and why you should be concerned
Successive government have sought to deskill the clinical workforce in the NHS. Physician Associates and others are undermining proven training and progression routes for fully qualified doctors.
The Physician Associate (PA) and Anaesthetist Associate (AA) roles were introduced into Britain in 2002 and 2004 respectively. Collectively these roles, together with Surgical Care Practitioners are known as Medical Associate Professionals (MAPs), and NHS England plans to increase their numbers dramatically.
There are currently about 3,500 PAs and 100 AAs working in NHS England. Of these, 1,500 work in hospitals and about 1,700 in GP practices. This compares with a current workforce of about 130,000 qualified doctors.
The government’s long-term workforce plan is to expand the number of PA training places to 1,500 per year by 2031/2, establishing a workforce of 10,000 PAs by the mid 2030s. For AA’s, the plan aims for 280 to qualify each year, to a workforce of 2,000 by the mid 2030s.
The government has created financial incentives to foster the plan. A starting salary for PA posts, which is higher than that of many resident (junior) doctors, is geared to attracting recruits to PA studies. GPs are emncpuraged also to hire PAs because they get extra funds through the “additional roles reimbursement scheme” (ARRS).
WHY? Because PAs etc are much cheaper to train.
There is an acute shortage of doctors in the NHS – 11,000 vacancies in England alone. PAs are a cheap substitute for real doctors because the extensive and intensive training real doctors receive is a long and very expensive process.
The key difference between qualified doctors and PAs is the very marked difference in levels and breadth of medical knowledge, understanding and training. A PA has only two years of a medical training degree, following an undergraduate degree which may or may not be in a related subject. Not only are the entry requirements into medical school very tough but the intensive five year medical degree covers all areas of medical science, and is followed by two years compulsory ‘foundation years’ of guided experience on wards and in GP surgeries.
In spite of the limited training PAs and other are being used as substitute doctors in hospitals and GP surgeries. They appear on hospital rotas up to Senior House Officer roles and are used in GP surgeries to see ‘undifferentiated’ patients to make a first diagnosis.
They are not real doctors
When PAs were first introduced they were called ‘physician assistants’, with a role limited to supporting fully qualified doctors. The change of name was not cosmetic, although it may have been portrayed as such: it came with a change in their role to effectively mimic that of junior doctors, GPs anaesthetists etc. (Link to government factsheet)
But government guidelines are very unclear. “Physician associates” they say “and anaesthesia associates are healthcare professionals, …..work alongside doctors providing medical care as an integral part of the multi-disciplinary team. PAs can work autonomously, but always under the supervision of a fully trained and experienced doctor. AAs are qualified to administer anaesthesia under the supervision of a medically qualified anaesthetist.”
This is an Orwellian word salad: PAs and others “can work autonomously, but always under the supervision of a fully trained and experienced doctor”. Which is it? Autonomous or supervised?
The medical profession is profoundly disturbed
The British Medical Association (BMA) conducted a survey of doctors which showed that 87% thought that the way PAs currently work in the NHS is always or sometimes a risk to patient safety.
A survey by the Royal College of GPs showed that 50% of all respondents reported being aware of specific examples of patient safety being compromised by the work of PAs, with common themes including misdiagnosis and diagnostic errors by PAs, inappropriate prescribing and management, and lack of communication to patients and GPs.”
The use of PAs increases the workload for fully trained, overworked Doctors who must supervise and train PAs. Some Doctors have reported that their workload has doubled as a result.
Properly trained doctors find themselves competing for limited training places with much less well-qualified MAPs. This will limit the numbers of real doctors progressing to become registrars and consultants.
HALT!
Many doctors’ organisations as well as patient campaign groups called for a halt in the expansion of training for PAs until their use and regulation had been thoroughly reviewed. The Leng Review published in July 2025 made some recommendations which could assuage some concerns eg:
The role ofphysician associate should be renamed as ‘physician assistant’, indicating the role was as a supportive, complementary member of the medical team;
PAs should wear badges etc so that patients could distinguish them from doctors;
Except under clearly defined conditions Physician assistants should not see undifferentiated patients that is patients whom a medic had not first reviewed.
Deskilling still the name of the game
Among GPs the numbers of PAS employed is decreasing, but Wes Streeting’s 10 Year Plan for the NHS makes it quite clear that further deskilling of the medical workforce is the aim.
