Study Raises Concerns Over Safety of Physician Associates in NHS

Recent research has revealed significant concerns regarding the safety and effectiveness of physician associates and anesthetic associates within the UK National Health Service (NHS). A systematic review published in the British Medical Journal highlights the lack of robust evidence supporting the value of these roles in primary care settings.

The study, conducted by experts in the field, emphasizes that the absence of reported safety incidents in a limited number of studies cannot be interpreted as confirmation of the safety of deploying physician associates and anesthetic associates. The authors call for urgent research to assess staff concerns, investigate safety incidents, and clarify the scope of practice for these emerging roles.

Physician associates and anesthetic associates are trained professionals who work alongside doctors and nurses, having completed two years of additional training after obtaining a health or life sciences degree. Their introduction into the UK healthcare system has sparked considerable debate regarding their effectiveness and safety.

In response to these concerns, the UK government has initiated an independent review to evaluate the scope and safety of these roles within the NHS, aiming to better integrate them into patient care. The researchers undertook a thorough investigation of existing literature by examining three electronic research databases--PubMed, CINAHL, and the Cochrane Library--for studies concerning physician associates and anesthetic associates published from 2015 to January 2025.

Out of 52 eligible papers reviewed, only 29 met the criteria for trustworthiness and relevance to current UK healthcare policy. Notably, the total number of physician associates examined in these studies was minimal, particularly in primary care environments, and no studies directly assessed the competencies of anesthetic associates.

Among the reviewed studies, only one involved a physician associate being evaluated by a physician through direct observation. Alarmingly, no studies investigated safety incidents related to the roles of physician associates or anesthetic associates.

While some findings indicated that physician associates could effectively support ward teams and function in emergency departments under appropriate supervision, the limited number of subjects and contexts studied means these conclusions should be approached cautiously. Furthermore, it was noted that physician associates faced challenges in primary care due to the autonomous nature of the role, the diversity of patient cases, and the complexity of clinical decisions, alongside inadequate institutional support and supervision.

Patients generally expressed positive or neutral opinions regarding physician associates, whereas healthcare staff voiced worries concerning the competence of these associates to manage complex or high-dependency patients, as well as their abilities to order diagnostic scans or prescribe medications. Physician associates themselves reported varied experiences and expressed a need for clearer role definitions within healthcare teams.

The authors of the study recognized certain limitations, such as the exclusion of evidence from similar roles in other countries, but insisted that their focused analysis on UK research and the identification of gaps in existing literature provide valuable insights for the ongoing policy review.

The authors concluded that very few studies in the UK have adequately evaluated the clinical competence and safety of physician associates and anesthetic associates. They warned that conclusions drawn from non-randomized studies indicating non-inferiority may mask significant unmeasured differences in the quality of care provided.

In a related editorial, a professor from the University of Manchester criticized the lack of investment in research concerning the healthcare workforce, highlighting the unclear and unbudgeted plans for workforce expansion and the inadequacies in the regulatory frameworks governing health professions. He pointed out the likelihood of a compromise emerging from the ongoing discussions surrounding physician associates and anesthetic associates but stressed the importance of improving workforce reforms to ensure both patient safety and staff well-being in the future.