Friday, 04 July 2025
A new study, led by experts from the University of Nottingham, has shown that Physician Assistants (PAs) can increase patients’ access to healthcare, but they should only work under the supervision of a doctor.
The ‘Impact of physician assistants on quality of care: rapid review’ is published in the BMJ and was carried out by a group of experts from the University of Nottingham, led by Nicola Cooper, Professor of Medical Education in the School of Medicine.
In the UK, degrees in PA Studies focus on foundational knowledge and the clinical skills necessary to assist doctors in patient care. However, concerns have been raised about the implementation of the PA role in six broad areas: scope of practice, patient safety, informed consent, preferential employment conditions, additional workload of doctors supervising PAs, and impact on medical training.
This rapid review was conducted to address the impact of PAs on quality of care in response to calls for a review in to the safety and effectiveness of this new role.
Information about the safety and effectiveness of PAs is limited, but our team systematically reviewed studies which compared PA care with doctor care. We found the greatest number of studies with the most consistent results were those that found PAs practice safely and effectively when working under direct supervision, or in post-diagnostic care. The evidence is limited and does not support the safety or effectiveness of indirect supervision of PAs in undifferentiated (not-yet-diagnosed) settings.”
Forty studies were included in the review. Eligible studies were those which compared the care delivered by PAs with care delivered by doctors. The outcomes of interest were outcomes related to quality of care, including safety, effectiveness, patient-centredness, timeliness, efficiency, and equity.
A narrative synthesis – a method using findings from multiple studies using text and narrative as opposed to statistical analysis – was conducted by primary care, secondary care, PAs vs residents in hospitals, diagnosis/performance, and cost-effectiveness.
PAs can increase access to care when added to teams because they increase the number of clinical staff available to see patients. However, they are not necessarily cost-effective when compared with resident doctors or GPs, although they are cheaper to train. The review also found that patients are more likely to see a PA if they live in a socio-economically deprived area in the UK.
Professor Cooper adds: “These findings have important implications for the NHS, and how PAs are deployed safely and effectively within the service.”
The full study can be found here.
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More information is available from Professor Nicola Cooper at nicola.cooper@nottingham.ac.uk
Notes to editors:
About the University of Nottingham
Ranked 97 in the world and 17th in the UK by the QS World University Rankings, the University of Nottingham is a founding member of Russell Group of research-intensive universities. Studying at the University of Nottingham is a life-changing experience, and we pride ourselves on unlocking the potential of our students. We have a pioneering spirit, expressed in the vision of our founder Sir Jesse Boot, which has seen us lead the way in establishing campuses in China and Malaysia - part of a globally connected network of education, research and industrial engagement.
Nottingham was crowned Sports University of the Year by The Times and Sunday Times Good University Guide 2024 – the third time it has been given the honour since 2018 – and by the Daily Mail University Guide 2024.
The university is among the best universities in the UK for the strength of our research, positioned seventh for research power in the UK according to REF 2021. The birthplace of discoveries such as MRI and ibuprofen, our innovations transform lives and tackle global problems such as sustainable food supplies, ending modern slavery, developing greener transport, and reducing reliance on fossil fuels.
The university is a major employer and industry partner - locally and globally - and our graduates are the third most targeted by the UK's top employers, according to The Graduate Market in 2024 report by High Fliers Research.
We lead the Universities for Nottingham initiative, in partnership with Nottingham Trent University, a pioneering collaboration between the city’s two world-class institutions to improve levels of prosperity, opportunity, sustainability, health and wellbeing for residents in the city and region we are proud to call home.
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