard to decision making, PAs should not work as senior decision makers and not decide on admissions or discharges in the secondary care setting.
PAs cannot prescribe drugs irrespective of their background and experience.
During consultations, PAs must explain their role to patients, families / carers and colleagues. Details of their educational and clinical supervision should be divulged as required.

As anticipated, the new guidelines released today have seen mixed reactions from the medical community as a whole. Clearly, the guidelines provide clarity as to the role of the PA in the modern-day healthcare workforce which reinforces standards of care for the community. By offering a detailed scope of practice, the interim guidelines hope to avoid overlap or confusion regarding healthcare responsibilities.

Conversely, the interim guidelines may be seen by some as too restrictive and possibly limit the efficacy in practice of PAs when trying to reduce the current workload on doctors. The inability to prescribe drugs could be viewed as a massive limitation on service provision, especially when some PAs originate from a prescribing background. As PAs would need to rely on doctors for prescriptions then inefficiencies and delays in patient care may arise.

The focus on supervision is another controversial element within the interim guidelines. A new strain on NHS senior medical staff may present and this in turn could negatively impact on the time doctors can spend on their own clinical responsibilities. Moreover, the fact that PAs should not operate as senior decision makers or decide on patient admissions for example could indeed limit their ability to contribute fully to the MDT. In situations where rapid decision-making is pivotal then this could possibly slow down the process down and impinge upon patient outcomes.

Concentration on clear and effective communication will be appreciated by all. This is so because ensuring that PAs give explanation about their role and supervision details to patients and colleagues can help build trust and understanding.

To conclude, the new interim guidelines for PAs that have been released on 17th December 2024 represent a step change in incorporating PAs into the NHS. As detailed above, patient safety has been prioritised and the healthcare team will continue to be supported. To end on a positive note, the recently released guidelines do offer a framework that can be built upon following release of the hotly anticipated Leng review in spring 2025.