RCP responds to NHS England recognition that PAs need 'support and clarity’ about their role and remit

The RCP is calling on NHSE to slow down the expansion of PA roles, review its projections for growth in the PA workforce as part of its planned revision of the LTWP in 2025 and lead the development of a national scope of practice for PAs, with input from royal colleges and specialist societies. At an extraordinary general meeting in March 2024, RCP fellows voted overwhelmingly for a ‘limit to the pace and scale of the roll-out [of PAs] until the medicolegal issues of regulation, standards and scope of practice are addressed’. 

Earlier this week, the BBC reported that the secretary of state for health and social care, Wes Streeting would be ‘putting the brakes on expansion while their role was reviewed.’ The secretary of state told the BBC that he was ‘taking concerns seriously’ and would be saying more ‘in the coming weeks.’ This follows a letter from the Academy of Medical Royal Colleges to the secretary of state for health and social care and the NHSE chief executive in September 2024, calling for a rapid review of the role of MAPs.

The RCP has been campaigning for a review of the role of PAs for the past 6 months. In May 2024, our short life working group on the role of PAs called for the development and publication of an evidence base, economic analysis, and evaluation framework around the introduction of PAs, including the impact on patient safety and doctors in training.

Yesterday (14 November), Sir Stephen Powis, national medical director of NHSE told the BBC that regulation of PAs would ‘give an added layer of supervision and an added layer of protection for the public.’ Regulation, he said, would ‘provide support and clarity’ for PAs ‘so that they are clear about what their role and remit is’.

Responding to the news, Dr Mumtaz Patel, acting as RCP president said:

‘In March 2024, the RCP held an extraordinary general meeting (EGM) to debate the role of PAs where fellows voted to limit the pace and scale of the rollout of the PA workforce. This position has been echoed by other royal colleges, including RCEM, RCGP and RCPCH ⁽¹⁾ and in the past year, the number of PA posts advertised in the NHS has dropped by 87% ⁽²⁾.

‘Earlier this year, RCP fellows voted overwhelmingly in favour of a slowdown in the expansion of the PA role. NHSE must now acknowledge that the landscape is changing and provide the necessary support to all those who have been affected.

‘We are calling on NHSE to review the number of projected numbers for PAs in the LTWP. The RCP campaigned long and hard for a dedicated long-term workforce plan that included an increase in medical school places and postgraduate specialty training posts, and we will continue to advocate for greater royal college involvement in workforce planning.

‘We have urged NHSE to prioritise more comprehensive and transparent modelling of postgraduate medical specialty places in the 2025 refresh of the LTWP – it is time to train more doctors who have the skills to diagnose complex illness, provide critical clinical expertise, bring down waiting lists and teach the next generation of physicians.’

Dr Hilary Williams, chair of the RCP oversight group for activity related to PAs said:

‘We need a full review of the role of MAPs. The RCP is supportive of MDT working, but this must be supported by full regulation and rigorous assessment of competencies, agreed at a national level.

‘The development of a PA scope of practice should led by the centre. This will help to reduce variation and protect patient safety.

‘We welcome the secretary of state’s suggestion that he is considering a review of projected numbers of PAs in the LTWP. The 2025 revision of the LTWP is a vital opportunity to review these projections given the growing concerns of the medical community. Many of our fellows and members have significant concerns about the safe deployment of PAs which is why we also believe that a national scope of practice and career development framework for PAs is now required.’

Draft guidance on safe and effective practice

In August 2024, the RCP consulted with external stakeholders on draft guidance for the safe and effective practice of PAs. Today, the college has published an externally commissioned, independent thematic analysis of the consultation responses, alongside the terms of reference for a new sub-group, tasked with redrafting the guidance based on feedback from fellows, members and external stakeholders.

The updated guidance will not set out a clinical scope (or ceiling) of practice – the RCP believes that this work should be steered and funded centrally by NHSE and other national bodies, including the General Medical Council (GMC), with input from royal colleges and specialist societies.

Dr Ben Chadwick, chair of the RCP PA guidance writing group said:

‘The RCP will publish an updated version of our draft guidance on safe and effective practice for PAs that makes it clear resident doctors should not be involved in supervising PAs. Scope of practice for PAs should be determined nationally to reduce variation and enhance patient safety.’

Regulation 28 report to prevent future deaths 

The Chief Coroner’s office has also published responses to the Regulation 28 report to prevent future deaths following the death of Mrs Susan Pollitt. The Faculty of Physician Associates submitted a response at the specific request of the coroner and the RCP provided a supplementary response to provide additional context and clarify the college position on the role and scope of PAs. The GMC also submitted a response.

Responding to this Regulation 28 report, Dr Patel said: 

‘Our thoughts and sincere condolences are with Susan Pollitt’s family. The RCP recognises that considerable work is required to enhance the safety of the deployment of PAs as part of multidisciplinary teams. This will require national leadership and open, transparent and constructive collaboration between the NHS, patient groups, royal colleges, professional bodies and the GMC.’