Medical associate professions briefing

This briefing covers the increasing presence of MAPs (medical associate professions) in the NHS, their regulation, prescribing rights and the BMA’s view on the these developments.

Location: UK
Audience: All doctors
Updated: Monday 25 September 2023
NHS Structure Article Illustration

What are MAPs?

The following three professions are part of the MAPs (medical associate professions) grouping. These are the only professions that are considered to be MAPs:

  1. physician associates (PAs)
  2. anaesthesia associates (AAs) – known as physician’s assistants (anaesthesia) prior to 2019
  3. surgical care practitioners (SCPs)

Advanced Critical Practitioners withdrew from the programme in April 2022 – read their statement.

For more information about the training and work of these professionals, please see our guide to new clinical roles within the NHS.

MAPs numbers in the UK

Physician associates are by far the most numerous of the MAPs. The Faculty of Physician Associates estimate that there are currently around 3000 qualified PAs working in the UK.

As of 2021, there are around:

  • 300 AAs working in the NHS
  • 600 surgical care practitioners working in the NHS.

The decision to group the professions

The move to bring the professions under a single umbrella began with HEE (Health Education England) in 2014, with the intention to work ‘towards a common education and training programme to support a route to statutory regulation’. This originally applied to PAs, AAs and SCPs with ACCPs added later (with ACCPs having withdrawn since).

HEE created a MAPs oversight board and invited the BMA to send a representative to its Career Framework & Quality subgroup along with representatives from employers, royal colleges and the devolved nations.

The group’s task was ‘to describe quality management, training and a career framework for MAPs, so that a clear professional identity is developed which supports arrangements for statutory regulation’. The work of the subgroup has now been subsumed into HEE’s MAPs oversight board, on which the BMA is represented.

MAPs differ in crucial ways; in terms of the tasks they perform, the ways that they train and their entry requirements. These differences mean that developing a single career framework is challenging. Development is ongoing and with preparations underway for regulation, the role of the GMC may be crucial in the future of a combined MAPs career framework.

Reasons for the introduction of MAPs

The appearance of MAPs in UK healthcare reflects a trend towards the development of multi-disciplinary teams as well as ensuring that there is sufficient workforce to meet demand in the NHS. 

PAs are seen by the UK government as one of the ways in which workforce pressures in the NHS can be alleviated. In June 2015, the then secretary of state for health, Jeremy Hunt, announced that 1,000 PAs would be introduced into general practice in England to assist in tackling GP workload pressures (as of August 2022 the number stands at 621). 

The devolved governments have also identified PAs as a potential way to address pressures. 

The NHS in England remains committed to developing multi-disciplinary working and continues to promote PAs as a major component of the future workforce, as demonstrated in the NHS Interim People Plan.

Regulatory status

None of the MAPs are currently regulated specifically for their role as MAPs, however surgical care practitioners and advanced critical care practitioners are subject to statutory regulation through previous roles.

Unlike PAs and AAs, SCP roles can only be taken up by individuals who are already registered healthcare professionals. 

Currently, physician associates and anaesthesia associates are not subject to any form of statutory regulation, however following a 2017 consultation, PAs and AAs are now scheduled for statutory regulation by the GMC.

BMA response to the consultation

The BMA response to the consultation argued that all of the medical associate professions should be regulated and that HCPC (Health & Care Professions Council) should take responsibility for regulation, rather than the GMC.

The choice of GMC as regulator

The GMC are to take on the role of regulator for PAs and AAs. They currently estimate that regulation will be in place towards the end of 2024.

The DHSC (Department of Health and Social Care) provided the following reasons for their choice.

  • The need to be assured that the chosen regulator will be best able to ensure effective public protection. Based on the independent assessment made by the PSA (Professional Standards Authority) on an annual basis, the HCPC has failed 6 out of 10 of the fitness to practice standards set by the PSA for the last two years. In contrast, the GMC continues to meet all of the PSA standards. 
  • PAs and AAs are both trained to the medical model and work closely with medical practitioners. Regulation by the GMC will mean that the organisation will have responsibility and oversight of all three professions allowing them to take a holistic approach to the education, training and standards of the roles.
  • The majority of respondents to the consultation were in favour of the GMC taking on regulation, including the professional bodies representing the two roles and medical royal colleges (59% for GMC, 20% for HCPC from 3063 total responses).

The decision to only regulate PAs and AAs

The government response to the MAPs consultation (published in February 2019) did not rule out the future regulation of SCPs and ACCPs.

PAs and AAs must hold an undergraduate degree, usually biomedical sciences or a health-related science. To become a PA or an AA there is no requirement to be a registered healthcare professional. These roles are described as ‘direct entry’ roles and currently they are not subject to any form of statutory regulation.

To become a ACCP or an SCP, it is necessary to already be a registered healthcare professional. These roles, therefore, do not have direct entry and practitioners will be subject to statutory regulation through their background role. 

It was decided to prioritise the two professions that are currently not subject to any form of statutory regulation.

Decisions on regulation and the career framework will apply across the UK.

Can MAPs prescribe?

Currently, MAPs are not given prescribing rights as a result of being a MAP. However, prescribing is a part of the role for both SCPs. Candidates for SCP roles must already be registered healthcare professionals, meaning that they are eligible to take a qualification in non-medical prescribing.

AAs and PAs are currently not permitted to prescribe or request ionising radiation. Unlike SCPs, AAs and PAs do not need to be registered healthcare professionals from a previous role. However, a small number of PAs have previously held prescribing roles and are registered health care professionals, and this means that they personally retain those prescribing rights.

We believe that this is potentially confusing for patients, clinicians and employers and in 2019 the BMA endorsed a statement from the Royal College of Physicians and the Faculty of Physician Associates which recommended that no PA should prescribe until all PAs are able to do so.

The consultation on regulation of MAPs included questions about the prescribing rights for MAPs, but in their response, the government stated that prescribing would be treated as a separate question and that a separate consultation would follow.

The BMA's view

We recently published position statements:

Professional indemnity coverage

Effective working with MAPs

We have produced guidance that outlines ways to improve how doctors and medical associate professions work together.

The set of principles and doctors’ experiences that are highlighted in the guidance will provide employers, doctors and MAPs with ideas that will be beneficial to their working life.