Two decades after PAs emerged in the NHS, how did the role become embroiled in such controversy?

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By Erin Dean

When the first ‘physician assistants’ entered the NHS workforce just over 20 years ago, few could have predicted the controversy that continues to consume medical discourse today.

In 2002, an advert appeared in the New York Times and online looking for ‘physician assistants’ who would consider moving across the Atlantic to work in the Midlands for the NHS.

Struggling with a severe shortage of doctors, local health service managers had decided to import this role well-established in the US.

Within two years, three American physician assistants were working in primary care in Sandwell and 12 more in emergency departments in West Bromwich and Birmingham, according to a University of Birmingham review from 2005.

This small group is thought to be the UK’s first foray into a role - then known by the US title but later changed to physician associate (PA) - which, more than two decades later, continues to grow in the NHS. The publication of the NHS Long Term Workforce Plan last June pledged that numbers of PAs would be increased to 10,000 by 2036/37.