The healthcare landscape is constantly evolving – bringing with it new ways of working and the development of new roles aimed at addressing the growing demands of modern medicine. As global populations age, all countries are facing major challenges to ensure that their health and social systems are able to make the most of this demographic shift (World Health Organization (WHO), 2024).
Older adults often require more complex care prehospitally, as well in hospital and post discharge, as a result of chronic illnesses and comorbidities, while advances in modern medicine raise expectations for high-quality treatment (Warshaw, 2006; Kumlin et al, 2020). This trend has put pressure on healthcare resources, the workforce and finances, and brought with it a need to make adaptations to meet the growing needs of ageing populations locally, nationally and worldwide (The Lancet Healthy Longevity, 2021).
The physician associate: origins
Close to 60 years ago, the physician associate role, originally known as the physician assistant, was established in the United States (US) (American Academy of Physician Associates, 2024). The role emerged as a solution to doctor shortages, increasing population health needs and rising healthcare costs. The role of the physician associates in the US is increasing rapidly (Patel et al, 2023) but has also been adopted globally, with countries such as Ireland, Canada and the Netherlands adapting the role to fit the needs of their respective healthcare systems. In the UK, the physician associate is following its own trajectory, being uniquely adapted to the NHS framework.
In 2003, the role was first formally introduced to the NHS (NHS Employers, 2024). It has featured in a number of NHS employee- and employer-related discussions since (for example, NHS Long Term Workforce Plan (NHS England, 2023)). Bagenal (2024) highlights that many patients in the UK are forced to wait over 4 weeks for an appointment with their general practitioner. Those experiencing a stroke or heart attack currently face extended waits for an ambulance, with each additional minute increasing the risk of permanent brain or heart damage, as well as death. The ongoing healthcare crisis in the UK has been exacerbated by underfunding, understaffing and inadequate resources in health and social care. In this context, Bagenal (2024) raises the question: ‘Is increasing the number of physician associates to expand the healthcare workforce a viable solution?’ She retorts: ‘The answer is undoubtedly yes.’
Role development
The role of physician associates in the NHS is currently being closely examined following recent legislative changes and ongoing concerns regarding their scope of practice in both primary and secondary care settings. In the UK, physician associates hold an undergraduate science degree, followed by 2 years of education. This enables them to enter the workforce much more quickly than doctors. To become a fully qualified physician associate, the student must pass an approved university programme, as well as the Physician Associate National Examination (PANE) – and now, they must also register with the General Medical Council (GMC).
Physician associates are part of the multidisciplinary team, working alongside, paramedics, doctors, nurses and other healthcare professionals. Physician associates belong to a specific group within the healthcare workforce that includes roles such as anaesthesia associates and surgical care practitioners. The role has been designed to support medical care delivery and address workforce challenges. It is aimed at complementing the work of doctors by providing support in diagnosing and managing medical conditions, which helps to enhance the overall efficiency and quality of healthcare delivery. The scope of practice remains poorly defined with regards to parameters, competencies and level of supervision required for physician associate roles in general, as well as for the specific work physician associates undertake while under supervision (British Medical Association (BMA), 2024).
Physician associates work within a defined scope of practice and limits of competence to perform their duties. Physician associates undertake a wide range of clinical activities; these include (NHS Employers 2024):
- Taking medical histories from patients
- Carrying out physical examinations
- Seeing patients with undifferentiated diagnoses
- Seeing patients with long-term chronic conditions
- Formulating differential diagnoses and management plans
- Carrying out diagnostic and therapeutic procedures
- Developing and delivering appropriate treatment and management plans
- Requesting and interpreting diagnostic studies
- Providing health promotion and disease-prevention advice for patients.
Physician associates are not able to prescribe, nor request ionising radiation (for example, a chest X-ray or a CT scan), although there is some enthusiasm to extend prescribing rights in the future (Lynn, 2023). Although they are not independent practitioners as they work under the supervision of a doctor, they are capable of working autonomously within the limits of their education and competence. This makes them a flexible and valuable addition to the healthcare team. Role confusion/role delineation is however an issue. Lynn (2023) notes that the extent of autonomous working for physician associates has been left to the discretion of individual employers, which generally consist of NHS general practices or hospital trusts. Physician associates are responsible for their actions and decisions while doctors, Lynn opines, are ultimately responsible for the patient.
As part of the Medical Associate Professions (MAPs) grouping, which also includes roles such as anaesthesia associates and surgical care practitioners, physician associates represent a growing workforce aimed at addressing the increasing demands on healthcare systems. Their contribution can help to alleviate pressure on doctors and other healthcare professionals, with the intention of ensuring timely and effective care for patients. This must not, however, in any way compromise patient safety.
Physician associates have the potential to also bring consistency to patient care, as they often work across a range of different specialties and settings; this includes general practice, hospital wards and emergency departments. Their adaptability permits them to respond to the diverse needs of patients and fill critical gaps in healthcare delivery, particularly in those areas that are experiencing workforce shortages.
Regulation and registration
From 16 December 2024, physician associates and anaesthesia associates will be able to apply to join the GMC register. The decision to register physician associates with the GMC has been controversial for many reasons.
Traditionally, the role of the GMC is to regulate doctors. The inclusion of roles such as the physician associates could be seen by some as a shift in the organisation's key focus. Critics have voiced their concerns across various platforms, ranging from government briefings and parliamentary discussions, to anonymous and often vitriolic posts on social media. There is a concern that allowing the physician associate to gain entry to the GMC's professional register could dilute the GMC's critical role in maintaining high standards in healthcare by regulating physicians, ensuring their competence and protecting patients through robust oversight and calling registrants to account. Other apprehensions have been voiced as well; registration with the GMC may create confusion about the roles and responsibilities of physician associates versus doctors. This could potentially affect public trust and perceptions. Currently, there is limited knowledge of the public's understanding of physician associates and their levels of satisfaction with these healthcare providers.
The title ‘physician associate’ remains an issue. Prior to 2014, the role was known as a physician assistant. However, the title was changed to differentiate it from other roles that also used the title, but were non-clinical, such as technician roles, which did not share the educational background of the current physician associate role. The BMA has advocated for a return to the original title, arguing that it would better protect patients and enhance their care by more accurately reflecting the role's position within clinical teams (BMA, 2023).
From December 2026, it will become an offence for anyone to practise as a physician associate in the UK without being registered with the GMC (GMC, 2024a). Whether newly qualified or already practising, all professionals are required to provide evidence to the GMC that they meet their established standards and that they are able to fulfil all registration requirements before being granted official registration (GMC, 2024b). This process ensures that every individual seeking registration possesses the necessary qualifications, skills and knowledge to practise safely and effectively. By maintaining these rigorous standards, the GMC aims to uphold the integrity of the profession and protect the public by ensuring that only competent and qualified professionals are authorised to practise.
Conclusion
The future of physician associates in the UK holds significant potential to address the growing demands on the healthcare system, particularly within emergency and primary care settings. As the healthcare workforce continues to face challenges such as understaffing, increasing patient loads and long waiting times, the integration of physician associates can offer a practical solution to enhance service delivery. By expanding the workforce with skilled professionals who can provide essential clinical support under the supervision of doctors, physician associates can help to alleviate pressure on overstretched services, improve patient outcomes and provide timely care. With the right education, support, supervision and a clear role definition, physician associates can play a key role in shaping the future of UK healthcare, supporting a sustainable and more efficient system for both patients and healthcare professionals.