PAs and AAs in practice

Clinical governance

Effective clinical governance systems are vital to ensure that PAs and AAs are properly and safely deployed. Organisations that employ PAs and AAs should make sure their governance arrangements take into account that these professionals are trained and will be registered on the basis that they will always work under supervision.

We recommend that organisations identify an individual at board level who is responsible for PAs and AAs and that local processes are established governing how these professionals are deployed and supervised.

The aim of these processes should be to ensure high quality, safe care, and to support effective multi-disciplinary working.

Understand more by reading our effective clinical governance for support revalidation guidance. 

Scope

To ensure safe patient care, physician associates (PAs) and anaesthesia associates (AAs) are required to always work within their competence. Good medical practice, the professional standards that apply to PAs and AAs states: ‘You must be competent in all aspects of your work including, where applicable, formal leadership or management roles, research and teaching’. [para. 1], and ‘You must recognise and work within the limits of your competence’. [para. 2]

The tasks that individual professionals can safely carry out depend on their skills and competence, which develop over time. You will sometimes hear this referred to as a professional’s scope of practice. Professional healthcare regulators don’t usually determine this for their registrants. We don’t do this for doctors, and we don’t for PAs and AAs.

Supervision

Our clinical governance handbook sets out our expectation that organisations who employ PAs and AAs should make appropriate arrangements for their deployment and supervision.

As with other professionals that doctors supervise and work alongside in multi-disciplinary teams, doctors are not accountable to us for the decisions and actions of PAs and AAs, provided they have delegated responsibility in line with the standards and guidance in:

• Good medical practice
• Leadership and management
• Delegation and referral

Many doctors already supervise colleagues or lead multi-disciplinary teams that include PAs and AAs. When it comes to good supervision, there isn’t a one-size fits all approach. PAs, AAs and their named supervisors should agree a level of supervision appropriate to each individual’s skill level, experience, role and the nature of the task.

Working within competence

Like doctors, PAs and AAs will be required to work within their competence once they register with us to ensure safe patient care.

Good medical practice, is the professional standards that apply to PAs and AAs registered with us and says:

• You must be competent in all aspects of your work including, where applicable, formal leadership or management roles, research and teaching. [para. 1]
• You must recognise and work within the limits of your competence. [para. 2] 

Introductions

Just like doctors, PAs and AAs have a responsibility to clearly communicate who they are, and their role in the team. Good medical practice, the professional standards that PAs and AAs must follow, says ‘You must always be honest about your experience, qualifications, and current role. You should introduce yourself to patients and explain your role in their care.’ [para. 82]. 

Prescribing and ionising radiation

PAs and AAs can’t legally prescribe or order ionising radiation, but they may propose or recommend medications for an authorised prescriber to review and approve.

Any decision on whether to extend prescribing responsibilities to PAs and AAs in future is for the UK government, and not the regulator. It would require separate legislation.

Ionising radiation is covered by different legislation to prescribing. Registered healthcare professionals can request ionising radiation for patients as ‘non-medical referrers’ (NMRs) providing their employer has entitled them as an NMR and they have undergone the appropriate training.

The position statement from the British Institute of Radiology provides further detail on the training and governance requirements for NMRs and the different types of NMR entitlement. PAs and AAs may be able to become NMR’s once they are registered with us.

Indemnity and insurance

PAs and AAs require appropriate indemnity and insurance cover for the work they undertake in the same way doctors do. 

We ask PAs and AAs to sign a declaration that they have an indemnity arrangement, insurance policy, or combination which provides adequate cover for all areas of their practice when they apply for registration. PAs and AAs may need to seek their employer’s advice about the level of cover they need.