Our position on Physicians Associates in Paediatrics
On 28 November 2024 we published the independently led data and analysis of our member consultation survey on PAs in paediatrics. We have also published alongside this report our response, which contains:
- The key findings from the member consultation survey
- Good practice points for child health multi disciplinary teams
- Five key recommendations to Governments and health bodies across the UK
- Next steps for RCPCH
View our response and the report here.
RCPCH member consultation survey - autumn 2024
On 9 August 2024, RCPCH launched a survey to eligible UK-based members on their views and experiences of Physician Associates in paediatrics. It ran for four weeks, and closed on 9 September. A link to the survey was sent to eligible members via the email address on their RCPCH records.
This survey continued our programme of member consultation and gathered 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.
This was led by an independent, experienced research agency, Research by Design including the analysis of the survey results and subsequent report.
This survey closed on 9 September 2024 at 17:00, and Research by Design shared their initial findings with us in mid October. On 31 October we responded to these findings by calling for a pause in recruitment of PAs in paediatrics.
A subsequent full response to the survey findings, along with the survey results, was published on 28 November.
Who to contact
For anything relating to our work on Physician 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
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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?
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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?
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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?
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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?
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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.
Evolution of work on PAs at RCPCH
The College is aware of concerns raised 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.
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, and it was announced this would begin in November 2024. 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.
The independent report from our member consultation survey outlines the latest views and experiences of members, and our response outlines our next steps as an organisation, including engaging closely with the national review launched by Professor Gillian Leng.
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. PAs should not be performing child protection and forensic medical assessments. 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.
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 December 2024.
What can PAs do?
PAs are trained to work within a defined scope of practice and limits of competence to perform certain duties, 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).
- Perform child protection and forensic medical assessments
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.
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. Our statement published at the end of November 2024 sets out a series of good practice points to support our members, PAs and other health care professionals working in the paediatric multidisciplinary team (MDT).
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.
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.