Working with PAs and AAs

Supervision of PAs and AAs

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 for all doctors
• 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, the professional standards that will apply to PAs and AAs once regulation starts say:

• 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]

Prescribing and ordering ionising radiation

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

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

Ionising radiation is covered by different legislation to prescribing. Registered healthcare professionals can request ionising radiation as ‘non-medical referrers’ (NMRs) providing their employer has authorised them to be 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.

Using prescribing responsibilities obtained in another regulated role while working as a PA or AA

The Department of Health and Social Care has confirmed that once PAs and AAs are regulated roles, individuals working in these capacities cannot lawfully prescribe using prescribing rights from another regulated role.

Prescribing rights are specific to the regulated profession in which they were granted and aren’t transferable. For example, if you gained prescribing rights as a nurse or doctor, you cannot use them while working as a PA or AA.

From 13 December 2024, healthcare professionals working in designated PA or AA roles should not prescribe medicines, even if they hold prescribing rights from a previous profession or have previously been authorised to prescribe by their employer.

Training opportunities 

We’ve heard concerns that local choices about deployment of PAs and AAs have reduced access to learning opportunities for some doctors. But we’ve also heard that PAs and AAs have freed up time for others to learn.

We work with others across the health system to make sure that doctors get the education and training they need to deliver good, safe patient care. Our approval of postgraduate training for doctors is on the basis that training organisations can deliver the opportunities for trainees to achieve their curricular requirements and meet our standards.

We’ve publicly called on system leaders across the four countries of the UK to collectively address pressures on doctor training capacity, supervisors and trainees as part of their work to implement long term workforce plans across the four countries of the UK. We’ve urged them to: 

• grow training opportunities and capacity across the system
• increase the trainer workforce
• protect time for training
• ensure employers are providing training opportunities 

Professional behaviours and teamworking

The professional standards for doctors and, in future, PAs and AA have a strong focus on behaviours and values which create respectful, fair and supportive workplaces. These types of environments have a positive impact on both wellbeing and development and patient care. Good medical practice says:

• You must treat colleagues with kindness, courtesy and respect. [para. 48]
• You must help to create a culture that is respectful, fair, supportive, and compassionate by role modelling behaviours consistent with these values. [para. 52]
• You should be aware of how your behaviour may influence others within and outside the team. [para. 53]

Terms and conditions and deployment

As a regulator, we don’t have a role in: 

• setting terms and conditions of doctors, PAs and AAs - the UK’s health services and employers are responsible for setting pay scales for PAs and AAs, which vary and are dependent on the skills and experience of individuals.
• recruitment of doctors, PAs and AAs - employers are responsible for all recruitment matters, including how roles are advertised and how job titles are decided.
• deployment of doctors, PAs and AAs- the health services and employers are responsible for deployment across the four countries of the UK. 
• determining the number of doctor, PA and AA training places or the funding of doctor, PA or AA courses or student finance - the four governments of the UK and health services are responsible for all these matters.