RCP publishes updated position on physician associates working in secondary care in the medical specialties

At an RCP Council meeting on 19 November, Council members discussed a proposal on opposing the future role of physician associates (PAs) in hospitals, either completely (option A) or equal to/beyond the scope of an FY1 doctor (option B). Afterwards, Council members were asked to submit their feedback in writing on the proposal.

There was broad agreement that PAs should have a limited role working in hospitals if they are supported with proper supervision, professional regulation, and a nationally agreed scope of practice. Council members were clear that the role of a PA should not be compared to that of a doctor at any career stage.

Feedback was received from 11 individual Council members including RCP censors, resident doctors, elected councillors, representatives of specialist societies and regional advisers.

RCP Council agreed that:

• PAs should support, not replace, doctors
• the RCP should not draw any comparisons between PAs and doctors
• PAs should have a nationally defined ceiling of practice and a clearly defined MDT role 
• PAs should only be supervised by consultants, specialist or associate specialist doctors 
• the RCP should clarify what clinical supervision means for general internal medicine 
• the RCP should call on the Leng review to consider the impact of the PA role on training opportunities for resident doctors. 

RCP Council also received an update on the work of the RCP oversight group for activity related to PAs (PA oversight group, or PAOG), and noted that all the recommendations of the RCP short life working group on PAs have now been delivered.

In December 2024, the RCP will publish draft safe and effective practice guidance on the supervision of PAs, alongside a definition of the PA role drafted by the RCP Resident Doctor Committee (RDC) and agreed by PAOG and RCP Council.

The RDC is also working with PAOG to develop an interim GIM (general internal medicine) scope of practice document for newly qualified PAs that will act as a placeholder until the Leng review reports in spring 2025. In the meantime, the RCP will continue to advocate for a nationally agreed ceiling of practice for PAs in its written evidence to the Leng review.