Supervision of physician associates and anaesthesia associates

Working with PAs and AAs

Physician associates (PAs) and anaesthesia associates (AAs) are members of the healthcare team. Not all doctors who work with PAs and AAs will have the responsibility of supervising them. But, even if you do not have this responsibility, it is important to know about their professional role and to respect their contribution in the healthcare team. 

In this section we will give advice on

• Understanding and working with PAs
• Understanding and working with AAs
• What PAs and AAs cannot do

Understanding and working with PAs

PA’s education and the standards they have to meet 

PAs usually start out as health professionals or with biomedical science or life science degrees. They undertake a two-year post-graduate healthcare qualification and before they register and begin work, they have to pass the physician associate two-part exam.  From September 2025, PAs will take the Physician Associates Registration Assessment (PARA) in line with the GMC’s physician associate assessment content map. 

We set the standards for the delivery of PA pre-qualification education that we expect organisations that deliver this training to meet. This includes standards on developing and implementing curricula and assessments. We also set out the generic and shared professional capabilities and outcomes that newly qualified PAs have to meet to be registered by us.

Qualified PAs

Once qualified, PAs can work in a range of different areas in primary and secondary care, and in the community. They often work in one area of care for an extended period of time allowing them to build up increased skill or expertise in certain procedures or areas of care.  

Their named supervisor, who will usually be a senior doctor who is a consultant, GP or autonomously practising SAS doctor, will have a clear understanding of their competence, skills and experience. If the named supervisor is not working directly with the PA themselves, they will work with the PA to communicate this to the doctor who is responsible for overseeing the care of patients. This will enable that doctor to make sure all members of the team are working together to provide the best care for the patient.

If you are unsure or concerned about what a PA is doing, then you can ask them. They are expected to work in line with the principles, values, and standards of professional behaviour set out in Good medical practice and the more detailed guidance. This means they ought to have a good understanding of what level of supervision is required for them to deliver care.

They also have a duty to prioritise patient safety and seek help, if they do not have the level of competence, training or approval to carry out a task or procedure safely, even if they’ve already agreed to carry out a task.  

Some PAs run induction sessions about their role. You may find this helpful in understanding what they do and how they fit in with the rest of the team.

NHS Employers outline a number of the day-to-day tasks PAs may be trained to perform. This is not an exhaustive list and may differ depending on the employer and contract.

Duties may include:

• taking medical histories from patients
• performing physical examinations
• diagnosing illnesses
• seeing patients with long-term chronic conditions
• performing diagnostic and therapeutic procedures
• analysing test results
• developing management plans
• providing health promotion and disease prevention advice for patients.

Health Education and Improvement Wales (HEIW) have created a number of case studies about PAs working in various different clinical settings, including an acute medical unit and colorectal surgery.  

Understanding and working with AAs

AA’s education 

AAs are professionals who work within the anaesthetic team. They have at least three years clinical experience (for example, as a nurse or an operating department practitioner) or a biomedical/biological science degree. They have also completed a two-year post-graduate degree programme. 

We set the standards for the delivery of AA pre-qualification education that we expect organisations that deliver training to AAs to meet. This includes standards on developing and implementing curricula and assessments. We also set out the generic and shared professional capabilities and outcomes that newly qualified AAs have to meet to be registered by us. AAs who qualify after September 2025 will need to pass the anaesthesia associates registration assessment (AARA) before they can apply for registration with us. 

Working with AAs 

You may find that if you are working with an AA, they have been in the role for some time and may have developed additional competencies beyond their outcomes specified in the curriculum for qualification. At all times they will have a named supervisor who will usually be a consultant anaesthetist or other autonomously practising SAS anaesthetist.

The named supervisor will determine the range of activities an AA can do and with what level of supervision. This may be modelled on the supervisory approach set out by the Royal College of Anaesthetists in 3.10 of their Anaesthesia Associate Interim Scope of Practice 2024. 

If you are unsure or concerned about what an AA is doing, then you can ask them. They will know how they are being supervised and what level of supervision has been agreed for each aspect of their practice.  

They also have the same professional standards as you. This means they have a duty to prioritise patient safety and seek help if they do not have the level of competence, training or approval to carry out a task or procedure safely, even if they’ve already agreed to  do it.

Some AAs run induction sessions about their role. You may find this helpful in understanding what they do and how they fit in with the rest of the team. 

What PAs and AAs can't do

PAs and AAs can't work completely independently of supervision. For example, they can't work as a sole practitioner or in settings where doctors are not present. 

They can't perform activities that are legally restricted to other professions. This includes a range of activities such as signing death certificates.

