First introduced in 2015 as part of the continuing drive to provide safe, accessible and high-quality care for patients, the NHS has seen the expansion of medical associate professions (MAPs) working across multi-professional teams.
This article explains what these job roles are about, what that means for employers and resources to support their implementation.
Three roles have become increasingly important across both hospital and community services. These are collectively known as medical associate professions (MAPs) and they include:
Note that from December 2021 Advanced Critical Care Practioners (ACCPs) were realigned as Advanced Practitioners
The different medical associate professions
Physician associates (PAs)
PAs have completed a generalist medical education covering a broad medical curriculum. They work as part of a multidisciplinary team with supervision from a named senior doctor, such as GMC registered Consultant or General Practitioner) providing care to patients in primary, secondary and community care environments. PAs work within a defined scope of practice and limits of competence.
PAs are accountable for ensuring that the care of patients is of a high standard at all times. PAs work in hospitals, general practices and can also be deployed in mental health settings. The first physician associate roles were introduced to the NHS in 2003.
Surgical care practitioners
Surgical care practitioners are trained clinical professionals who have undergone further training to work as a member of a surgical team under appropriate supervision from a named senior doctor. The main responsibility of a surgical care practitioner is to support surgeons and other medical professionals before, during and after medical procedures.
Surgical care practitioner undertake a wide range of roles within the multidisciplinary team including preoperative assessments, assist with preparation of patients for theatres and provide assistance with surgical procedures.
On top of assisting in operating theatres, they help on wards and in clinics. Surgical care practitioners can prescribe medications relevant to their individual specialty following appropriate training for non-medically qualified prescribers.
Anaesthesia associates (AAs)
AAs were first introduced in the NHS in 2004. AAs are trained, skilled individuals who work as part of a multi-disciplinary anaesthesia team and have been trained to provide anaesthetic procedures under the supervision of a named senior doctor. Overall responsibility for the anaesthesia care of the patient remains with the named senior anaesthetist at all times.
AAs provide anaesthetic and perioperative patient care, usually with a senior Anaesthetist overseeing them. AA roles may be utilised by employers as part of the multi disciplinary team to reduce theatre downtime, leading to increased throughput and theatre utilisation.
What this means for employers
Employers have an important role to play in ensuring that they have planned and modelled their workforce well at a strategic level, and that the incentive for introducing new or extended roles into the workforce is to improve service delivery and patient experience.
Recruitment and employment policy and practice should support staff to ensure that their new recruits have qualified from recognised programmes, and that they have passed the relevant national exam within the UK (and recertification where necessary).
New staff should be well supported and integrated into the multidisciplinary teams they are working in and provided with appropriate supervision and continuous professional development.
The wellbeing of all staff should be paramount and reflected in their rotas and their training and development plans to enable flexibility and best use of professional and clinical skillsets to maximise outcomes for patients.
Regulation of medical associate professions
In October 2017, the Department of Health and Social Care (DHSC) sought views on the regulation of the medical associate professions (MAP) roles in the UK.
Following the consultation, DHSC has announced it will proceed with the statutory regulation of anaesthesia associates and physician associates. The General Medical Council (GMC) was deemed best placed to regulate AAs and PAs, and was invited to carry out this function in July 2019.
The legislative provisions have been drafted on the basis of the detailed policy proposals consulted on in Regulating healthcare professionals, protecting the public, published in March 2021.
On the 11 December 2023, the government's response to this legislation was published, with the legislation being laid before parliament on the 13 December 2023. Statutory regulations for MAPs is intended to be in place by the end of 2024.
We welcome this news and fully support the regulation of these roles. It will provide a standardised framework of governance and assurance for clinical practice and professional conduct to enable these healthcare professionals to make a greater contribution to patient care.
In the meantime, anaesthesia associates and physician associates are able to apply for inclusion on managed voluntary registers held by the Royal College of Anaesthetists and the Royal College of Physicians respectively.
Although we acknowledge the benefits of voluntary registration for practitioners, patients and employers, it is also worth noting that where there are restrictions to gaining access to a managed voluntary register (such as requiring paid membership of a professional body), employers may not be able to ask for voluntary registration as an essential pre-requisite for employment.
Download our handy checklist to learn about the steps you can take to recruit and develop medical associate professionals (MAP) roles to your organisation.
This checklist includes useful steps on how to develop business plans, gain support from stakeholders, plan a recruitment campaign for MAPs, and provide an effective induction programme. It is based upon the experience of Sheffield Health and Social Care NHS Foundation Trust and the learning it has gained from its work introducing physician associates.