The voice of nursing in the ongoing physician associate (PA) review is “scarce” despite the implications the role has for advanced nurse practitioners (ANPs), a conference has heard.
Members of the Royal College of Nursing (RCN) this week called on the college’s governing council to investigate the impact of PAs on nursing.
“It’s about protecting nurses, ensuring we are not devalued”
Onyekachim Umenze
The motion – at the 2025 RCN Congress, held in Liverpool this week – was passed.
It comes as, in November 2024, the government ordered a review of PAs and anaesthesia associates (AAs) in England, after growing concern about their use in the NHS and the risk of doctor substitution.
The review, being chaired by Professor Gillian Leng, is set to examine the safety of these roles, how they support wider health teams and their place in providing patients with good-quality care.
It will also look at how effectively these roles are deployed in the NHS and will offer recommendations on how new roles should work in the future.
At RCN Congress, members set out some of their concerns around the PA role, and what their implementation might mean for nurses, particularly those working at advanced practice level.
Onyekachim Umenze, from the RCN’s West Midlands branch, said the growing presence of PAs in the NHS “raises urgent questions for our profession”.
She said: “While collaborative, multidisciplinary care is essential, we must now stop and examine the real impact this role is having, not just on patient care delivery, but nurses themselves.”
There are around 3,500 PAs and 100 AAs working in the NHS, including in GP surgeries and hospitals.
They can order some scans, take medical histories and conduct physical examinations, but cannot prescribe.
Since December 2024, the General Medical Council has been the regulator of PAs and AAs.
Ms Umenze argued that “regulation alone doesn’t address the full picture”.
She said: “We are seeing physician associates with shorter training and a different professional background being placed in positions that were traditionally being held by advanced nurse practitioners.
“This isn’t just a question of role clarity, it’s about employment opportunities, professional identity and fair workforce planning.
“It’s about protecting nurses, ensuring we are not devalued.”
Meanwhile, Jenny Riley, from the RCN’s advanced nurse practitioner forum, told congress that there was a “strong medical voice” throughout the terms of reference in the Leng Review but that the input from nursing was “scarce”.
She said: “We urge congress to agree this resolution to enable the scrutiny and that nursing voice to be heard within this independent review of the PAs.”
Ms Riley said the review should consider the pressure on nurses to provide supervision for PAs in practice, which for some nurses “can feel very uncomfortable”.
She added that there was “continued confusion” among healthcare staff and the public around “the differences of educational preparation and clinical experience” of PAs compared to ANPs.
Luke Evans, chair of the RCN’s public health forum, said the PA debate was “not about opposition” to the role but rather about “ensuring that nursing voices are part of the conversations as healthcare roles continue to evolve”.
“Pointless professional protectionism will not benefit patients”
Ruth Stafferton
He noted that PAs had, in recent months, experienced “bullying and hostility from the medical community, both online and in their clinical environments”.
Mr Evans added: “I want to be clear that this debate is no place for bullying [or] for criticising individuals or some bad eggs.
“They are not representative of the entire physician associate workforce and these individuals have gone into the medical profession in order to help people.
“This is something incredibly noble and this is something that will resonate with us all.”
Not everyone agreed that the RCN governing council should investigate the impact of PAs on the profession while the Leng Review was ongoing.
Ruth Stafferton, from the college’s Liverpool and Knowsley Branch, highlighted that there were around 3,000 PAs working in the NHS compared to more than 400,000 nurses.
“The impact of this small number of PAs on one of the largest staff groups in the NHS alone does not warrant an investigation by the RCN,” she said.
“Pointless professional protectionism will not benefit patients.
“The government has commissioned the Leng report into the PA role – please leave this to them and, until then, get to know your PAs. Our roles complement each other, not compete.”
Last year, the Nursing and Midwifery Council said it would monitor the review into PAs closely, in case there was any learning to be had for nursing.
It comes as concerns have been raised that the toxic debate about PAs could lead to ANPs and other nurses becoming collateral damage.
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