One in five PCNs have reduced their use of PAs

More than one in five PCNs have reduced the number of physician associates (PAs) they employ over the past year, a survey has found.

The Pulse, Pulse PCN and Management in Practice survey polled GPs and practice managers, with 21% of respondents from 425 distinct PCNs reporting a reduction in PA numbers in the last 12 months.

Of those, many cited the restrictions on what work PAs can undertake independently as having limited their use in general practice, while others stated that these restrictions mean PAs need too much supervision that practices don’t have the resources to provide.

In March 2024, the BMA laid out a national scope of practice for physician associates and anaesthesia associates in what it hailed as ‘first of its kind’ guidance. It stated that GPs ‘should first triage’ all patients before deciding which cases a PA can see, and that associates should never see ‘undifferentiated’ patients.

Last autumn, the RCGP followed suit and published its own guidance that significantly limits the scope of practice of PAs already working in general practice. The move came after the College voted overwhelmingly in favour (61%) of completely opposing the role of PAs in the setting.

Responding to the survey, one GP said: ‘We had a PA but now don’t use them because of the change in guidance. We can’t afford to pay someone with such limited scope.’

A practice manager said: ‘BMA constraints meant [our PA] could do very little. It is such a shame as they had a biomedical sciences degree and could even help with some HCA and nursing elements. We had to let them go.’

Another also said they’d been forced to make their physician associate redundant ‘primarily due to the additional time needed to support the role, as the BMA made it impossible for them to work independently’.  

They described the limitations placed on PAs as ‘a missed opportunity, which could have been avoided’.

One GP accused the government and NHS of being ‘totally irresponsible’ over the handling of the PA role, which he said were ‘pushed onto us’ due to a lack of GPs yet are now prevented from doing the job they were employed to do.

He said: ‘They [the NHS] have dumped this problem on GPs to face legal action and the costs associated with it. We are in a no-win situation.

‘As for the PAs, they have been encouraged to take on debt for second degrees with the promise of a well-paid clinical role. They are now being told their employers can’t employ them for the role they were trained in. This leaves them potentially with no job, or a job with less pay, but they still have huge debt.

‘The Government and NHS have let these clinicians down in a big way. On top of that, they have left the problem at the feet of GPs with no clear resolution.’

Dr Stephen Taylor, the GP spokesperson for Doctors Association UK, echoed this sentiment, saying that PAs are entitled to feel aggrieved because ‘they have been given false information about their careers’.

‘It is really the fault of policy leads at NHS England for failing to understand the risks and the complexity of seeing undifferentiated patients. A simple consultation is really only simple in retrospect having taken a full history, appropriate examination and tests.’

He added: ‘The challenge for practices is that with better guidelines for the supervision of PAs, many practices have seen that the role of PAs is unsustainable. 

‘NHS England stipulated PAs see undifferentiated patients with limited supervision in ARRS. This was never safe for PAs or patients. So, the new guidelines will have made many if not all PA roles difficult to maintain.’

Last month, Professor Gillian Leng’s independent review into the safety and efficacy of physician associates was published.

The DHSC accepted all of Professor Leng’s recommendations, which include that the role should not be scrapped but instead renamed as physician assistant, that PAs undergo more extensive training and their focus shifted to preventative care, such as NHS Health Checks and lifestyle support.

Professor Kamila Hawthorne, chair of the RCGP, said: ‘The College’s position, following consultation with members and discussion at our governing Council, is to oppose a role for PAs in general practice. This is due to valid concerns about patient safety and the suitability of the role in a general practice setting.

‘Recognising that there are already PAs working in general practice settings, we have developed guidance on induction, supervision and scope of practice for practices already employing PAs. Our position and our guidance are advisory, and decisions regarding PAs rest with GPs as employers.’

Other respondents to the survey said they’d seen fewer PAs employed or their PCN had let some go because there had been concerns or complaints about their competence.

‘We had a PA one day a week and participated in the training of PAs for one year,’ said one GP. ‘They were not confident (understandably) and did not have sufficient depth of clinical knowledge.  

‘PAs do not alleviate GP burden if I still have to check their history, examination findings and prescribe for them. They are increasing my workload.’

Some 79% of GPs and practice managers who answered the poll said their PCN had not reduced the numbers of PAs in the last year. More than a quarter (28%) of those said in comments that they had never employed physician associates in the first place.

Speaking to Pulse PCN on the results of the survey, one clinical director who wished to remain anonymous, said: ‘We haven’t reduced our use but did put a recruitment freeze on PAs.

‘The uncertainty around regulation and guidance, the serious untoward incidents reported nationally, and the lack of a clear scope of practice have influenced many PCNs to reduce usage.’

They added: ‘We felt the PA workforce are an important part of the primary care multidisciplinary team contributing to better patient access and with our supervision and competency framework, we were doing as much as we could to ensure they were practicing safely in the absence of formal national guidance. With the Leng review, we are developing an assurance plan to ensure compliance.’

Also speaking on the survey results, clinical director at SMASH PCN in Cheshire, Dr Neil Paul, said his PCN had ‘historically been quite sceptical about PAs’.

However, he added that he’s had several PAs apply for administrative jobs.  

‘Recently, we actually took on a PA to work in my clinical trials team, and to some extent, this has been quite revelatory,’ he said.

‘I'm massively impressed with her knowledge, skills, attitude, and enthusiasm. Certainly, with regards to clinical research, it's been a breath of fresh air because it's been really difficult to find research nurses. This might be a potential avenue for PAs because, as you probably know, the NIHR and NHS are very keen for more clinical trials to be done in primary care.’

He added that he was ‘fairly convinced’ that there is a role for PAs in primary care, one assisting particularly in the management of chronic conditions and helping to maintain continuity.

Following the Leng review, PCN leaders said the role ‘remains viable’, however there needs to be some development around their responsibilities.

Stephen Nash, general secretary of PA union United Medical Associate Professionals (UMAPs), said: ‘This survey shows precisely why the BMA’s guidance and Leng Review recommendations are so disastrous.

‘GP surgeries are now losing highly motivated and experienced medical professionals because we are being prevented from carrying out the jobs we are trained to do. This is wreaking havoc on NHS backlogs and patients’ access to care.’

He added: ‘Despite pressure from the BMA and NHS England, according to this survey the vast majority of PCNs are retaining their PA staff. This is a testament to PAs’ hard work and expertise.’

It comes as UMAPs’ legal bid to stop NHS England from implementing Leng review recommendations was unsuccessful last week.

The latest quarterly statistics for physician associates employed in PCNs across England show that they were down by 63 between March and June 2025.

PCNs and practices were recently warned of the legal risks in making changes to the PA role following NHS England guidance after the publication of the Leng review.