Physician Associates in Paediatrics

A multi-professional workforce is pivotal to achieving improved child health outcomes, and multidisciplinary teams are vital in bringing together professionals with diverse talent, knowledge and experience. Physician Associates, also known as PAs, are comparatively new in paediatrics and are not that frequently utilised within the multidisciplinary child health team as in other specialties.

The RCPCH Workforce and Careers team is working over the coming year to understand the current role of PAs in paediatrics, how this is working in practice in services, and gather the experiences of our members.
Last modified
3 April 2024

You can read more on the Faculty of Physician Associates (FPA) website (part of the Royal College of Physicians).

Our position

  • We firmly believe in the value of multidisciplinary teams (MDT) across child health services. Having a well-supported and skilled MDT is beneficial for children and young people and supports the robustness of the paediatric workforce. Clarity about the different roles within the MDT is important – both for the team members and our patients.
  • While we have had many years of effective joint working between paediatricians and other professional groups, PA roles are comparatively new in paediatrics and are not as widely utilised within child health teams as in other specialties.
  • We hear the concerns of some of our members and the wider medical workforce on how PA roles are being implemented in parts of the NHS. We also acknowledge trainee concerns about their own training opportunities and the need for clear definition of PA roles and training pathway. Deaneries must abide by the RCPCH Trainee Charter in ensuring training opportunities and experiences for paediatric trainees are protected.
  • PAs must not replace paediatricians in the delivery of care to children and young people. On 7 February 2024, NHS England wrote to the Royal College of Physicians to confirm its view that PAs cannot and must not replace doctors.
  • More needs to be considered around what the appropriate role of PAs is in paediatrics. If utilised appropriately, PAs could add to the wider MDT with responsibilities and skills that collaboratively help to enhance patient care. A clear national capability framework from the NHS would provide an assured level of competence to help define scope of practice.
  • As a College, we will continue our planned work over the next 12 months to understand the appropriate role of PAs in paediatrics and how this is working in practice, and gather views and experiences of our members, health services and children and young people. We welcome the views of our members on this.
  • We will also continue to advocate for the needs of paediatricians, the wider child health workforce, and for children and young people, on the NHSE Long Term Workforce Plan (LTWP) and beyond.

Member consultation

The RCPCH is undertaking a programme of work to understand the appropriate role of PAs in paediatrics and how this is working in practice, and to gather views and experiences of our members. Alongside this, we continue to advocate for the needs of paediatricians and the wider child health workforce, and for children and young people. In a formal response to the NHSE LTWP, the RCPCH has called on stakeholders to begin a programme of work to appropriately reflect the needs of 25% of the UK population across the whole child health service.

The results of a short College survey in October 2023 highlight that there is a variation in the experiences of our members and more needs to be understood about the current role of PAs across paediatrics settings.

The planned programme of work will look in more detail at the experience of our members and PAs working in paediatrics. It will build on learning from the survey and seek to capture more information to build an evidence base of practice.

This work will consist of extensive consultation with RCPCH members and sit alongside a call for case study submissions on existing models of care and experience of PAs, as well as effective workforce transformation and shared learning from MDT-working within the current child health workforce. The learnings from this work will directly feed into our recommendations for central decision-makers and stakeholder organisations on the future role of PAs in paediatrics.

RCPCH snapshot survey, October 2023

We undertook a 72-hour snapshot survey to gather member experiences of PAs in Paediatrics. Below is more detail on the responses.

About the survey

The RCPCH undertook a 72-hour snapshot survey in October 2023 to gather experiences of PAs in Paediatrics. There was a total of 593 responses from healthcare professionals, the majority of which were Consultants, Postgraduate Doctors in Training (PDiT) and SAS doctors. Trends in responses differ based on role and if a respondent has experience of working with PAs or not. A notable variety of experience was reported.

It is important to note that this survey is the result of the College’s initial and limited engagement with our members on this issue. The survey was designed to quickly understand the overarching views of members, rather than a thorough consultation and engagement process. This programme of work is now under way and will report more substantially at the end of this process.

Do you have direct experience of working with Physician Associates? 

Yes – 74%, No – 26%

81% of PDiTs reported direct experience of working with PAs compared to 53.1% of Consultants and 65% of SAS doctors. This may reflect the nature of rotational training and insight was not gathered on whether this related to only PAs working in specific paediatrics settings.

Do Physician Associates in the paediatrics workforce support service delivery?

Yes – 40%, No – 60%

Results differed between respondents that had experience working with PAs and those that did not. 54% of Consultants responded ‘Yes’ overall. 62.8% of Consultants that had direct experience of working with PAs responded ‘Yes’. For PDiT, 34% overall responded 'Yes' and this rises by a further 10% in those with direct experience of working with PAs.

Do Physician Associates in the paediatrics workforce support delivery of training?

Yes – 14%, No – 86%

Over 90% of trainees selected “No” for this question. There was no uplift in ‘Yes’ responses amongst those who have previous experience of working with PAs.

What do you think the role of the College should be in this space?

The RCPCH assisting in defining a PA job description and/or profile was the most common response of all free text answers, representing 35% of the comments. Advocate for paediatrician training is second at 20%.

For PDiTs, both assisting and defining the PA job description and profile, and advocating for paediatric training were equally as important.

Who are PAs?

PAs are collaborative healthcare professionals with a generalist education, who work alongside doctors and support delivery of care as a part of the multidisciplinary team. They are dependent practitioners working with a dedicated supervisor but are able to work autonomously with appropriate support in some cases.

PAs are scheduled for statutory regulation by the General Medical Council (GMC) estimated to take place in 2024-25. This will see duties of PAs clarified and could be expanded to cover prescribing rights and requesting of X-rays/ other ionising radiation requests.

What can PAs do?

PAs are trained to work within a defined scope of practice and limits of competence to perform certain duties in adult care settings, detailed by NHS employers.

Currently, PAs are not able to carry out the following:

  • Prescribe
  • Request ionising radiation (eg chest X-ray or CT scan).

The scope of PA duties may change with GMC regulation expected in 2024-25.

There is currently no national framework or curriculum for PAs in paediatrics. The RCPCH joined an intercollegiate working group led by the Faculty of Physicians Associates (FPA) at the Royal College of Physicians, and the College is scoping the experience and thoughts of our membership to inform future discussions about this role in Paediatrics.

For further information on service planning it may be helpful to visit the Academy of Medical Royal College’s High Level Principles for PAs supportive document.

What are doctors responsibilities when working with PAs?

It is important that PAs have a clearly defined job plan to allow both employer and PAs to understand what is expected of them and the supervision that is needed. The job plan should indicate hours of work, opportunities for development and required duties. It is also critical to ensure that all team members understand the PA role and their scope of practice.

The British Medical Association has published Principles for Effective Working for doctors when working with Physicians Associates and other Medical Associate Professionals

Good Medical Practice guidance from the GMC includes useful information including the responsibility of doctors when delegating.

You can also find further information on delegation and referral as part of the GMC’s ethical guidance.

Video interviews

These interviews in the below video were recorded during the RCPCH Advanced Clinical Practitioners and Physician Associates Event in 2020. In this interview, PAs give us an insight into their respective careers. Questions covered included:

  • What encouraged you to chose your respective career path
  • Why paediatrics
  • What a typical day/ week looks like
  • What do you enjoy about the role
  • What are your hopes for the future in your role

What if I have further questions?

You can email the Faculty of Physician Associates at fpa@rcplondon.ac.uk or contact the RCPCH Workforce and Careers team on careers@rcpch.ac.uk.

We will update this page as the work progresses.