The contribution of physician associates in secondary care in England (PA-SCER)  research study 

What is the background to the study? 

Physician associates are a new professional group in health care teams in the National Health Service (NHS) in the United Kingdom. The Department of Health defines the physician associate as: …a new healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision. (Department of Health Competence and Curriculum Framework for the Physician Associate 2006, updated 2012)

 Increasing numbers of hospitals in  the UK were employing physician associates in a widening range of medical and surgical specialties.   However, as they are so new to the NHS, there is little evidence as to what work the physician associates undertake in the medical or surgical teams or what difference they make to patients treatment, the quality of the service or the cost. The study addressed these questions reporting in 2019.


Where can I find out more about physician associates?

More information about the education and work of physician associates can be found on the webpage of the Faculty of Physician Associates at the Royal College of Physicians

The research & key papers 

We used a qualitative and quantitative methods in 4 work-streams .  The study started in 2015 , ended in 2018 and the final report was published in 2019. 

The main papers from the study were: 

  1. Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, Gabe J, Gage H, Levenson R, de Lusignan S, Begg P, Parle J. The role of physician associates in secondary care: the PA-SCER mixed-methods study. Southampton (UK): NIHR Journals Library; Health Services and Delivery Research Volume: 7, Issue: 19, June 2019 . 
  2. Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, Gabe J, Gage H, Levenson R, de Lusignan S, Begg P, Parle J. What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study. BMJ Open. 2019 Jan 30;9(1):e027012. doi: 10.1136/bmjopen-2018-027012. PMID: 30700491; PMCID: PMC6359738.
  3. Halter M, Drennan V, Wang C, Wheeler C, Gage H, Nice L, de Lusignan S, Gabe J, Brearley S, Ennis J, Begg P, Parle J. 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. 2020 Sep 1;10(9):e037557. doi: 10.1136/bmjopen-2020-037557. PMID: 32873677; PMCID: PMC7467515.

Key findings 

From organisational case study research in six hospitals, the team found that physician associates were often credited as providing stability in the medical/surgical team. This benefited patients through continuity of presence on the inpatient wards, increasing the medical/surgical teams’ accessibility for patients and nurses. Patients themselves, while often unaware of the differences from doctors, were generally supportive of the new role.

In-depth case note reviews at six hospitals showed that the patient outcomes and consultation records of junior doctors and physician associates in the emergency department were comparable. A random sample of 613 patient records was analysed. The re-attendance rate within seven days was 9% for physician associates and 7% for FY2 doctors (odds ratio 1.33, 95% confidence interval 0.69 to 2.57).

Physician associates were often in the position to build up a solid knowledge of their working environment as their roles were frequently static and developed to fulfil specific functions within the team. This knowledge revolved around departmental policies and practices, individual consultants, as well as the hospital itself and was particularly valued by junior doctors who frequently moved hospitals. 

A summary of the study can be found at NIHR Dissemination Centre Signals 

More publications 

  1. Halter M, Wheeler C, Pelone F, Gage H, Lusignan S, Frost-Bridges E, Parle JV, Grant R, Gabe J, Nice L. The contribution of physician assistants/associates to secondary care: a systematic review. BMJ Open.  2018 Jun 19;8(6):e019573. doi: 10.1136/bmjopen-2017-019573.
  2. Halter, M., Wheeler, C., Drennan, V.M., de Lusignan, S., Grant, R., Gabe, J., Gage, H., Ennis, J. and Parle, J., 2017. Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment.Clinical Medicine, 17(2), pp.126-131.
  3. Wheeler, C., Halter, M., Drennan, V.M., de Lusignan, S., Grant, R., Gabe, J., Gage, H., Begg, P., Ennis, J. and Parle, J., 2017. Physician associates working in secondary care teams in England: Interprofessional implications from a national survey. Journal of interprofessional care, 31(6), pp.774-776.