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What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study
  1. Vari M Drennan1,
  2. Mary Halter1,
  3. Carly Wheeler1,
  4. Laura Nice2,
  5. Sally Brearley3,
  6. James Ennis2,
  7. Jonathan Gabe4,
  8. Heather Gage5,
  9. Ros Levenson6,
  10. Simon de Lusignan7,
  11. Phil Begg8,
  12. James Parle2
  1. 1 Centre for Health and Social Care Research, Joint Faculty of Kingston University and St. George’s University of London, London, UK
  2. 2 Institute of Clinical Sciences, University of Birmingham, London, UK
  3. 3 Centre for Public Engagement, Joint Faculty of Kingston University and St. George’s University of London, London, UK
  4. 4 Department of Criminology and Sociology, School of Law, Royal Holloway, University of London, Egham, UK
  5. 5 Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
  6. 6 Independent consultant, London, UK
  7. 7 Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
  8. 8 Royal Orthopaedic Hospital, Birmingham, UK
  1. Correspondence to Dr Vari M Drennan; v.drennan{at}


Objectives To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients’ experience and outcomes and the organisation of services.

Design Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis.

Setting Six acute care hospitals in three regions of England in 2016–2017.

Participants 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives.

Results A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams’ workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors.

Conclusions This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice.

  • organisation of health services
  • physician associates
  • physician assistants
  • workforce
  • hospitals
  • mixed methods

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Patient consent for publication Not required.

  • Contributors Conception, design and receiving funding for the study: VMD, MH, SB, SdL, HG, JG, PB, JE, JP. Lead for PPI: SB. Acquisition of the data: CW, LN, JE, RL, MH, VMD. Analysis and interpretation of the data, drafting and critical revision of the manuscript for important intellectual content, accountable for all aspects of the work and approval of the final manuscript: VMD, MH, CW, LN, RL, SB, SdL, HG, JG, PB, JE, JP.

  • Funding This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 14/19/26). This paper presents independent research commissioned by the National Institute for Health Research (NIHR).

  • Disclaimer The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, the Health Service and Delivery Research Programme or the Department of Health.

  • Competing interests SdL is head of the Department of Clinical and Experimental Medicine at the University of Surrey, which launched a physician associate course in 2016. JP chairs the UK and Ireland Board for Physician Associate Education and was director of the physician associate course at the University of Birmingham. PB is honorary faculty at the University of Birmingham and has taught on the physician associate programme since 2008. JE teaches part time on the University of Birmingham physician associate course.

  • Ethics approval The NHS Health Research Authority approval (IRAS project ID: 181193) and NHS London Central Research Ethics Committee (REC reference: 15/LO/1339) approval were obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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