As the RCP prepares to consult with key stakeholders on new draft guidance for safe and effective practice for PAs, the chair of a new oversight group has announced that the RCP has already delivered, or is in the process of delivering, the majority of recommendations made by the short life working group (SLWG) on PAs that was established following an extraordinary general meeting (EGM) in March 2024.

Following the EGM, the RCP is now calling for a limit to the expansion of the PA workforce until issues of scope and regulation are addressed, and while we continue to support the UK government in its commitment to deliver a long term workforce plan for the NHS, we have urged NHS England to review its current projections for growth in the PA workforce.

In recent months, organisations including the British Medical Association (BMA), Royal College of General Practitioners (RCGP), Royal College of Emergency Medicine (RCEM) and, most recently, Healthwatch England have also raised issues. Evidence now suggests that many doctors are worried about the risk of role confusion, the potential for a negative impact on the quality of postgraduate training for doctors, the lack of national guidance on supervision and scope of competence for PAs, and patient safety.

Publishing national guidance on safe and effective practice for PAs has been a long-standing commitment of the RCP to its members and fellows. Following internal consultation with RCP Council, the new draft guidance will be shared this week for consultation with over 20 national organisations, including the UK and devolved governments, NHS, BMA, GMC and Academy of Medical Royal Colleges.

This version of this draft guidance was developed by a group of consultant physicians, with input from RCP Council and others, including the Trainees Committee, Faculty of Physician Associates and the SLWG on PAs. It covers a wide range of good practice for employing and supervising PAs and reiterates the RCP position that PAs are not doctors, should never be used to replace a doctor on a rota, and must always refer any prescribing matters to a fully registered prescriber.

Later this week, the RCP will host the first meeting of a newly established oversight group for RCP activity linked to PAs. Chaired by vice president for Wales Dr Hilary Williams, the group will meet on 31 July for the first time. Dr Williams also chaired the post-EGM SLWG on PAs. A medical oncologist working at Velindre Cancer Centre in Cardiff, she will lead work to:

• ensure a consistent and coherent approach to PA-related work at the RCP
• oversee the delivery of the SLWG recommendations
• begin the process of developing specialty-specific guidance for PAs
• advise on the future of the Faculty of Physician Associates.

Of the 16 recommendations made by the SLWG in May 2024, 15 were accepted by RCP Council. The final recommendation – that the RCP should close the PA Managed Voluntary Register (PAMVR) to new entrants – was rejected after a vote of RCP Council members. The RCP has since announced that the PAMVR will close to all PAs in December 2024 once the General Medical Council (GMC) becomes the regulatory body for medical associate professionals. The RCP will begin to transfer PAMVR data to the GMC from October. RCP Council has also agreed that to have some oversight of patient safety standards, the RCP Assessment Unit will continue to deliver the PA National Exam for at least another year.

Dr Williams will report regularly to RCP Council and will share written updates with our fellows and members on the RCP website. The first update will be published later this week.

Dr Hilary Williams, vice president for Wales and chair of the PA oversight group said: 

‘I am honoured to be working with colleagues to hold the RCP to account on delivering the recommendations of the post-EGM short life working group. As I said in May when we published our report, we cannot allow patient safety to be risked by anyone in the multidisciplinary team working outside of their clinical scope of practice or without appropriate supervision.

‘The publication of this new draft guidance on safe and effective practice for PAs is a positive and very welcome step forward. Now it is time to work with the specialist societies to consider what role PAs can safely play in clinical practice.

‘We are also writing this week to the GMC as the regulatory body for PAs from December 2024 with questions about their future role on scope of practice and the rules around prescribing.

‘I’m also delighted to say that this autumn, we will launch a new programme of work focused on our early career doctors – putting our trainees, locally employed and specialty doctor colleagues at the heart of the college. Led by senior censor and vice president for education and training Dr Mumtaz Patel, who is currently acting as RCP president, this work will bring together fellows and members from across career grades and specialties to consider the design and delivery of medical training and what needs to change.

‘We are also pleased that DHSC has committed to improvements and we look forward to working closely with them to influence the way forward.

‘2025 will be the year of “generation next” at the RCP. It is time for the college to refocus its attention, refresh its policy positions, and reset its relationship with fellows and members.’