Physician Associates in General Practice in England: a challenge to professional boundaries

Like other health care systems, the National Health Service (NHS) in England faced with medical staff shortages and rising costs, has looked to new staffing configurations. One solution has been to employ physician associates (PAs). PAs are trained in the medical model to assess, diagnose and commence treatment under the supervision of a physician. This paper explores the effects on professional boundaries of introducing a completely new professional group into health care services and the workforce. It draws on a study completed in 2014 of the effect of PAs working in general practice (the medical and nursing primary care services in the UK). From documentary analysis, interviews with professionals and managers at the macro level (e.g. officers of the Department of Health and Royal Colleges n=25) and at the micro with General Practitioners, nurse practitioners and practice staff (n=30) as well as observation at clinical and professional meetings, it is argued that the professional boundaries become malleable and subject to negotiation at the micro level of service delivery. However, at the macro level the stratification within professional groups creates nuanced responses from acceptance to hostility in the face of a new and potentially competing, occupational group.