Physician Associates in Paediatrics

Evolution of work on PAs at RCPCH

The College is aware of concerns being raised by our members that there are inconsistencies in College messaging about the use of Physician Associates (PAs) in paediatrics. Instances of College work from previous years have been recently highlighted to us as potentially conflicting with our current position that PAs must not replace the role of paediatricians in the delivery of care to children and young people. 

As a College, we acknowledge that our position on PAs has evolved since they were first introduced by the NHS 20 years ago. Health policy and the NHS workforce continually develop and change as new information and evidence becomes available, including the views and experiences of our members. This webpage is the most up-to-date source for our current work relating to PAs. Any member seeking clarity on the College’s position should default to the information on this webpage, which will be regularly updated as our work develops.

Further work on Physician Associates is now being undertaken in response to the current medical landscape and paediatric workforce, which we know have significantly changed in recent years. The College will continue planned work over the next month to build an evidence base of practice that is informed by paediatricians on the ground. This follows a survey launched on 12 August 2024 for eligible UK-based members on Physician Associates in paediatrics. 

This survey, which ran for four weeks, continues our programme of member consultation and has gathered the experience of College members on PAs working in paediatric settings, as well as member views on the role of PAs in paediatrics overall. The results of this engagement will bring together an independent report, with all results and analysis to be published in full on the RCPCH website, alongside a College response. 

In September 2024, the Academy of Medical Royal Colleges called for the Government to begin an independent review into the use of physician associates in healthcare. The RCPCH has been highlighting the need for clear central structures and robust guidance for some time. An independent review must include consideration of the role of PAs in paediatric settings and the safe care of all children and young people, regardless of specialty or setting. We will provide input and follow this work closely as it evolves.

Our current 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 the role of 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.

Ongoing Member consultation

On 12 August 2024, RCPCH launched a survey to eligible UK-based members on Physician Associates in paediatrics. It ran for four weeks, and closed on 9 September at 17:00. A link to the survey was sent to eligible members via the email address on RCPCH records.

Why are we doing this work  

This survey continues our programme of member consultation and will gather insight into what PAs in paediatrics are currently doing, as well as member opinion on the role of PAs in paediatrics. The work aims to build an evidence base of practice that is informed by paediatricians on the ground.

We have brought in an independent, experienced research agency, Research by Design, to lead on this work, including the analysis of the survey results and subsequent report.    

After the survey 

This survey closed on 9 September 2024 at 17:00, and Research by Design have begun their analysis. This will be anonymised and independently analysed without input from RCPCH. Research by Design will bring together a report containing the independently analysed survey data, which the College will receive in late October. All results and analysis will be published in full on the RCPCH website, alongside a College response. We expect this work to be completed in November 2024. 

Who to contact

For anything relating to our work on Physicians Associates please email careers@rcpch.ac.uk. 

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 at the end of 2024. 

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 which will come into effect that the end of 2024. 

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.

PAs in Child Protection Medicals 

We are aware of some concerns being raised that PAs are taking on roles in child protection medicals. The RCPCH is clear that PAs must not replace the role of paediatricians in the delivery of care to children and young people. Our intercollegiate guidance ‘Safeguarding Children and Young People: Roles and Competencies for Paediatricians’, sets out that paediatricians responsible for child protection medical assessments, and their subsequent reports, must meet the Level 3+ Safeguarding Competencies. This guidance is currently undergoing an update as part of the regular review schedule, and the update will consider the competencies and skills of all roles supporting paediatricians in undertaking child protection medicals. Our Child Protection Service Delivery Standards, published in 2020, further set out that child protection medicals should be delivered at by paediatric clinicians working at ST4 level or equivalent.  

New position statement on PAs from the Faculty of Forensic and Legal Medicine (FFLM)

The FFLM’s statement of the 1 October 2024 provides useful clarity on the processes around the examination of children who disclose or may be at risk of abuse and the provision of evidence arising from such examinations.  

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.

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.