Two specific areas are worth noting

Ionising radiation

It is for each employer to determine whether an individual PA or AA may be trained and approved as a non-medical referrer for ionising radiation. 

Prescribing and proposing prescriptions

PAs and AAs can't prescribe, even if they hold prescribing rights from a previous profession and have previously been authorised to prescribe in that role by their employer. However, PAs and AAs can propose treatments and devices if they have adequate knowledge of the patient’s health, and they are satisfied that the medicines serve the patient’s needs. 

If a PA or AA is proposing prescription of a medicine, they have to be satisfied they have sufficient information, experience and knowledge of the patient and the medicine, treatment or device. It is also in line with the professional standards for them to answer your questions and otherwise assist you in caring for the patient, as required.

If you are prescribing based on the proposal or recommendation of a PA or AA, it is essential that you are satisfied that:

• the prescription is needed
• the prescription is appropriate for the patient
• the prescription is within the limits of your competence 
• you have enough information to safely proceed.

This is because you are responsible for the steps you take to ensure that the prescription is appropriate, necessary and safe. 

If you do not believe the conditions are met to issue the prescription, then it would be in line with the professional standards to raise this with the doctor who is in charge of the patient’s care.  

Named supervisors

The named supervisor role will often be agreed with your employing organisation. This role will usually be taken by a consultant, GP or autonomously practising SAS doctor. There will be specific expectations around the supervision of PAs and AAs. For example, you may be expected to maintain an overview of their work, and a focus on their professional development. 

In this section, we give advice on:

• Employer’s responsibilities  
• Becoming a named supervisor

Employer’s responsibilities

In the guidance on effective clinical governance we say: 

“…organisations that employ PAs and AAs should make sure their [clinical] governance arrangements take account of the fact that these professionals are trained and registered on the basis that they will always work under supervision. We recommend that organisations identify an individual at Board level [or equivalent for those organisations that do not have a board structure] who is responsible for PAs and AAs, and that local processes are established governing how these professionals are deployed and supervised. The aim of such processes should be to ensure high quality, safe care, and to support effective multidisciplinary working.”

The Care Quality Commission (CQC) sets out that the GP practice directing and controlling a regulated activity is responsible for compliance with regulation and legislation. This means that even if a practice is not responsible for someone’s direct employment, it may be responsible for making sure it has oversight of that person’s support, supervision, guidance, advice and information. 

The Supervision guidance for primary care network multidisciplinary teams from NHSE, sets out the principles of supervision for roles new to general practice. The aim of this is to support primary care networks and GP practices to provide effective supervision for their growing multidisciplinary teams. It identifies best practice to support the development of good clinical governance and provides guidance on training and developing the workforce.

The statutory guidance on the Health and Care (Staffing) (Scotland) Act 2019, was published on the 1 April 2024. It explains that one of the three areas which must be included in the wider professional responsibilities of clinical leaders, is time to manage and support the development of staff for whom they are responsible. The guidance provides more detail about what that means in practice.

Becoming a named supervisor

If you have volunteered or have been asked to be a named supervisor to PAs or AAs, it is important that you are supported to carry out your role. We would advise speaking to your employer to establish:

• the scope of your role  
• the time you have to carry out your supervisory responsibilities 
• any areas of supervision where you may need additional training.    

The role of the named supervisor

The role of a named supervisor is likely to develop over time. In this time, you will develop a relationship with those you supervise to understand their developmental needs and the appropriate levels of supervision depending on the nature of the task or care.

You may find it helpful to include activities such as, continual professional development and annual appraisals into the personal and career development plans for PA and AAs. You may also want to support individuals’ wellbeing and development through regular review meetings and overseeing arrangements for progression in line with employer clinical governance policy.

No matter the approach you take to supervision, it is important that every PA and AA has a managed support system with clear escalation protocols. This includes addressing any problems you identify where you can, or raising these with your employer if you need to. This is especially important if you identify problems arising from poor communication or unclear responsibilities within or between teams.

Day-to-day supervision

Part of the role of doctors who are responsible for the overall day-to-day care of patients, includes making sure that the healthcare team they are overseeing or working with can work effectively together. It also includes consideration of any reasonable adjustments in line with the Equality Act 2010.

Health professionals that work in the team, including physician associates (PAs) and anaesthesia associates (AAs), have to have the appropriate level of supervision in line with their competence, skills, knowledge and experience.  

