The Faculty of Physician Associates (FPA) at the Royal College of Physicians (RCP) provides professional support to physician associates across the UK. Members of the faculty are part of a professional membership body campaigning for progress and change in the profession, advising government, and taking part in national debates on medical, clinical and public health issues.
The FPA reviews and sets standards for:
- the education and training of physician associates
- accreditation of university programmes and
- physician associate national certification and recertification examinations
The FPA provides support to both qualified and student physician associates in their education, training and professional development, giving members access to a benefits package that includes a CPD diary, publications, library resources, and discounts on professional development courses and events.
The FPA oversees and administers the running of the Physician Associate Managed Voluntary Register (PAMVR) and is campaigning to achieve statutory registration of the profession.
- What is a physician associate?
- What do physician associates do?
- What is the relationship between physician associates and their supervisors?
- How do physician associates fit into the NHS workforce?
- Why did the RCP agree to establish the FPA?
- Why is physician associate not a registered or protected title?
- Where are we with regulation?
- How are qualified physician associates able to practise in the UK?
- What experience do physician associates have before training?
- Can physician associates prescribe in the UK?
- Do physician associates require professional indemnity (malpractice) insurance to practise in the UK?
- Can doctors who trained abroad work in the UK as physician associates?
- Can physician associates who trained outside the UK or US work in the UK?
- Do physician associates need a licence to work in the UK?
- Why are other healthcare roles described as physician associate or assistant?
- How much do physician associates earn?
- Do physician associates get paid study leave?
Physician associates (PAs) are healthcare professionals with a generalist medical education, who work alongside doctors, physicians, GPs and surgeons providing medical care as an integral part of the multidisciplinary team. Physician associates are dependent practitioners working with a dedicated supervisor, but are able to work autonomously with appropriate support.
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
- see patients with long-term chronic conditions
- formulate differential diagnoses and management plans
- perform diagnostic and therapeutic procedures
- develop and deliver appropriate treatment and management plans
- request and interpret diagnostic studies (except those involving ionising radiation)
- provide health promotion and disease prevention advice for patients.
Physician associates are not able to:
- request ionising radiation (eg chest X-ray or CT scan)
- provide care or treatments to patients in an unsupervised setting.
Physician associates are dependent practitioners working with a dedicated consultant supervisor, but are able to work autonomously with appropriate support.
Supervision of a qualified physician associate is similar to that of a doctor in training or trust grade doctor in that the PA is responsible for their actions and decisions. However, the clinician who is ultimately responsible for the patient is the consultant.
As a clinical supervisor there is also a responsibility for ongoing development of the PA, including appraisal and development of a professional development plan (PDP).
Levels of supervision will vary somewhat from individual to individual and are dependent on a number of factors including, but not limited to, their past healthcare experience and years of experience as a physician associate. A new graduate will require much more intensive supervision compared to an experienced physician associate.
Physician associates have been practising in the UK for 10 years, so are relatively new members on clinical teams. Physician associates' ability to practise medicine is enabled by collaboration and supportive working relationships with their clinical supervisors (consultants), meaning that there is always someone senior who can discuss cases, give advice, and attend to patients if necessary.
Physician associates can be found working in this way in primary and secondary care across 20 specialty areas throughout the UK.
In a GP surgery, physician associates may see patients of all ages for acute and chronic medical care. Physician associates can refer patients to consultants, the acute medical unit or the emergency department when clinically appropriate. Other duties include home visits, prescription reauthorisation, review of incoming post and laboratory results. Physician associates are an additional healthcare team member to help the practice reach quality outcome framework targets.
In emergency departments, just like in general practice, physician associates are able to see patients with undifferentiated diagnoses. They consult with patients in minors and majors as well as resuscitation and post-resuscitation. They are also able to see medical, trauma, mental health, paediatric, obstetric and gynaecology cases. Physician associates obtain the history, conduct the physical exam, request and interpret investigations, diagnose and manage patients. They are able to make referrals both to in-house specialties as well as arrange for outpatient appointments or GP reviews. Physician associates are able to discharge or admit patients and can arrange for intermediate care or community services as well. Some experienced physician associates help with teaching for the physician associate and medical students as well as foundation year one and year two doctors.
The RCP established the Faculty of Physician Associates (FPA) in 2015 in conjunction with the UK Association of Physician Associates (UKAPA), Health Education England (HEE) and other medical royal colleges in order to strengthen and develop the close working relationship between doctors, across the specialties, and with physician associates.
