RCPsych publishes final report on Physician Associates

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Physician Associates (PAs) are a relatively new part of the mental health workforce, working under supervision to support multi-disciplinary teams.

Given the growing number of PAs in the NHS, the Royal College of Psychiatrists commissioned a review to ensure their employment in psychiatry is grounded in clinically led, evidence-based care that upholds patient safety and supports the development of psychiatrists.

We are pleased to publish the report and recommendations of the RCPsych Physician Associates Task and Finish Group. The guidance, discussed and approved by the RCPsych Council on Friday 4 July 2025, provides clear direction for employers of PAs working in psychiatry and wider mental health services.

The Task and Finish Group was co-chaired by the RCPsych Dean, Professor Subodh Dave, and Dr Laura Thorn, immediate past Chair of the RCPsych Psychiatric Trainees’ Committee (now known as the Psychiatric Resident Doctors’ Committee). It brought together a wide range of voices including, among others, representatives from the SAS doctors, a patient representative, RCPsych Council, and a Physician Associate working in mental health.

Over the past year, the group carefully considered the concerns, expectations and contributions from across the membership and beyond, including feedback from psychiatrists, employers, sector stakeholders and other Medical Royal Colleges.

Throughout the review, the group prioritised patient safety, the need for safe, high-quality mental healthcare that protects training time for doctors, ensures appropriate levels of supervision, transparency, and defines the roles of PAs clearly within multidisciplinary teams. Ensuring that PAs work within well-governed, clearly scoped roles is vital. So too is the expectation that supervision is provided by senior psychiatrists, such as consultants or SAS doctors, and that training needs are assessed without compromising the experience of psychiatric resident doctors.

It is essential that employers provide a clear quality and economic justification for these roles, one that includes not only the direct costs but also the implications for senior supervision and support across the wider multidisciplinary team.

Dr Lade Smith CBE, President of the Royal College of Psychiatrists, said:

“It is important to acknowledge the ongoing concern surrounding the role of Physician Associates, and I want to be absolutely clear – PAs are not, and must not be seen as, substitutes for psychiatrists. Clarity on this point is vital.

“Doctors across all specialties, including psychiatry, have raised valid concerns about the rapid expansion of PA roles particularly regarding their scope of practice, training, supervision, and most recently, regulation.

“Over the past year, the Task and Finish Group has engaged in extensive discussions that have been instrumental in shaping the final recommendations. We are deeply grateful to all who contributed their insights and perspectives. Throughout this process, our guiding priority has remained the care and safety of patients, underpinned by clinically-led, evidence-based approaches.

“This will be an ongoing conversation with more work to be done. I look forward to the publication of the Leng Review, with whom we shared our interim guidance, and will continue these conversations across the Academy, the GMC and the membership to ensure we are at the heart of decisions made for our patients.”

View the full report: Physician Associate Review