The Irish Nurses and Midwives Organisation (INMO) “opposes” the introduction of physician assistants (PAs) in Ireland. The position is revealed in its submission to a HSE review of the PA role.
The submission, released to the Medical Independent (MI) under Freedom of Information law, outlined: “The INMO opposes the introduction of physician associates in Ireland on the grounds that international evidence does not demonstrate safety, efficacy, or added value, and such a move would undermine patient safety and public confidence in the health service.”
The INMO acknowledged that the PA role was long established in the United States (US). However, it argued that the US operated a “fundamentally different” healthcare model.
The union said investment must focus on expanding training places for nurses/midwives and advanced and specialist posts. It said these advanced roles are regulated, evidence-based, safeguard patient safety, and improve outcomes.
Submissions from individual consultants to the review process were positive about PAs. However, submissions from three postgraduate medical training bodies reflected concerns relating to patient safety, NCHD training, and medical workforce planning.
According to a submission signed by five consultants at Beaumont Hospital in Dublin: “We strongly support the further integration of PAs across the Irish health service. With clear governance, regulation, and defined career pathways, their role can provide continuity, service development, and essential support for both patients and clinical teams.”
They said the PA on their team works “in close collaboration” with the consultants and registrars, with “clear pathways” for supervision and escalation.
Another submission from a consultant at Beaumont stated: “The addition of a physician associate has only enhanced patient care, safety, and consistency with which we look after our patients. I have no doubt that if this role was to be rescinded or taken away, it would leave a large deficit which would be difficult to fill.”
A submission from Cavan General Hospital outlined: “Their scope [at the hospital] is well defined, governance arrangements provide clarity and accountability, and their contribution to continuity of patient care and engagement is notable. Challenges remain around role clarity and limitations in acute care, but with safe deployment and appropriate clinical oversight, they represent a strong asset to the Irish healthcare system.”
The PAs at the hospital report to a named consultant “ensuring accountability and clarity of supervision”. Their work is “always consultant-led and delegated by same or [the] SpR, which helps define professional boundaries.”
There are currently 38 PAs working in HSE-funded services. A further 20–25 are working in private healthcare settings.
The Independent Review of the role of Physician Assistant in the Irish Public Health System was published in May. According to the review, PAs were “consistently” described as providing valuable continuity and organisational support within consultant-led teams. “Their permanent presence contributes to safer care through consistent documentation, reliable follow-up processes, and support for multidisciplinary communication, while freeing NCHDs to focus on training and clinical decision-making.”
However, the role had evolved without a “clear, nationally agreed” definition of its purpose, scope of practice, or governance framework. This had resulted in “considerable variability” across sites, uncertainty for clinicians and PAs, and avoidable risk
The review made recommendations to support safe deployment of PAs, particularly relating to governance structures and scope of practice. Diagnosis is among the activities that must not be delegated to a PA.
A HSE spokesperson told MI it is working with stakeholders to implement the recommendations. It is also engaging with the Department of Health to secure a grade code and salary scale, relevant to the scope of practice outlined in the review. This will require approval from the Department of Public Expenditure. Recruitment of new PAs “remains on hold” until this matter is concluded. See news feature, p4-6.
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