The aim of the faculty is to support the professional development of physician associates and thereby enhance patient safety, by providing access to the educational and professional development resources from the RCP and our publications. The FPA is a national body, so standards apply across the UK.
The RCP also provides high-quality administration for the faculty, which includes the running of the Physician Associate Managed Voluntary Register (PAMVR). The faculty and the RCP are also campaigning to achieve statutory regulation of the PA profession.
The decision to oversee the FPA stemmed from the concerns, related to the decision to increase the number of physician associates, coming from the Department of Health, HEE and universities, and to ensure that any expansion in numbers could be aided and evaluated over the period of growth. The FPA and the RCP aim to ensure that this expansion of a new clinical workforce is done as safely as possible pending formal regulation, which requires a change in the law. The RCP wants to support highnational standards of physician associate training, and to campaign for effective regulation.
The RCP Council made this decision as it was seen as important to support, shape and understand the needs of the profession, in a manner that is complementary to the needs of physicians.
It also aligned with the RCP's aim to support the future clinical workforce as set out in the Future Hospital Commission report, published in 2013:
The roles of advanced nurse practitioner and physician’s associate should be evaluated, developed and incorporated into the future clinical team in a role and at a level of responsibility appropriate to their competencies.
As a new role in the UK, physician associates are still seeking statutory regulation and therefore the title ‘physician associate’ is currently not protected. The Faculty of Physician Associates, along with the universities involved in training physician associates, continues to work toward registration of the profession in order to protect the title.
As a relatively new role in the UK physician associates are still seeking statutory regulation, which the FPA is consistently campaigning for publicly and behind the scenes. The government and the Department of Health are considering regulation in order to provide a legally accountable framework for patient safety, set standards for the profession, education, protection of the title, fitness to practise, and continuing fitness to practise. While these are already in place for physician associates nationally and overseen by the FPA, they cannot be legally enforced without statutory regulation.
The fact that physician associates are not a regulated profession means that they cannot prescribe medication or order ionising radiation (ie order X-rays) and the title ‘physician associate’ is not protected.
At present there is a Physician Associate Managed Voluntary Register (PAMVR) housed at the FPA which keeps details of physician associates who meet all the required standards. The PAMVR does not currently have force of law, so is 'voluntary' as its name suggests. However, the FPA strongly encourages all qualified physician associates to join the register, and all trusts and practices to ensure that the physician associates they employ are registered. Employers should check this at appointment and at yearly appraisals. This will help ensure that only those properly trained are able to practise as physician associates. While work towards statutory regulation is underway, the overall decision regarding the eventual registering body for physician associates will be made by the government. All UK-based physician associates are therefore strongly encouraged to join the PAMVR as it will form the initial list of physician associates to enter a statutory register when established.
The Faculty of Physician Associates at the RCP, Health Education England and the higher education institutes involved in training physician associates continue to work towards regulation of the profession and the establishment of a statutory register. Once this is in place, it is envisaged that those on the PAMVR will be transferred to the statutory register, the title physician associate will become protected, and only those on the statutory register will legally be allowed to practise as a physician associate.
Physician associates are able to practise in the UK as a result of a clause within the General Medical Council's guidance on good medical practice.
Delegation is discussed within paragraph 44–45 as follows:
44. You must contribute to the safe transfer of patients between healthcare providers and between health and social care providers. This means you must:
a. share all relevant information with colleagues involved in your patients’ care within and outside the team, including when you hand over care as you go off duty, and when you delegate care or refer patients to other health or social care providers 8,14
b. check, where practical, that a named clinician or team has taken over responsibility when your role in providing a patient’s care has ended. This may be particularly important for patients with impaired capacity or who are vulnerable for other reasons.
45. When you do not provide your patients’ care yourself, for example when you are off duty, or you delegate the care of a patient to a colleague, you must be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for the patient.
All physician associates hold at least a bachelor's degree, usually in a life science field (biomedical science or a health-related science degree). Most physician associate programmes require at least a 2:1 honours degree for entry into the postgraduate diploma course along with some prior health or social care experience. In addition to their first degree the prior experience of physician associates is diverse, ranging from cardiac physiology and psychology to pharmacy and health education.
Physician associates are currently unable to prescribe medication in the UK.
Close work with supervising physicians and arrangements developed individually allow for flexible ways of working and continuation and expansion of quality patient care. For instance, many physician associates working in general practice may propose prescriptions (which is no different to non-prescribing nurses) and have the ability to quickly interrupt their supervising physician for a signature and then continue their work. If further advice on a case is required, the GP and physician associate take time out to discuss it and/or see the patient together to come to a decision on further treatment.
