Spotlight on professional standards

We’ve engaged widely to create interim professional standards for physician associates (PAs) and anaesthesia associates (AAs).

It started with gaining a strong understanding of the risks to patient safety at one end of the spectrum and the best practice that exists at the other. We began with desk research, then surveyed our community of interest. We followed up with focus groups and explored key themes with individual interviews.

Below, you can read what we learned and what we plan to offer to help bring our guidance to life.

When will the interim guidance be ready?

We’ve now created a draft of the interim guidance which will be reviewed by our Council in the coming months. After that we’ll share it with you. Everyone will have time to familiarise themselves with it before the guidance comes into effect. That will be on the day you join our register.

The guidance is interim because we are currently reviewing of our core guidance for doctors Good medical practice which will include a public consultation. When this concludes in 2023, we will update the standards for all our registrants.

Survey: key findings

In 2020 we contacted our community of interest to ask them about their reflections and experiences of working as, or with, a PA or an AA. We particularly wanted to understand views on:

  • delegation and supervision, 
  • scope of practice,
  • multi-professional team working, and
  • patient awareness of the two professions.

We had 1147 respondents - 225 PAs (19%), 78 AAs (7%) and 708 doctors (62%).

91% respondents agreed that AAs and PAs should adhere to the standards set out in our core guidance for doctors, Good medical practice.

However, there wasn’t consensus among doctors and patients, as well as some PAs and AAs on:

  • Dependence: The concept of ‘dependent practice’ i.e. responsibility for supervision and accountability for actions.
  • Role differentiation and communication: how are PAs and AAs different/similar to doctors? Where do PAs and AAs fit in the team? How can patients understand these roles? 
  • Scope of practice – what can/can’t PAs and AAs do? How does this change over time?
  • Supervision and accountability
  • The overall role of PAs and AAs and their contribution to the team

Focus groups: key findings

We held seven focus groups to follow-up on our survey results. For each of the topics the survey had identified we were able to take away further learning.

Dependence

  • The term isn’t widely used in practice or seen as particularly helpful. It can be misleading for PAs, AAs and doctors alike.
  • PAs and AAs remain practically dependent for prescribing and ordering ionising radiation. But in their other work, they tend to become more autonomous as they demonstrate competence over time to their supervisor.

Role differentiation and communication

  • Although they are supervised professions, PAs and AAs work towards increased autonomy. Over time, they develop the necessary competencies and can perform a wide range of tasks. 
  • PAs are generalists but can gain competencies in specialties they work in, and some get very specialised.
  • Many PAs and AAs have developed tried and tested ways of communicating effectively with patients and colleagues about their roles. However, patients don't always appreciate different roles within the multi-disciplinary team and this is a broader issue that requires addressing across the system.
  • PAs and AAs need to be defined in positive terms, not just by what they can’t do.

Scope of practice

  • PAs are generalists but can gain competencies in specialties they work in, and some get very specialised.

Supervision

  • Needs to be individually tailored to the level of skill and experience.
  • Newly qualified PAs and AAs have differing needs to more established PAs and AAs.
  • Named supervisors can agree an expansion of the scope of practice with the PA/AA over time. Other doctors also play a role day-to-day, but this is not always well defined or understood.

Contribution to the team

  • When introduced and used effectively, PAs and AAs genuinely add value to teams. Examples include effectively managing the ward to free up consultant time for complex cases or training doctors, and training being led by experienced PAs and AAs where appropriate.
  • PAs and AAs provide continuity of care and are a source of local knowledge drawn on by rotational team members.
  • The roles can be flexibly used where needed; this has been especially useful in the pandemic.

Concerns

  • Poor integration in teams can be a problem. Issues can arise from overlapping or poorly defined/communicated roles. Hostility and poor/ non-cooperation from doctors and other members of the team can be a problem too.
  • Lack of understanding by rotational workforce can lead to difficulties with delegation.
  • Tensions can exist around prescribing needs. Some doctors feel they take on extra work and potential risk because PA and AAs currently can’t prescribe.
  • Some trainees feel that their training opportunities are affected by PA/AAs.
  • There can be a tension between being a profession supervised by doctors and being used to train doctors for some procedures.

Guidance and resources for you

Good medical practice guidance for PAs and AAs

An interim version of our guidance will take PAs and AAs up to the publication of the revised Good medical practice for all registrants in 2023. The interim guidance will closely mirror the existing version for doctors. Alongside it, we’ll develop a range of resources to help you apply the principles in practice.

Good practice case studies

We’ll share examples of where PAs and AAs are well-integrated into the workplace and multi-disciplinary team. These will also include where initial challenges were identified and later overcome.

PA/AA standards hub with signposting

A dedicated area on our website will highlight other relevant standards and guidance in addition to Good medical practice. For example, Duty of candour, Leadership and management for all doctors and Delegation and referral.

Advice for doctors who supervise or work alongside medical associate professions (MAPs)

This will be drawn from our existing standards, for example on supervision and teamwork. We'll also provide case studies highlighting good practice, including practical peer-to-peer advice.

Equality, diversity & inclusion

Throughout this process we’ve engaged with a diverse range of PAs, AAs and doctors from within our community of interest. We've also spoken to our external advisory group, which includes representatives from all four nations of the UK. And we've heard from patients about receiving care from PAs and AAs.