The RCPCH member consultation survey on Physician Associates in paediatrics was conducted and analysed by the independent research company, Research by Design (RbD). A comprehensive report setting out the detailed survey results and analysis has been produced by RbD independently of RCPCH. You can download and read this in full. We want to thank the 2,000+ members who gave their time to complete the survey and share their views and experience on the place of Physician Associates in paediatrics.
Since the publication of our interim statement, over the past month members of RCPCH Executive Committee together with College staff from the Health Policy and Workforce & Careers Teams have worked with RbD to review the findings of the survey and develop this response. For more information about our work on Physician Associates to date, please visit our dedicated Physician Associates web page.
Survey context
The survey was open to all RCPCH members in the UK. Eligible members were each supplied with a unique link, meaning participants could only complete the survey once. A direct email was sent to all members of RCPCH in the UK who have not opted out of College surveys and communications were sent to remind members how to opt in if they would like to do so. A total of 12,798 members were invited to take part between 9 August 2024 and 9 September 2024. The survey received 2285 responses, which represents a 17.9% response rate. The report from RbD was received on 17 October 2024, and the initial findings were discussed by RCPCH Executive Committee on 24 October 2024.
The survey was designed to capture both the experiences of those who had worked with PAs and the perceptions of those who had not. 44% of respondents had experience of working with PAs in paediatric settings, and 27% in non-paediatric settings. The profile of respondents was compared to the full set of invited participants, and there was less than a 4% variance in the proportion of key demographics (role, location) in the survey population compared to those invited to participate, therefore there was no need to weight the data. In light of both this and the response rate, the results were accepted by the RCPCH EC as consensus from the College membership.
Key survey findings
The original questions asked in the survey are represented in italics below. Respondents answered questions based on their respective experiences.
- The questions in section 1 were asked to those with recent experience of working with PAs in paediatric and non-paediatric settings.
- The questions in sections 2-5 were asked to those with recent experience of working with PAs in paediatric settings.
- The questions in sections 6-7 were asked to all respondents.
This survey was only about views and experiences of working with PAs, and does not capture experience of working across the whole multidisciplinary team (MDT).
1. PAs undertaking referrals
Do you receive referrals directly from PAs? (paediatric and non-paediatric settings) (p.16)
- 60% of respondents with experience of PAs working in non-paediatric settings receive referrals directly from PAs.
- 40% of respondents with experience of PAs working in paediatric settings receive referrals directly from PAs.
How would you generally rate the quality of referrals you have received from PAs? (p.18)
- Respondents with experience of PAs working in non-paediatric settings: 46% rate as poor and 27% rate the quality of these referrals as very poor (total 73% negative).
- Respondents with experience of PAs working in paediatric settings: 30% rate as poor and 17% rate the quality of these referrals as very poor, (total 47% negative).
2. PAs on paediatric medical rotas
Which of the following statements is correct with regards to PAs in your paediatric service? (Note: This question was multi-selection) (p.22)
- They work alongside trainee doctors on rotas: 66% of respondents
- They have filled a previous doctor gap: 29% of respondents
- Neither of the above: 27% of respondents
3. The capacity and confidence of members in supervision of PAs in the workplace
Do the PAs in your team have a named clinical supervisor on shift? (p.33)
- 49% do not know if PAs have a clinical supervisor on shift.
Do/did clinicians undertaking educational supervision of PAs have time in their job plan for this? (p.37)
- 70% of respondents do not know if educational supervisors have time in their job plan
4. Local processes for sign-off of prescriptions and ionising radiation
Who is required to sign off prescriptions/ionising radiation for PAs in your service? (Note: This question was multi-selection) (p.27)
- Over 50% of respondents report that either ST1-4 or ST5+ are required to sign off prescriptions / ionising radiation for PAs within their paediatric service. In other cases, this is a consultant (47%) or a specialty doctor (45%). 21% are not aware (“I don’t know”) of who is required to sign off prescriptions / ionising radiation for PAs.
5. Access to training
What impact, if any, does the presence of PAs in your department have on access to training? (NB: This question was only asked to doctors in training) (p.42)
- 53% of respondents said it reduces access to training for doctors in training. 46% said current trainers have less time available to train doctors in training.
6. Scope of practice
Should the NHS centrally define a training framework and scope of practice for PAs across their specialty work areas? (p.44)
- 94% of respondents indicated yes, with 75% stating that input from specialty bodies should be required in this process.
‘PAs can support teams the delivery of high-quality care’ (p.45)
- 54% of respondents agreed or strongly agreed with the statement in the context of an acute care environment where there is a specific training framework and scope of practice for PAs in paediatrics
- 55% of respondents agreed or strongly agreed with the statement in the context of a scheduled care environment where there is a specific training framework and scope of practice for PAs in paediatrics
7. PA recruitment in paediatrics
‘PA recruitment should be halted whilst the NHS develops structures for appropriate deployment of PAs’ (p.49)
- 80% of all respondents agreed or strongly agreed with the statement.
