Vol. 16 No. 1 (2024): Mental Health & Wellbeing

A Multiprofessional Survey on the Role and Impact of Medical Associate Professions in the NHS

Triya A Chakravorty BA (Oxon) MBChB (Oxon)
Guys & St Thomas's Hospitals, London, UK
Archie Parekh
University of Manchester, UK
Professor Shivani Sharma DPsychol
University of Aston, Birmingham, UK
Professor JS Bamrah CBE FRCPsych
Greater Manchester Mental Health Trust, Manchester, UK
Jyothi Srinivas MD FRCPCH
Milton Keynes University Hospital, Milton Keynes, UK
Vipin Zamvar MS CTh FRCS
Edinburgh Royal Infirmary, Edinburgh, UK
Priyavanshi Desai MSc (PA studies)
Stratford General Practice
Kalindi Tumurgoti FRCGP
Ramesh Mehta CBE MD FRCPCH
British Association of Physicians of Indian Origin, Bedford, UK
Professor Indranil Chakravorty MBE PhD FRCP (Lond, Edin)
University of Hertfordshire, UK

Published 2024-03-26


  • Patient Safety,
  • Regulation,
  • UK NHS,
  • Medical Associate Professionals,
  • Physician Associates,
  • Surgical Practitioners,
  • Anaesthesia Associates
  • ...More

How to Cite

Chakravorty, T. A., Parekh, A., Sharma, S., Bamrah, J., Srinivas, J., Zamvar, V., Desai, P., Tumurgoti, K., Mehta, R., & Chakravorty, I. (2024). A Multiprofessional Survey on the Role and Impact of Medical Associate Professions in the NHS. Sushruta Journal of Health Policy & Opinion, 16(1), 1–12. https://doi.org/10.38192/16.1.12


Background: With the global scarcity of the healthcare workforce, innovations in healthcare professional (HCP) roles include the model introduced in the 1960s in the USA of medical associate professionals (MAPs). Since 2003 in the UK, MAPs had a scope of practice defined by local employers. In 2024, the UK Parliament passed a resolution to bring the MAPs under regulation by the General Medical Council. However, multidisciplinary team and public awareness of MAPs have come under scrutiny, due to uncertainties around roles, unmonitored expansion of scope of practice, patient safety concerns, and competition for jobs and training with doctors.

There is a need for rigour in exploring the opinions of the whole spectrum of HCPs, especially locally employed doctors (LEDs), Specialty and Associate Specialities (SAS) and international medical graduates (IMGs) who not only make up a large cohort of doctors in the UK but work closely with MAPs and support their prescribing and ordering investigations functions.

Aim: Designed by a multi-professional working group, an online survey of HCPs was conducted to explore the role of MAPs in patient care, and how workforce plans around the roles align with the roles, responsibilities, and training of doctors.

Findings: A total of 583 responses were collected which included consultants (43%), postgraduate doctors in training, General Practitioners, LEDs, IMGs (75%), nurses, and allied health professionals.

  • Role: 53% of respondents were uncertain of the specific role of MAPs within the team; 43% agreed primary roles of MAPs involved delivering specific, well-defined skill-based services, reducing workload (20%), and providing continuity (19%). 89% emphasised the importance of a clear distinction between the roles of doctors and MAPs.
  • Patient Safety: 77% agreed that MAPs currently may pose a risk to patient safety. 89% recognised the risk associated with MAPs working beyond their scope. 69% agreed with the need for a competency framework for MAPs.
  • Supervision: 75% expressed concerns about the increased clinical risk and burden faced by doctors in supervisory roles.
  • Impact on Doctors: 69% reported reduced job prospects and 67% reduced training opportunities.
  • Regulation: 74% agreed with regulation by an independent regulator, not the GMC.

Free text: The analysis of free-text comments revealed a predominantly negative sentiment regarding the role of MAPs. Concerns about patient safety, lack of proper training, additional workload implications for doctors, the potential for misrepresentation, the erosion of training opportunities for doctors, the risk of scope creep, and confusion among patients.

Conclusion:  Innovation in healthcare professional roles and functions is key to supporting the human resource shortage in health systems. The results of this survey from Multiprofessional respondents including IMGs, suggest that caution is required in how roles are positioned to the public, to avoid blurred lines of responsibility or interchange between professional roles, and to avoid confusion and consequent risk to the public. MAPs need a robust national framework of competencies, an independent regulator for licensing, and support doctors but not compete for resources, jobs, and training opportunities.


