The role of physician associates is under the spotlight again after it was revealed that they have been used in senior roles at Birmingham Children’s Hospital.

Physician associates (PAs), who were introduced nationally in 2003 to support doctors, have worked as the responsible clinician in Birmingham Children’s Hospital’s liver unit, with a consultant on call.

Medics across a third of the country seek specialist advice from the liver unit at Birmingham Children’s Hospital, and it has been revealed that the PA at the unit advised doctors who contacted the hospital.

More work is needed to define the role of PAs and the training pathways, the Royal College of Paediatrics and Children’s Health (RCPCH) has said after its members raised concerns, while the British Medical Association, the doctors’ union, said recruitment of PAs should be delayed until proper regulation and supervision is established.

The trust in charge of Birmingham Children’s Hospital has said its PAs do not work in isolation.

Physician associates are not doctors – normally, they have science degree and will have completed a post-graduate two-year qualification. They cannot prescribe medication.

PAs have been in place at Birmingham Children’s Hospital for a decade. Records show some PAs on the hospital’s tier two rotas, which are normally staffed by registrars – senior doctors.

The hospital’s trust said it normally takes about three years for a PA to be added to a tier two rota and the decision to allow them to give advice to other centres would depend on their competency.

The trust’s chief medical officer, Dr Fiona Reynolds, said the safety of patients would not be compromised, adding: “Although small in number, [the PAs] skills and dedication to offering the best for our patients complements that of their colleagues in all fields – all of which are hugely valued by our trust.”

The Department of Health and Social Care announced in July that it plans to increase the number of PAs across the country to 10,000 by 2037.

The government is planning to bring in regulations for PAs by the end of 2024, as the role is currently unregulated.

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