On 3 December, the Irish Medical Council released a position statement on physician associates (PAs). The Council stated that, as the independent statutory body regulating doctors, it did not believe it was the appropriate body to regulate PAs.
Providing further context to its position, the Council also referenced “the potential for emerging patient safety risks arising from confusion for patients, as observed recently because of regulation of PAs by the GMC [General Medical Council] in the UK”.
The Council stated its primary purpose was to protect the public by setting high standards of professional conduct, education, training, and competence among doctors.
“The Medical Council is aware that PAs are being trained and employed in the Irish healthcare system, working under the supervision of doctors to support the provision of healthcare, contribute to patient management, and improve healthcare access. [The Council] considers it essential that these PA roles are defined with respect to their scope of practice.”
Currently, the Department of Health is reviewing an application from the HSE to formally recognise the PA grade.
On 22 November, the Department informed the Medical Independent there was ongoing engagement with the HSE “on the important areas related to this role, including clinical governance and scope of practice”.
“The Department has not asked any regulator to assess the feasibility of future regulation of physician assistants as its policy development work in relation to the regulation of healthcare professions is ongoing.”
The RCSI, which offers the only MSc PA programme in the Republic of Ireland, “welcomed” the Council’s statement. “A regulator that ensures a streamlined process for monitoring physicians associates and their supervising consultants, while protecting the public, is the overarching goal that the RCSI has been advocating for,” it outlined.
PAs were not replacements for doctors, it said, but they increase the productivity of the medical or surgical team “by enhancing access to care”. They “complement” the roles of medical or surgical trainees, as directed by their consultant supervisor.
The College added: “Without significant change in our health service, the future demand for healthcare is unsustainable and we will face a public healthcare crisis that will see many more of us unable to access the care we need. Worldwide there is broad agreement that the most promising model for a sustainable healthcare system is one that increases productivity by extending the scope of practice of existing healthcare professionals and creates new professional groups, in line with calls from the World Health Organisation to innovate medical workforces.”
The UK government’s decision to regulate PAs through the GMC has caused significant tumult within the medical profession, who fear this further blurs the lines between the professions. There have been reports of NHS Trusts and other healthcare settings failing to implement appropriate supervisory arrangements and rostering PAs onto doctor shifts.
On 20 November, an independent review of PAs (and anaesthesia associates) was established by the UK Health and Social Care Secretary Wes Streeting to consider “how these roles are deployed across the health system, in order to ensure that patients get the highest standards of care”. The review, chaired by Prof Gillian Leng, will conclude in spring 2025.
Although still small in number, PAs have been operational within the Irish system for almost a decade. They are part of healthcare teams in numerous public and private hospitals and the RCSI programme is graduating new cohorts annually.
There is now an opportunity to learn from the experience in the UK, albeit finding a consensus on the parameters of the PA role may prove very difficult indeed.
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