Short History of the PA profession in the UK

In 2003 the first American trained Physician Assistants came to work in the UK. Simultaneously in the UK there was also the development of the Healthcare Practitioner and subsequently the Medical, Surgical and Anaesthetic Care Practitioner roles. The first PA training programmes were piloted between 2004-2006 in several locations in the UK. During this period, a steering group was established by the Department of Health in partnership with the Royal College of Physicians, the Royal College of General Practitioners and in consultation with a range of other stakeholders. A national curriculum was developed and published in 2006. Unique amongst UK clinical professions, a national examination was created, with graduates from the pilot sites sitting this in 2007. Following the publication of the PA national curriculum and the establishment of the national exam, the first official PA programmes opened. In 2007 the UK University Board for PA Education was formed, which is now known as the Physician Associate Schools Council (PASC).  

The first professional body for PAs was established in 2005, the UK Association of Physician Assistants (UKAPA). In June 2010, the PA Managed Voluntary Register for Physician Associates was created. 2013 saw consultation on the title of Physician Assistant with the title changed to Physician Associate. In 2015, UKAPA became the Faculty of Physician Associates, part of the Royal College of Physicians. In 2018, the then Secretary of State for Health announced that PAs would be regulated in the UK with the General Medical Council named as the regulator in 2019. On 16 December 2024, the GMC opened the statutory register for PAs and Anaesthetic Associates (AAs). There is a 2-year transitionary period and by Dec 2026 all PAs and AAs must be on the register to practice. In the UK, PAs and AAs belong to a group of clinical professions known as Medical Associate Professionals (MAPs).

Education

Currently there are over Higher Education Institutes (HEIs) providing PA education in the UK. These programmes are mainly postgraduate (PG), however there are some programmes which are undergraduate (UG) and more recently PA apprenticeships. At present most PA programmes are in England with 2 in Wales and 1 in Scotland and 1 in Northern Ireland.

Entry criteria

Postgraduate Programmes and Apprenticeships 

• Biomedical or healthcare related science degrees with a minimum classification of a 2.2 (some programmes will only accept classifications of 2.1 or above).  
• Some programmes will consider non-science degrees at a 2.1 classification or a 1^st class honours degree and addition requirements such as relevant experience in healthcare or additional courses in physiology.  

Undergraduate programmes 

• These programmes will have specific GCSE and A level or equivalent requirements for admission to their programmes. They may also ask for some work experience.  

Length of programmes

• Undergraduate: 48 months (4 years)
• Postgraduate: 24 – 27 months (2 years 3 months)
• Apprenticeships: 36 months (3 years)

There is a National PA Curriculum which is owned by PA Schools Council (PASC) and quality assured by the General Medical Council. Higher Education Institutions providing PA education are asked to complete an annual self-assessment questionnaire administered by the GMC. This is to demonstrate that they are meeting the educational standards set by the GMC. The GMC also visit all HEIs who run PA programmes.  

Professional Licensure

Once students have successfully completed the requirements of their programme, they must undertake the PA National Registration Assessment (PARA) to be able to work as a qualified PA in the UK. This examination is a safety and competency-based assessment comprised of 200 single best answer questions and a 14-station objective, structured, clinical examination (OSCE) which assesses clinical practice. This assessment is delivered independently by the Royal College of Physicians (RCP) assessment unit. Candidates have 4 attempts to pass each component.  

All postgraduate programmes are at master’s level (level 7) but students may step off with practicing awards such as: 

• Masters in Physician Associate Studies
• Masters of Science in Physician Associate Studies
• Postgraduate diploma in Physician Associate Studies

Scope of Practice

Physician Associates work within a defined scope of practice and limits of competence. At the point of qualification, they are expected to be able to with appropriate supervision from a named senior doctor:

• take medical histories from patients
• carry out physical examinations
• see patients with undifferentiated diagnoses
• formulate differential diagnoses and management plans
• perform diagnostic and therapeutic procedures
• develop and deliver appropriate treatment and management plans
• request and interpret diagnostic studies
• provide health promotion and disease prevention advice for patients

Currently, due to lack of legislation, Physician Associates cannot:

• prescribe

Although PAs are now a registered healthcare professional group and meet the eligibility criteria to request investigations requiring ionising radiation this is currently restricted and requires further discussion. (e.g. chest x-ray or CT scan)

Financing Education

There are various funding models across the four countries of the UK. Students are mainly self-funding, borrowing money to fund tuition fees. A few countries offer a mixture of funding for tuition fees, grants, and bursaries. 

Job Opportunities

PAs in the UK are working across primary and secondary care in more than 30 specialties. The job situation for PAs in the UK is challenging with few posts available. UK graduates cannot at present work in other countries with this qualification, although this is changing. 

Maintaining Role / Continuing Practice

PAs in the UK will be expected to revalidate with the GMC. This process ensures PAs remain up to date and fit to practise post registration. PAs will be asked to provide supporting information on:

• continuing professional development
• complaints and compliments
• feedback from colleagues
• feedback from patients
• quality improvement activity
• significant events.

In addition, once every five years employers will be asked for a recommendation to confirm PAs are:

• collecting the required supporting information and discussing this during annual appraisal
• fit to practise, complying with any conditions of registration and working within the bounds of competence
• keeping knowledge and skills up to date by participating in appropriate CPD and learning activities

Governing/professional bodies/associations

Regulatory Body: General Medical Council (GMC)

Professional body: College of Medical Associate Professionals (CMAPS)

Educational body: Physician Associate Schools Council (PASC)

Future perspectives

PA Numbers

The PA profession in the UK continues to grow. There are approximately 6000 PAs qualified and an estimated 1000 graduates per year.  

Prescribing

PAs currently cannot prescribe. There will need to be further consultation, agreement, and a change in law for PAs to have prescribing rights. This is several years away.  

Scope of Practice, Supervision, and Career Pathways

Additionally, there is work ongoing regarding clarity on the Scope of Practice, Supervision and Career development for the PA profession in the UK.  

Leng review

The Leng review was established by the DOH in England, to determine whether the roles of Physician Associates (PAs) and Anaesthesia Associates (AAs) were safe and effective as members of the MDT, and to consider secondary questions including, including what modifications might be required to improve confidence in the roles and whether the roles have been safely and effectively deployed.

The review concluded that the evidence available on the safety, efficacy and efficiency of PAs and AAs was limited, however there was no overwhelming evidence or views from patients, clinicians, experts, PAs, AAs and workforce requirements, to abolish the roles or to continue with the roles unchanged.

The review made 18 recommendations to provide the necessary changes required to ensure safe and effective deployment of the roles, bring clarity where required and provide an opportunity to reset and move forward. In England these have been accepted with some recommendations proposed for immediate implementation. The other 3 countries of the UK have yet to advise on their position of the recommendations and implementation of these.

Links

• General Medical Council
• Home – CMAPs
• The Leng review: an independent review into the physician associate and anaesthesia associate professions

Contact person: Prof. Jeannie Watkins, PA, MSc, Senior Fellow Higher Education Academy, Past Chair PA Schools Council, Associate Dean, Health Education and Improvement Wales (HEIW).