Overview
Physician Associates and Anaesthetic Associates in the UK: A Rapid Systematic Review of Published Research to Inform the Leng Review was published on SSRN (Social Science Research Network) on February 1, 2025.
The author of the paper is Trish Greenhalgh from the University of Oxford and a Fellow of the Royal College of Physicians of London.
Note: This preprint research paper has not been peer reviewed.
Abstract
This paper describes a systematic literature review of UK-based empirical research on physician associates (PAs) and anaesthetic associates (AAs), published in peer-reviewed journals between January 2015 and January 2025. Keyword search of 3 databases, author search, citation-tracking and mining 12 previous systematic reviews identified almost 5000 titles. Manual screening of these identified 47 eligible papers. These papers were appraised and collated under 6 topic headings:
- clinical performance and safety;
- costs and cost-effectiveness;
- patient and public attitudes;
- other professions’ perceptions;
- experiences, training, identity and career paths of PAs; and
- policy, organisation and system research.
Overall, the literature was sparse, of variable quality, had important gaps and parts of it were out of date. It appears to support the use of PAs to complement and support the work of ward-based MDTs in an ongoing way, when and insofar as the roles they are given are appropriate to the PA’s competence and experience, adequately supervised and have been optimally embedded in team relations, routines and activities. A more limited evidence base suggests that there may be a role for PAs in emergency departments too, with the same caveats. PAs appear to struggle in primary care, however, because the role is more autonomous; the case mix is more diverse; decisions are more uncertain; institutional support is more limited; and supervision arrangements are more challenging. There is no evidence that PAs add value in primary care and some evidence suggesting that they do not. There is no direct evidence from research studies on the competence or safety of AAs.
Importantly, I identified no UK-based research evidence which directly examined the safety of PAs’ or AAs’ clinical decisions and actions. The absence of evidence of safety incidents in a small number of studies appears to have been misinterpreted by policymakers to mean that there are no safety concerns with the substitution of doctors with PAs. This is an error of logic which, if not corrected, is likely to cost lives.
Findings of apparent non-inferiority when PAs substitute for other staff groups in non-randomised comparative studies may obscure important unmeasured differences in quality of care. Concerns from clinicians and managers about whether PAs are competent and safe in particular clinical roles – especially in relation to managing undifferentiated, clinically complex or high-dependency patients, ordering ionising radiation, and prescribing – should be fully explored and not dismissed as “negativity”.
ASA Anaesthetist Workforce Modelling Final Report
In this recent article in The Australian newspaper[1], Professor Steve Robson discusses the ongoing crisis in the Australian public hospital system, particularly focusing on the mass resignation of psychiatrists in New South Wales and the broader implications for healthcare access and workforce shortages across the country. The article references the Anaesthetist Workforce Modelling commissioned by the ASA in 2023 and published in mid-2024.
The ASA will continue to highlight this modelling and our workforce report when advocating to all Australian governments. The solutions proposed by the ASA are eminently achievable and will help maintain access to safe, high quality care provided by Australian anaesthetists, which the community wants and expects.
[1] Robson, S. (2025). Think you’ll have access to a specialist doctor if you need one? Don’t be so sure. [online] Theaustralian.com.au. Available at: https://www.theaustralian.com.au/health/expect-access-to-a-specialist-doctor-if-you-need-one-dont-be-so-sure/news-story/f9f4fe8b65b08d52ee144952dca4cfc7. [Accessed 10 Feb. 2025].