Minister Donnelly has asked officials to ‘progress’ physician associate grade

Minister for Health Stephen Donnelly “wants to see” a grade for physician associates (PAs) introduced into the Irish health service and “has asked his officials to progress this”, the Department has informed the Medical Independent (MI).

“Physician associates are not currently a recognised grade in the Irish health service so the Department of Health is currently engaging with the HSE regarding an evaluation of the role with a view to progressing the matter,” added the Department spokesperson.

“Having sufficient capacity in the health workforce and the appropriate configuration of staff and skill-mix are integral to the delivery of safe and timely health services. The Department of Health is supportive of any initiative which ensures that sufficient professionals are trained, attracted, and retained in the areas where healthcare need is anticipated.”  

There are currently 62 PAs working in the Republic of Ireland, according to statistics from RCSI, which runs a MSc programme in PA Studies and has been advocating for recognition and regulation. Most PAs are working in public and private hospitals, and a smaller number are based in primary care.

PAs are trained in the medical model and work under consultant or GP supervision. They support physicians and surgeons in the diagnosis and management of patients and are trained to perform several roles, including taking medical histories, performing examinations, making diagnoses and analysing test results. They are well established in US healthcare and growing considerably in the NHS. The UK’s Department of Health and Social Care is currently consulting on the legislative provisions that will provide the General Medical Council with the necessary powers and duties to regulate PAs.

PAs work under supervisory arrangements with their consultant. The Irish Society of Physician Associates (ISPA) manages a voluntary register that is open to graduates from PA programmes in Ireland, the UK, the US and Canada. The register allows employers and potential employers to confirm whether an applicant or employee is fully qualified. Under this system, PA graduates must undertake a national certifying exam and a recertification exam every six years, as well as engage in continuing professional development.

However, in the absence of regulation, PAs cannot order ionising radiation or prescribe medications. There is also no statutory regulatory process in place if serious concerns were to be raised about a PA’s conduct or performance. Recognition of the grade is considered the first step towards establishing a regulatory system for the profession.

The PA role was first introduced in Irish healthcare in 2015 when RCSI commenced a small-scale two-year pilot at Beaumont Hospital’s surgical directorate involving four overseas-qualified PAs. In 2016 the College launched the first (and to date only) PA postgraduate course in the Republic of Ireland (Ulster University also offers a programme). Prospective candidates must have a science-related/health sciences degree to gain admission to the “fast-paced” two-year course at RCSI.

Last year, the Department informed MI it would need to consider “the benefits of the introduction of a further wider pilot project” that would “better inform future deliberations” about potentially granting recognition for a PA grade.