Associate Professionals have a significant impact on Emergency Departments, but there is a lack of evidence on their performance within NHS
The following blog post is written by Nicole King, an Physician Associate (PA) working in an Emergency Department.
Nicole has a dual role with NHS England as a PA Ambassador and also a professional doctoral student for the past 6 years at the University of Portsmouth focusing on the Impact and Perception of the PA role in UK Emergency Departments.
Who are Physician Associates?
PAs are healthcare professionals, trained to the medical model. They have been present in the UK since 2003 (although have been present in the US for over 60 years).
PAs work alongside doctors providing medical care as an integral part of the multi-disciplinary team. PAs can work autonomously but are dependent practitioners who are supervised directly or indirectly by a senior doctor (consultant, registrar level 4 or above or GP).
Why were PAs introduced into the NHS?
The NHS is experiencing increasing patient demands due to a growing ageing population and a lack of capacity to meet the demands due to medical staffing shortages. PAs were introduced not to replace, but to instead supplement by increasing the capacity of the medical team to deliver care to patients. Currently, there are over 4,000 qualified PAs with a set annual rise of 1,300 PAs per annum as part of the NHS Longer Term plan’s aim to reach 10,000 quailed PAs by 2036/7. There are also plans to expand the doctors’ workforce by 60,000 within this time.
What training do PAs have?
PAs usually undergo a three-year undergraduate degree in health, biomedical science, or life sciences, followed by a two-year master's level intensive PA training program. To become qualified, they need to complete 1,600 clinical hours and pass a National Examination.
PAs are generally trained to perform clinical duties such as taking medical histories, conducting physical examinations, developing, and delivering treatment and management plans across various specialties. Being permanent non-rotating staff members, PAs provide continuity of care to patients.
Who governs PAs?
Currently, PAs are regulated by a voluntary body and registered on the PAMVR, which is managed by the Faculty of Physician Associates (FPA) at the Royal College of Physicians (RCP).
In 2018, the General Medical Council (GMC) made the important decision to statutorily regulate PAs and Anaesthesia Associates (AAs). By the end of 2024, the registration process is expected to be complete. The GMC's main objective is to ensure that PAs and AAs maintain their competence and stay up to date in their practice. Through the regulation of these healthcare professionals, the GMC will have greater oversight of their education, training, and standards. This coordinated effort will undoubtedly make it easier for patients, the public, and employers to understand the roles of medical associate professionals and how they relate to doctors, thus improving the overall integration of these professionals into the medical workforce.
Can PAs prescribe medication?
Currently, PAs are not legally authorised to prescribe medication or order investigations involving ionisation radiation such as X-rays or CT scans because there is no statutory regulation in place. The UK government is currently engaged in a collaborative effort with various professionals and professional bodies to put forth a compelling case for extending prescribing responsibilities to PAs under GMC regulation. Subsequently, the proposal will undergo a rigorous process that involves the Human Medicines Act and ministerial approval before being enacted into legislation.
What evidence has your research found about the Impact of the PA role in the ED?
I conducted a systematic scoping review to understand the contribution of Physician Assistants (PA) in the Emergency Department (ED). I found 31 studies covering nine themes, including perceptions of the PA role, wait times, acuity of patients seen, length of stay (LOS), patients leaving without being seen (LWBS), clinical outcomes, pre-admission rates, well-being, and scope of practice. Both doctors and patients generally hold a favourable view of PAs in the emergency department. However, the inability of PAs to prescribe was identified as a hindrance.
The studies that were included indicate that when PAs attend to patients with moderate-to-low acuity, it leads to a reduction in waiting times, LOS, readmission rates, and cases of patients who LWBS. The review's findings support the potential positive impact that PAs can have on the NHS, particularly in improving emergency medicine throughput metrics. However, further research is required to gain a better understanding of the impact and perception of the PA role in emergency departments across the UK.
Following this I wrote up my study looking at the impact of the ED PA in a UK ED compared with Foundation Year one doctors in training (FY1s) using retrospective chart reviews. The study, published in BMJ Open, showed no significant difference in wait times, unplanned re-attendances within 72 hours or number of patients LWBS when patients were seen by a PA compared with those seen by a FY1. The LOS however of patients seen by PAs was significantly longer in comparison to those seen by FY1s.