More than 1,000 physician associates (PAs) could be entering the NHS workforce annually after the General Medical Council (GMC) formally approved dozens of training courses aimed at preparing them for clinical practice.
In a move that marks a significant step in the expansion of assistant roles within the health service, the GMC has announced its approval of 36 courses across the UK – 33 for PAs and three for anaesthesia associates (AAs). Collectively, these courses have capacity for up to 1,059 physician associates and 42 anaesthesia associates to qualify each year.
PAs, who typically hold an undergraduate degree in a life or health science discipline, undergo two years of postgraduate training. Once qualified, they work under the supervision of doctors and are involved in a wide range of clinical duties including diagnosing patients, taking medical histories, performing examinations, analysing test results, and developing treatment plans.
Anaesthesia associates, meanwhile, work as part of the surgical and anaesthetic teams, supporting the safe delivery of anaesthesia and patient monitoring during operations.
The GMC took over regulation of both professions in December 2024, and says that approving these training courses will ensure that the public, healthcare employers and medical colleagues can have confidence in the competence and safety of newly qualified associates.
“This is an important milestone in the regulation of PAs and AAs,” said Professor Colin Melville, the GMC’s Medical Director and Director of Education and Standards. “It will provide assurance, now and in the future, that those who qualify in these roles have the appropriate skills and knowledge that patients rightly expect and deserve.”
He added: “As a regulator, patient safety is paramount, and we have a robust quality assurance process for PA and AA courses, as we do for medical schools.”
Despite the optimism, the announcement comes amid growing debate over the role of physician associates in the NHS, particularly in the wake of the tragic death of Emily Chesterton in 2022. The 30-year-old died from a pulmonary embolism after being misdiagnosed twice by a PA. The case has fuelled concerns about the boundaries of practice and level of oversight for these healthcare professionals.
While 33 PA courses received approval, four – at Bradford, Greater Manchester, Queen Mary University of London, and Sheffield Hallam – were approved with “conditions” after issues were raised during the assessment process. These institutions have been required to implement targeted action plans to resolve the concerns.
One course, at the University of East London, failed to gain GMC approval altogether.
The three courses for anaesthesia associates – located at the University of Birmingham, University College London, and Lancaster University – were all fully approved without conditions.
NHS Employers chief executive, Danny Mortimer, welcomed the development, describing the formal accreditation of PA and AA training as “an essential component of regulation and public safety.” However, he also noted the importance of ensuring ongoing professional development and appropriate supervision of associates once in clinical roles.
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Meanwhile, the British Medical Association (BMA) expressed concern over the GMC’s decision to approve courses ahead of the completion of the Leng Review – a government-commissioned inquiry into the future of PAs and AAs.
Professor Phil Banfield, chairman of the BMA council, said it was “difficult to understand” how course approvals could be finalised before the review’s findings are published. “The medical profession has alarming worries about the quality and robustness of these courses, with reports of exams with 100% pass rates,” he said.
The BMA has called for an independent panel of doctors, unaffiliated with course providers, to establish realistic and safe curriculum expectations for these roles, especially given the condensed nature of their two-year training programmes.
As the NHS faces growing workforce pressures and increasing patient demand, the integration of more physician and anaesthesia associates is seen by many as a necessary measure. Yet the debate over training quality, scope of practice, and patient safety is unlikely to subside any time soon.