In this section, we will give advice on:

• Doctors who are responsible for the day-to-day care of patients
• How to establish the level of supervision required
• Considerations when supervising care
• The competence to supervise

Doctors who are responsible for the day-to-day care of patients

In many circumstances, the doctor who is responsible for the day-to-day care of the patient will also be the PA’s or AA’s named supervisor.  This means they will have a good knowledge of the PA’s or AA’s competence, will have agreed the range of tasks and care they can carry out and the level of supervision required.  

However, if you are overseeing the clinical work of a PA or AA and you are not the named supervisor, you still need to be aware of the range of tasks and the extent of their competence and make sure they have the appropriate level of supervision. 

How to establish the level of supervision required 

You may be seeking to establish what care PAs and AAs can undertake. The knowledge and skills expected at qualification or PAs and AAs are set out in the pre-qualification education framework. They will also have a job description which will outline what they are able to do and what knowledge, skills and experience is required for the post they undertake. 

However, more experienced PAs and AAs may have extended their safe scope of practice beyond this level, shaped by their supervised training and experience, and the clinical context of their work. 

Some royal colleges and PA and AA professional bodies have published interim guidance on post-qualification scope of practice. Though there is no set consensus, you may find them helpful as a starting point. The Leng Review is also likely to make recommendations in this area later in 2025. 

We would therefore recommend you do the following. 

• Familiarise yourself with any employer workplace policies or protocols that set out what PAs and AAs can do.   
• Ask the PA or AA about their skills, knowledge, and experience to get an understanding of their areas of competence. 
• Ask  their named supervisor about the skills, knowledge, and experience of the PA or AA. 
• Remember that PAs and AAs have the same professional standards as you do. They have to have the necessary knowledge, skills or training to carry out tasks or procedures safely. They also have to prioritise patient safety and seek help, even if they’ve already agreed to carry out a task independently. 

Considerations when supervising care 

Supervising care given by a PA or AA will involve overseeing tasks and responsibilities that they undertake in line with their skills, knowledge, and training.  Alternatively, it may involve asking them to take responsibility for providing part of the care or treatment on your behalf.

In doing this, it is important that you are: 

• confident they have the necessary skills, knowledge and training to carry out the task;
• able to give clear instructions about what is expected;
• available to answer questions or provide help when needed;
• sure they are clear on how to escalate any concerns.

It is vital you encourage PAs and AAs who you are supervising to seek clarification or ask questions. This is especially important if they express uncertainty or a lack of confidence. This will make sure they feel safe to communicate concerns and are supported in resolving any issues.

It is also your responsibility to foster an open and safe environment for PAs, AAs and others in the healthcare team. This means it is important to listen, communicate clearly, recognise their contribution and be willing to lead or follow as the circumstances require.

The competence to supervise 

If you do not have the skills, knowledge, or experience to supervise members of your team and you are not able to get the training that is needed to be able to do this, it would be in line with the more detailed guidance on Raising and acting on concerns about patient safety to raise this with the appropriate person.

Questions and Answers

Do I need indemnity/insurance to supervise physician associates (PAs) and anaesthesia associates (AAs)? 

In line with the professional standards, you have to have the appropriate indemnity/insurance to cover the full scope of your practice. 

You can get advice from your Medical defence organisation and the BMA has information and advice about NHS medical indemnity systems in the UK.  We have also produced a guide on insurance, indemnity and medico-legal support. 

Can I refuse to supervise a PA or AA?

It will be up to your contractual arrangements as to whether you can or have to be a named supervisor for a PA or AA.

However, if you are the doctor in charge of a patient’s care, then we expect you to make sure that all the people who work in your team have appropriate supervision. We would also expect you to support any colleagues you have responsibilities for, to develop their roles and responsibilities, by agreeing appropriate levels of supervision based on the tasks or care they are providing. 

How can supervisors make sure there is fair access to training for all professions?

In Good medical practice, we say that if part of your role is helping staff access training, development and employment opportunities, you should do this fairly.

For this reason it may be useful to plan, as far as is possible, for resident doctors to have access to the training they need. And for PAs and AAs to be able to grow and maintain their skills. 

It is important to take account that organisations must make sure that work undertaken by doctors in training (resident doctors) provides learning opportunities and feedback on performance, and gives an appropriate breadth of clinical experience. (Promoting Excellence: Standard for medical education and training, R1.15)

Am I accountable for the actions of PAs and AAs?

You are accountable for the actions, steps, and decisions that you take. If you are the responsible consultant or clinician, you are also accountable for the overall management of a patient.

PAs and AAs are accountable for the actions, steps and decisions they take to prioritise patient safety. They are under professional obligations to recognise and work within the limits of their competence and to seek help if they are not confident they have the knowledge, skills, or training to carry out a task safely. Even if they have already agreed to carry out the task independently.