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 13 December 2023, legislation was laid before parliament to bring PAs and AAs into regulation. In the UK, PAs belong to a group of clinical professions known as Medical Associate Professionals (MAPs). This group currently includes PAs, Anaesthetic Associates (AAs) and Surgical Care Practitioners (SCPs).
Education
Currently there are 37 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.
University Programmes in the UK – programmes in England unless stated otherwise (as of Dec. 2023).
| Aberdeen | Edgehill | St George’s University London (SGUL) |
| Anglia Ruskin | Greenwich | Sheffield |
| Aston | Hertfordshire | Sheffield Hallam |
| Bangor (Wales) | Hull & York | Surrey |
| Birmingham | Keele | Swansea (Wales) |
| Bolton | Leeds | University of Central Lancaster (UCLan) (PG) |
| Bournemouth | Leicester De Montford (DMU) | UCLan (UG) |
| Bradford | Manchester | University of East London (UEL) |
| Brunel | Newcastle | University of Ulster (Northern Ireland) |
| Brighton and Sussex | Plymouth | University of West England (UWE) |
| Buckinghamshire New | Portsmouth | Worcester |
| Canterbury Christchurch (CCC) | Queen Marys University London (QMUL) | |
| Chester | Reading (PG) | |
| East Anglia | Reading (UG) |
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 1st class honors 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 the Faculty of Physician Associates 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 Assessment (PANE) 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. They:
- 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 are not able to:
- prescribe
- request ionising radiation (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 are generally in demand in the UK working across primary and secondary care in more than 30 specialties. UK graduates cannot at present work in other countries with this qualification, although this is changing.
Maintaining Role / Continuing Practice
Until regulation is achieved PAs are required to maintain their continuing professional development (CPD) and must achieve 50 hours of CPD each year. This is a requirement for the PA Managed Voluntary register. In addition, PAs must log evidence of their knowledge in core areas of practice, maintain a record of developing specialty-related clinical knowledge, clinical competencies, and feedback.
Once GMC regulation begins, all PAs will need to follow its revalidation process to remain registered. PAs will be expected to evidence their ongoing competency, engagement with CPD, appraisal and employer assurance.
Governing Bodies
Professional body: Faculty of Physician Associates (FPA) a faculty of the Royal College of Physicians (RCP)
Educational body: Physician Associate Schools Council (PASC)
Regulatory Body (pending): General Medical Council (GMC)
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
The work on making the case of need to enable legislative change for PAs to prescribe is in progress, however it cannot begin in earnest until regulation of the profession. Once regulated 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.
Links
Contact person : Prof. Jeannie Watkins, PA-R, MSc, Senior Fellow Higher Education Academy, Chair PA Schools Council
