Physician Associates (PAs), Anaesthetic Associates (AAs) and Doctor’s Assistants (DAs) are all separate and well-defined roles within the NHS. These professionals work within multidisciplinary teams (MDTs) across the UK, but despite their established and individual scopes of practice, the similar nomenclature frequently confuses the public and healthcare professionals alike.
It is important to understand the differences in these roles, to help patients and other healthcare professionals understand the safe and appropriate roles each professional can undertake.
Here we explore each role, to better understand the qualification processes, their typical day-to-day job and how these staff work within their respective MDTs.
Physician Associates (PAs)
PAs have been working in the NHS since 2003. PAs hold both a Bachelor’s degree in relevant life science, such as biomedicine, followed by a 2-year master’s Degree or Post Graduate Diploma in Physician Associate Studies, which is a post-graduate medical qualification. Following completion of this, alongside 1,600 clinical hours and completing skill sign-offs, PAs must pass the FPA National Examination, consisting of objective structured clinical examinations (OSCEs) and a written paper.
PAs can work within primary care, secondary care across medical and surgical specialities and within psychiatry. The Faculty of Physician Associates (FPA) describes PAs as “dependent practitioners working with a dedicated consultant or GP supervisor”. PAs are trained to take medical histories from patients, perform clinical examinations, request relevant investigations ie blood tests and ultrasound scans and formulate differential diagnoses and management plans.
Whilst they can advise on management plans, PAs currently cannot prescribe medication or ionising radiation such as X-rays or CT scans. PAs can also work non-clinically within their department on audits, quality improvement and research projects. The PA role is on the NHS Agenda for Change at Band 7-8b depending on experience and managerial responsibilities.
Anaesthetic Associates (AAs)
Anaesthetic Associates were established in 2004 and were previously named Physician Assistants (in Anaesthesia or PAA), but were renamed for clarity in 2019. An AA must have completed a 2-year postgraduate Anaesthetic Associate training course developed by The Royal College of Anaesthetists, in collaboration with The General Medical Council (GMC).
AAs will have completed a life sciences degree before this. AAs work across a wide variety of surgical specialities and work with patients and the anaesthetic team during the preoperative and operative periods.
They work under the supervision of an autonomously practising anaesthetist, in a 2:1 or 1:1 supervision model, depending on the acuity and needs of the patient. AAs can undertake pre-operative assessment and provision of sedation. They may also work as part of the hospital cardiac arrest team. AAs also work non-clinically within the anaesthetics department on audits and research. The AA role is on the NHS Agenda for Change at Band 7-8a depending on experience.
Doctor’s Assistants (DA’s)
Most DA jobs require a Level 3 National Vocational Qualification (NVQ) in care or equivalent experience and will undertake an induction period in their hospital of employment. An NVQ Level 3 is equivalent to 2 A-Levels. DAs were introduced as a large proportion of doctor’s or clinician’s time is spent on administrative tasks. A DA is a versatile and skilled member of the MDT who can undertake a wide variety of tasks as advised by their supervising doctor.
These may include clinical tasks such as phlebotomy and cannulation, ECGs, blood glucose testing, chaperoning patients, and dementia screening tests. DAs are also proficient in non-clinical tasks such as drafting discharge letters and preparing and writing patient notes. This role is also on the NHS Agenda for Change, at Band 3-4.
MAPs, including PAs and AAs, are currently a hot topic across UK healthcare news. With the NHS Long Term Plan setting out to increase the number of Medical Associate Professionals (MAPs) in the NHS workforce, work is steadily underway to regulate these staffing groups. This has sparked debate, particularly among doctors, as to whether these roles should be re-named. There have been calls for Physician Associates to be renamed “Physician Assistants” as some feel the role of a PA is exclusively to assist doctors.
Whilst PAs work closely with doctors, PAs are clinicians with a postgraduate medical education who can work under the supervision of their consultant to clerk, examine and formulate differential diagnoses and management plans for patients. This alone highlights the significant clinical responsibilities AAs & PAs have compared with DAs. Many PAs therefore feel that the “associate” title is more reflective of their day-to-day work than the “assistant” title, and helps to differentiate these roles.
To further complicate matters, Anaesthesia Associates were previously called Physician Assistants within the NHS, and Doctor’s Assistants already carry the “assistant” title. It could therefore be argued that changing the Physician Associate title after 21 years, to Physician Assistant would likely cause more confusion than clarity.
So what’s the solution?
To work effectively and efficiently within the NHS and to ensure a patient-centred approach to the care provided, healthcare professionals should be fluent and familiar with the nomenclature and the scope of practice of their fellow MDT members.
By knowing what skills and services other healthcare workers can offer our patients, we are more likely to utilise this broad range of skill sets to provide our patients with holistic and comprehensive care. In an understaffed and underfunded NHS, efficiency is key in optimising patient care and helping to reduce staff burnout. By delegating and referring to the appropriate team members, we can share the workload and ensure our patients receive the right care, from the right professional, at the right time.
It is important to note, that when the Anaesthesia Associates and Physician Associates (AAPA) Order 2024 comes into effect, the titles of Physician Associates and Anaesthesia Associates will become protected under UK governing Law, helping to further define and recognise the role PAs and AAs play in the wider MDT.