The increasing use of physician associates (PAs) within the NHS has hit the headlines in recent months, with numerous social media discussions, many of which has been acrimonious, and negative headlines in the mainstream media about their work.

Such is the concern over their use, and the related profession of anaesthetic associate (AA), that the BMA and the Royal College of Anaesthetists, have called for a pause in recruitment and the GMC has called on NHS England to confirm there is no plan to replace doctors with PAs.

PAs have worked within the NHS for 20 years, as have AAs and related positions that all come under the grouping medical associate professionals or MAPs. So what has happened to trigger the current debate and outcry over their use?

The media spotlight comes at a time of increasing recruitment of medical associate professionals (MAPs) within the NHS, primarily PAs and AAs, following a pledge within the long-term workforce plan published in June 2023. PA numbers are planned to increase to 10,000 by 2036-37 ( from around 3,000 at present) and AA numbers to 2,000 (from around 120 according to recent figures). This increase in number is a key component of the workforce plan.  And PAs, in particular, are becoming more visible to the general public as their numbers increase. 

Plus, the mainstream media picked up on two tragic cases of deaths due to mistakes made by PAs in GP surgeries. 

Emily Chesterton died in November 2022 after a PA failed to diagnose and treat her deep vein thrombosis and pulmonary embolus at two consultations and did not seek advice from a GP, and Colleen Howe, died in 2023 from aggressive breast cancer after delays caused by a misdiagnosis from a PA at her GP surgery.

These deaths highlighted the increasing use of PAs in GP surgeries and the lack of public understanding of the role. In both cases neither patient was aware that they were not seeing a professional that was not as well qualified as a GP.

Other social media discussions and media headlines have focused on PAs being used in positions that would previously have been the preserve of doctors. Recent headlines include the BBC revealing that Birmingham Children’s Hospital was using PAs in senior roles in the liver unit with a consultant on call. PAs have worked at Birmingham Children’s Hospital for 10 years but the BBC reported that it saw rotas which show them on tier two, normally a rota for senior doctors (registrars).

The discourse surrounding PAs on social media has been highly critical and acrimonious. The BMA has accused PAs of presenting themselves as GPs, doctors and consultants, and noting that there have been reports of medical students losing out to PAs for training. Plus there are reports of situations where PAs appear to be carrying out work that is outside of their remit.

Where do PAs fit into the NHS

Physician assistants, as they were originally known, were first introduced in the US in the 1960s to ease physician shortages. In the UK, PAs began work in 2003, and from 2013 they became known as associates rather than assistants.

PAs work as part of a multidisciplinary team with supervision from a named senior doctor (GMC registered consultant or GP), providing care to patients in primary, secondary and community care environments. AAs work under supervision in a similar way but only in the anesthesia setting.

The MAP grouping also includes Surgical Care Practitioners (SCPs) whose main responsibility is to support surgeons and other healthcare professionals before, during and after minor surgical procedures. Unlike PAs and AAs, SCP roles can only be taken up by individuals who are already registered healthcare professionals. 


Much of the media discussion has focused on the level of training that PAs/AAs receive before being allowed to work with patients.

To qualify as a PA in the UK, students had to have completed a bioscience-related first degree and then a postgraduate (level 7, i.e. a master’s level) degree in physician associate studies that takes two years. However,  there are now undergraduate integrated Master of Physician Associate Studies programmes available that require A-levels or equivalent for entry and there is also a level 7 apprenticeship. 

Registered healthcare professionals, such as a nurse, allied health professional or midwife can also apply to become a PA. 

A PA can carry out a wide variety of work, including taking medical histories from patients, carrying out physical examinations, carrying out diagnostic and therapeutic procedures, and seeing patients with undifferentiated diagnoses. 

However, they can not prescribe or request ionising radiation (eg chest X-ray or CT scan).


In 2005 the UK Association of Physician Associates was established. In 2006 the Department of Health released a competency framework for PAs in conjunction with the Royal Colleges of Physicians and General Practitioners. A voluntary register was founded in 2011. 

In 2015 the Faculty of Physician Associates (FPA) was established by the Royal College of Physicians to set standards and to oversee the PA-managed register. This register is voluntary.

Currently, PAs and AAs are not subject to any form of statutory regulation, but this is due to change. In July 2019, the Department of Health and Social Care (DHSC) asked the General Medical Council to regulate MAPs, including PAs and AAs.

In February 2023, the DHSC launched a consultation on PA regulation, which included extending prescribing responsibilities to PAs. This has closed now and regulation is expected for  the PA and AA profession by the end of 2024. 

What are the issues

The debate on the use of PAs and AAs in the NHS has highlighted a number of issues including: 

  • the pay differential between PAs and junior doctors, with newly qualified PAs earning around 35% more than junior doctors despite the difference in experience and responsibility; 
  • a reduction in training situations for medical students; 
  • concerns over patient confusion as to whether they are seeing a PA or doctor; 
  • and, the increasing use of PAs in GP surgeries in place of GPs.

In September 2023, the BMA published a position statement on PAs and AAs. In it the BMA noted:

Patients should always know who is treating them and when this is – and is not – a medically qualified doctor….Patients and their families are often unaware they have not been seen or assessed by a doctor; such confusion is understandable – on social media there is a proliferation of physician associates (PAs) describing themselves as doctors, GPs, and medical consultants.” 

On the pay differential, the BMA notes that it is:

“clearly wrong that a newly qualified doctor entering postgraduate training is paid over £11,000 less per year than a newly qualified PA, while the doctor’s role, remit and professional responsibility is far greater. We estimate that this is a 35% differential, which is manifestly unjust.” 

To reduce patient confusion, the BMA wants a return to the title physician assistants. Anaesthesia associates (AAs) were similarly previously known as physician’s assistants (anaesthesia). Patient confusion will also not be helped, the BMA feels, by the planned move for the GMC to regulate PAs and AAs. 

But the BMA’s objections to the current expansion of PAs and AAs goes far deeper that titles and regulator:

“Their use and planned expansion challenges what it means to be a doctor, reflects how the medical profession has been devalued, and demonstrates how the health system is seeking to undermine it in favour of colleagues with less training, skills and expertise.”

The BMA opposes the planned expansion of PA and AA roles, and the granting of prescribing rights following regulation, unless it can be demonstrated that the concerns have been addressed.

This month the BMA called for an immediate pause on all recruitment of Medical Associate Professionals (MAPs) in the UK including PAs and AAs across general practice and PCNs.

Doctors from across the UK who make up the BMA’s UK Council  passed a Motion calling for the moratorium on the grounds of patient safety. They want the pause to last until the government and NHS put guarantees in place to make sure that MAPs are properly regulated and supervised. 

Previously, in late October, the BMA junior doctors committee and GP registrars committee published a statement on MAPs (medical associate professionals), noting that:

“in response to the manufactured workforce shortage of nearly 10,000 doctors, the rapid expansion of medical associate professionals (MAPs)…is detrimental to the provision of high-quality healthcare and represents a long-term risk to patient safety.”

The Royal College of Anaesthetists convened an extraordinary general meeting in mid-October at which over 90% voted to pause the rollout of AAs. 

The GMC has written to NHS England, according to a report in HSJ, asking it to: “Directly tackle the perception that there is a plan for the health services to ‘replace’ doctors with PAs or AAs by convening and leading a system-wide discussion on an agreed vision for these roles.”

The national medical director at NHSE, Steve Powis, said in response to the GMC’s letter that there was no plan to replace doctors in the NHS.


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