  1. WHO. World Health Organisation: Global strategy on human resources for health: Workforce 2030, <https://www.who.int/publications/i/item/9789241511131> (2020).
  2. NHS England: 2021/22 priorities and operational planning guidance, <https://www.england.nhs.uk/wp-content/uploads/2021/03/B0468-nhs-operational-planning-and-contracting-guidance.pdf> (2021).
  3. Jones, R. F. & Korn, D. On the cost of educating a medical student. Acad Med 72, 200-210, doi:10.1097/00001888-199703000-00015 (1997).
  4. Densen, P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc 122, 48-58 (2011).
  5. Lane, J., Shrotri, N. & Somani, B. K. Challenges and expectations of international medical graduates moving to the UK: An online survey. Scottish Medical Journal 0, 00369330241229922, doi:10.1177/00369330241229922.
  6. Hooker, R. S. & Everett, C. M. The contributions of physician assistants in primary care systems. Health Soc Care Community 20, 20-31, doi:10.1111/j.1365-2524.2011.01021.x (2012).
  7. <https://ayush.gov.in/alldomains.html#education_content> (Health - Introduction to Ayush Systems of Medicine).
  8. Hu, S. W. Barefoot doctors: A solution to the dilemma of COVID-19 prevention and control in rural areas of economically underdeveloped countries. Front Public Health 10, 1020312, doi:10.3389/fpubh.2022.1020312 (2022).
  9. FPA. Faculty of Physician Associates. Who are Physician Associates?, <https://www.fparcp.co.uk/about-fpa/who-are-physician-associates> (
  10. Malone, R. The role of the physician associate: an overview. Irish Journal of Medical Science (1971 -) 191, 1277-1283, doi:10.1007/s11845-021-02661-9 (2022).
  11. UK Parliament. Anaesthesia associates and physician associates, <https://lordslibrary.parliament.uk/anaesthesia-associates-and-physician-associates/#fn-15> (2024).
  12. NHS Employers. Physician Associates. Information for employers on the physician associates role and how it fits within the NHS., <https://www.nhsemployers.org/articles/physician-associates> (2024).
  13. Guest, B. N., Chandrakanthan, C., Bascombe, K. & Watkins, J. Physician associate prescribing: perspectives, practices and pathways. Future Healthc J 9, 274-281, doi:10.7861/fhj.2022-0031 (2022).
  14. Drennan, V. M. et al. What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study. BMJ Open 9, e027012, doi:10.1136/bmjopen-2018-027012 (2019).
  15. Kartha, A. et al. Nurse practitioner and physician assistant scope of practice in 118 acute care hospitals. J Hosp Med 9, 615-620, doi:10.1002/jhm.2231 (2014).
  16. Timmermans, M. J. et al. Physician assistants in medical ward care: a descriptive study of the situation in the Netherlands. J Eval Clin Pract 22, 395-402, doi:10.1111/jep.12499 (2016).
  17. Halter, M. et al. Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes. BMJ Open 10, e037557, doi:10.1136/bmjopen-2020-037557 (2020).
  18. King, N. M. A. & Helps, S. Comparing physician associates and foundation year 1 doctors-in-training undertaking emergency medicine consultations in England: a quantitative study of outcomes. BMJ Open 14, e078511, doi:10.1136/bmjopen-2023-078511 (2024).
  19. Halter, M. et al. Contribution of physician assistants/associates to secondary care: a systematic review. BMJ Open 8, e019573, doi:10.1136/bmjopen-2017-019573 (2018).
  20. Tonkin, T. BMA sets out responsibilities of MAPs, <https://www.bma.org.uk/news-and-opinion/bma-sets-out-responsibilities-of-maps> (2024).
  21. NHS England. Physician Associate Role (Primary Care) Impact Case Study, <https://www.hee.nhs.uk/our-work/medical-associate-professions/impact-case-studies/physician-associate-role-primary-care-impact-case-study> (
  22. Berkowitz, O. & Kussmaul, C. J. L. Take Two of These and Call Me in the Morning: How Global Physician Assistants Cope With Limited Medication Prescribing Rights. J Physician Assist Educ 29, 184-187, doi:10.1097/jpa.0000000000000207 (2018).
  23. Halter, M. et al. Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment. Clin Med (Lond) 17, 126-131, doi:10.7861/clinmedicine.17-2-126 (2017).
  24. Jackson, B., Marshall, M. & Schofield, S. Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach. Br J Gen Pract 67, e785-e791, doi:10.3399/bjgp17X693113 (2017).
  25. General Medical Council. PA and AA regulation, <https://www.gmc-uk.org/pa-and-aa-regulation-hub> (
  26. Oliver, D. David Oliver: The fractious debate over physician associates in the NHS. BMJ 383, p2449, doi:10.1136/bmj.p2449 (2023).
  27. Hashim, A. Educational challenges faced by international medical graduates in the UK. Adv Med Educ Pract 8, 441-445, doi:10.2147/amep.S126859 (2017).
  28. GMC. General Medical Council. Spotlight on SAS doctors and LE doctors: analysis of Barometer survey 2022 results, <https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/research-and-insight-archive/spotlight-on-sas-doctors-and-le-doctors-analysis-of-barometer-survey-2022-results> (2023).
  29. BAPIO Impact of Physician Associates on International Medical Graduates, <https://www.bapio.co.uk/impact-of-physician-associates-on-international-medical-graduates/> (2024).
  30. Royal College of Physicians. EGM update: fellows’ ballot results announced, <https://www.rcplondon.ac.uk/news/egm-update-fellows-ballot-results-announced> (
  31. BMA urges House of Lords to block the regulation of physician and anaesthesia associates over risks to patient care, <https://www.bma.org.uk/bma-media-centre/bma-urges-house-of-lords-to-block-the-regulation-of-physician-and-anaesthesia-associates-over-risks-to-patient-care> (2024).
  32. British Medical Association. BMA sets out first national guidance for the role and responsibilities of physician associates in major intervention for patient safety, <https://www.bma.org.uk/bma-media-centre/bma-sets-out-first-national-guidance-for-the-role-and-responsibilities-of-physician-associates-in-major-intervention-for-patient-safety> (2024).
  33. NHS Employers responds to BMA guidance on the role of MAPs, <https://www.nhsemployers.org/news/nhs-employers-responds-bma-guidance-role-maps> (2024).
  34. NHS England’s position on physician associates, 7 February 2024 letter to Royal College of Physicians, <https://www.england.nhs.uk/long-read/nhs-englands-position-on-physician-associates-7-february-2024/> (2024).