Good practice points
The following good practice points have been written with a view to supporting our members, PAs and other health care professionals working in the paediatric multidisciplinary team (MDT), in addition to service providers.
1. It is good practice that any referral includes details of the referring professional and their role including, where relevant, information about any supervising clinician and approval process undertaken for the referral.
2. Clinical responsibility for individual patient care lies with the supervising paediatrician on shift, and they are responsible for ensuring the assessment and management of children occurs with appropriate supervision and within agreed entrustment levels. This is particularly important for the care of undifferentiated patients.
3. All members of the MDT working in child health settings should only undertake tasks that they have appropriate training to conduct. For example, PAs should not be doing the following
- Prescribing
- Requesting ionising radiation
- Performing child protection and forensic medical assessments
4. While PAs may assist in the prescribing recommendations process, decision making for prescribing medications is ultimately the responsibility of the independent prescriber.
5. Where patient safety issues have been raised regarding PAs in paediatrics, robust systems must be in place for reporting, escalating and learning from these concerns, as they should for safety issues relating to any member of the MDT.
6. PAs must not replace the role of paediatricians in the delivery of care to children and young people. In particular, PAs should not replace paediatricians on acute medical rotas of any tier.
7. Ensure appropriate induction, training, line management and appraisal is in place for the whole MDT, including PAs.
8. Ensure appropriate time for supervision is agreed for those assigned to supervise PAs both formally (e.g. named clinical or educational supervisor) and informally (e.g. those working with them on a shift). For consultant and SAS grades this should be formalised in job plans.
9. Providers and training bodies should follow the RCPCH Training Charter in ensuring training opportunities and experiences for paediatric postgraduate doctors in training are protected.
10. All members of the MDT should ensure they introduce themselves and explain their role appropriately to families and patients. PAs should follow the Faculty of Physician Associates guidance on this.
Recommendations for governments and health bodies across the UK
1. Pause PA recruitment in paediatrics whilst the NHS develops structures for appropriate deployment of PAs.
2. Develop a national scope of practice for PAs in the UK, which should include specific considerations for those working in child health.
3. Ensure the independent review of the ways in which PAs work in the NHS includes sufficient focus on paediatrics and child health.
4. As the GMC becomes the regulator for Physicians Associates in December 2024, regulatory processes and revalidation requirements should set necessary standards for PAs.
This should include the setting of specialty specific capabilities framework that need to be demonstrated in line with their scope of practice. These processes are needed to ensure the safe delivery of care for children and young people and a safe working environment for all members of the MDT.
5. Take action to re-invest in the paediatric workforce to meet the rising demand through the NHSE Long Term Workforce Plan (LTWP) and equivalent current and/or developing workforce plans across the devolved nations.
Investment in the paediatric workforce is crucial to ensure that there are safe and high-quality services for our babies, children and young people. Though PAs may help support their work they should not be used to replace paediatricians in the delivery of care to children and young people. The RCPCH Blueprint for transforming child health services in England outlines some of the next steps needed to create a safe and sustainable health service.
RCPCH next steps
We recognise that the survey results demonstrate a range of views and opinions from our members. For some services, PAs play a valuable role in provision of care to children and young people. We firmly believe in the value of multidisciplinary teams 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.
We also welcome the independent review of Physician Associates and will share the evidence provided in this survey directly with the review team, as well as calling for sufficient focus on paediatrics and child health in the review. This work is continuing to evolve, however, we remain clear that PAs must not replace the role of paediatricians in the delivery of care to children and young people.
A note on our work with Research by Design
Throughout this work we have always been committed to publishing the data as received by RbD, and the data and report have been analysed and produced independently from RCPCH. As part of the review process, the College requested the following additional clarifications to assist with interpretation:
- For all questions that were multi-select to have a label in the findings to clarify this.
- For q.2B6 the chart be amended, as the data was around 0.5% but the chart showed 0% (p.23).
- For q. 2B7 highlighting that further breakdown of responses is listed in the appendix (p.25).
- For q.2CP5B, comparing responses to 2B1 to highlight whether these responses mirrored the workplaces of respondents, or whether there was a variance (p.32).
- For Q.s OE1, 4OE2, 4OE3 a breakdown of whether the respondent has experience of working with PAs, their roles, and in what setting. (Expected to publish early December)
We have also requested more detailed analysis of the data to have the information to support the NHS’s central development of a future scope of practice development, namely:
- Supervision, prescription processes and patient safety
- Child protection and forensic medical assessments
- Further breakdown of experience of working with PAs in paediatrics based on clinical setting and role.
These will be shared by RbD as appendix reports by the end of December and will be published on this page when available.