Prescribing rights for physician associates may change once statutory regulation is introduced. At that time, decisions will be made regarding physician associates’ prescribing rights. As physician associates are not yet licensed nor regulated, this limitation also applies to requests for X-rays and other ionising radiation requests.
Do physician associates require professional indemnity (malpractice) insurance to practise in the UK?
Yes, physician associates require professional indemnity coverage. The Medical Protection Society (MPS), Medical Defence Union (MDU) and Medical and Dental Defence Union of Scotland (MDDUS) all provide professional indemnity for qualified physician associates.
Within trusts the practice of physician associates is covered by the Department of Health, clinical negligence scheme for trusts (CNST), published in 2012. However, qualified physician associates are strongly encouraged to have their own personal professional negligence insurance from one of the medical defence organisations listed.
In primary care, it is imperative that physician associates have their own indemnity. The annual physician associate census shows that in the majority of cases the cost of physician associate indemnity in primary care is covered by the employer and we recommend GP employers contact their own indemnity provider for guidance.
International medical graduates have not completed an approved physician associate training programme, and so are not eligible to work as a physician associate. Anyone wishing to become a physician associate must apply to and complete the entire physician associate programme, and pass the national examinations.
Physician associates are not doctors, but are dependent clinicians without independence or autonomy of practice.
At this time the FPA has three categories of membership:
- Physician associate member: A graduate from a recognised UK physician associate programme or from an accredited US physician associate programme
- Student physician associate member: A student enrolled on an accredited UK or US physician associate programme
- Friend of the faculty: Individuals who are interested in joining the faculty as a non-physician associate member.
In addition, a PA:
- applying for PA membership must have completed either a UK/US PA programme, passed the national PA exam in either US/UK, and either live or work in the UK
- student applying for PA student membership must be enrolled in a PA programme in the UK’.
We are not in a position to allow non-UK or non-US physician associates to join as student or physician associate members. Presently we are looking at other existing European physician associate programmes to determine how to include them and how to evaluate the equivalency of these programmes. Until that happens we can only allow these individuals to join as a friend of the faculty.
You can read more information regarding membership eligibility on the FPA website .
No, however they do need to meet the required UK national standards for physician associates. American-trained physician assistants are currently eligible to work in the UK but are required by their employer to have and maintain their National Commission on Certification for Physician Associates (NCCPA). In the future, US-trained physician assistants may have to take a UK certification exam or another route may be decided. This has yet to be determined.
In certain areas of the UK, there are organisations which employ people to do technical tasks in the hospital such as phlebotomy, arterial blood gases and administrative duties. While they are also called 'physician associates' or ‘physician assistants’, they have not undertaken the training required for physician associates in the UK at one of the recognised universities (listed on our website), have not passed the UK PA National Certification examination, and do not have the training of National Commission on Certification of Physician Assistants (NCCPA) American physician assistants. These are nationally set standards that enable the use of the title.
There is a clear distinction in the level of medical training and, for this reason, the Faculty of Physician Associates, along with the universities involved in training physician associates, continues to work towards regulation of the profession in order to protect the title.
There is also a separate profession called physicians’ assistant (anaesthesia). This is a separate profession with a different set of competencies which enable them to work under the supervision of anaesthetists within the operating theatre environment.
The newly qualified physician associate post has been evaluated under Agenda for Change at band 7. Higher level physician associates (usually requiring a minimum of 5 years’ experience and a relevant master’s degree) have been banded at 8a.
Physician associates have a responsibility to keep up to date. Continuing medical education (CME) or continuing professional development (CPD) is key to a physician associate’s ongoing clinical practice, so the majority of physician associates are provided with some form of study leave. This is to be determined through discussions with the physician associate and their supervising physician as well as their employer.
All physician associates are currently required to fulfil CPD requirements to remain on the Physician Associate Managed Voluntary Register (PAMVR), which is to be audited by the FPA in conjunction with the Royal College of Physicians using the CPD diary.
The Faculty of Physician Associates require documented evidence of members’ CPD as an essential component of the information needed to remain on the PAMVR. This evidence is required, under membership of the FPA, to be documented in the member’s RCP CPD diary. All physician associates are currently required to complete 50 hours of CPD per year. Further information can be found in the CPD guidance for physician associates.