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Update on delivering the NHS Long Term Workforce Plan ambitions around Medical Associate roles

This open letter was sent to partners on 17 October 2023.

We are writing to lay out NHS England’s approach to delivering the NHS Long Term Workforce Plan (NHS LTWP) ambitions around Medical Associate roles. This includes engaging with partners further about the pace at which these roles grow and ensuring alignment on the remit of their work in different specialties. 

The NHS LTWP sets out an ambitious long-term package of measures to ensure the NHS has the right staffing levels and skills mix it needs for the future. We remain committed to working with you, other partners and staff across the NHS to ensure we get implementation of the LTWP right.

With that in mind we thought you might find it helpful if we set out more fully how NHS England will approach the implementation of these proposals, building on the feedback from Royal Colleges, trade unions, and wider staffing groups since the Plan was published in July:

  • We will set our recruitment trajectory based on how confident we are that the local education capacity and faculty is in place to train all professionals to the highest standards.
  • We will only go as fast as safety, support and quality of experience for patients, doctors in training, physician associates and anaesthesia associates and their educators allows.
  • We will continue to listen and engage with professionals and colleges on associate roles. We want to ensure people train to work effectively in teams and will be actively seeking views from doctors, including those in training.

The NHS LTWP outlines how we can put the NHS on a sustainable future footing by training, retaining and reforming the workforce to deliver multi-disciplinary teams serving patients across the NHS. This means recruiting and training more doctors, nurses, allied health and other professionals and ensuring every team member can contribute their skills, experience and education.

As part of this package of measures, we have committed to expanding enhanced, advanced and associate roles already working across the NHS, such as Anaesthesia Associates (in the NHS since 2004), Physician Associates (in the NHS since 2004) and more recent Nursing Associate roles (in the NHS since 2016).

There are currently over 3,500 Physician Associates and over 150 Anaesthesia Associates on the respective managed voluntary registers, as well as 6,800 Nursing Associates regulated by the NMC.

The use of additional roles, like the UK Physician Associates and Anaesthesia Associates is being explored internationally as a way to increase the effectiveness of a multi-disciplinary team.

PAs and AAs usually undergo a three-year undergraduate degree, in a health, biomedical science or life-sciences subject followed by two years postgraduate training, gaining significant clinical experience. Having undertaken the requisite training to become a Physician Associate / Anaesthesia Associate, their role and clinical duties cannot, and will not, be as extensive as those of a doctor.

Like Allied Health Professionals, Advanced Clinical Practitioners, Health Care Scientists, and other roles, Associates perform specific aspects of patient care, increasing the capacity and flexibility of the multidisciplinary team and reducing the overall workload pressure on other clinicians.

The NHS is committed to upholding the highest levels of patient safety and welfare. As with all professionals, as Physician Associates and Anaesthesia Associates gain more experience, they may expand their skills to perform tasks beyond those attained at graduation. In these instances, appropriate supervision, quality assessments, managed voluntary registers and local governance mechanisms exist to ensure patient safety.

As we implement the NHS LTWP, NHS England is now taking the following steps, working with the relevant professional colleges and regulators, to ensure the use of associate roles is expanded safely and effectively:

  • Regulation of healthcare professionals is fundamental to a safe and effective workforce, so we remain absolutely focussed on achieving it for these roles. We are working with the Department of Health and Social Care to ensure PAs and AAs will be professionally regulated with the General Medical Council (GMC) by the end of 2024 at the latest.
  • NHS England has worked with the GMC, Royal Colleges and other stakeholders to develop appropriate curricula, core capability and career frameworks, standards for CPD, assessment and appraisal and supervision guidance for PAs and AAs. We will continue our work with partners to ensure the required expertise, infrastructure and leadership so associate roles can be effectively trained and integrated into teams, through developing national standards, defined scope of practice, and assessment of educational capacity.
  • We will remind local employers about their responsibility for ensuring effective and appropriate supervision of all associate colleagues, that they are shaping associate roles within an acceptable scope of practice, and making sure associates are working within established guidelines.
  • We will work with Colleges, other doctors’ representatives, and PAs and AAs to identify areas of concern. 
  • We will work with the Academy of Medical Royal Colleges and individual professional bodies to develop and implement recommendations as a result of what we learn. We have already heard the concerns of doctors in training about the impact of PAs and AAS on access to training and will be looking into this.

We know there are a range of strong views on this, which is why it is so important we continue to talk and work together respectfully for the benefit of our patients and our colleagues.

We look forward to hearing from you and we are keen to hear your views, on how we successfully implement these roles, and the wider NHS Long Term Workforce Plan, in the best interests of patients.

Yours sincerely,

Dr Navina Evans CBE, Chief Workforce, Training and Education Officer

Prof Sir Stephen Powis, National Medical Director