The evaluation of the National Physician Associate Expansion Programme   

The research  


An innovative workforce programme in England sought to create opportunities for more clinicians to experience working with PAs through the recruitment of experienced American PAs for a two year period (a visa period) to work in the National Health Service (NHS). 

 The aim of the programme was that the experienced PAs would demonstrate the contribution they could make to patient experience, act as ambassadors for their profession and support the clinical education of the soon to be burgeoning numbers of student PAs.  

The programme recruited PAs in the US in the winter of 2015/16 to commence employment with NHS hospital organisations (known as trusts) in four regions of England in the summer of 2016.  The evaluation was undertaken from 2016-2018. 

Key findings from the multi-site case (eight) organisational study

Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates.

The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.


  1. Drennan VM, Calestani M, Taylor F, Halter M, Levenson R. Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study. JRSM Open. 2020 Nov 27;11(10):2054270420969572. doi: 10.1177/2054270420969572. PMID: 33294201; PMCID: PMC7705788. 
  2. Taylor F, Drennan VM, Halter M, Calestani M. Integration and retention of American physician assistants/associates working in English hospitals: A qualitative study. Health Policy. 2020 May;124(5):525-530. doi: 10.1016/j.healthpol.2020.03.001. Epub 2020 Mar 16. PMID: 32201057.
  3. Taylor F, Halter M, Drennan VM. Understanding patients' satisfaction with physician assistant/associate encounters through communication experiences: a qualitative study in acute hospitals in England.BMC Health Serv Res. 2019 Aug 28;19(1):603. doi: 10.1186/s12913-019-4410-9.

Acknowledgement & Disclaimer 

This work was supported by a NHS innovation and workforce development fund for evaluation of the National Physician Associates Expansion Programme administered by Hillingdon Hospitals NHS Foundation Trust. The views expressed in this paper are those of the authors and not those of the funders or the NHS.Double click to edit the text.