In his latest blog post, Dr Jo Scott-Jones, clinical director shares some thoughts on the Physician Associate consultation. He is happy to talk to teams about the PA role, as is colleague Dr Ali Glover, a GP in Te Awamutu working with PAs (with five on their staff). 

Physician Associates are going to become part of the regulated health workforce in Aotearoa New Zealand. What general practice needs is for the regulation to allow them to work in our teams effectively, efficiently and safely to support us in our mission to provide high quality, first point of contact, comprehensive, coordinated continuous care. 

Please provide the NZMC with your feedback on the regulation.

The Physician Associate

The mismatch between population need and general practitioner service capacity has been growing for decades.

Pinnacle has recently published our population health resources which look at how demand will change over the next 15 years, and what primary care will need to look like to cope with the demand.

It will come as no surprise that our teams are going to have to change quite significantly if we are to have a functional primary care system.

One of the key lessons from this work is that medically trained people working in our communities in the future are going to have to be dealing with more complex patients, performing and interpreting more complex investigations, and doing more complex procedures than they are now.

Multiple changes are going to have to happen to enable this. Not least in the way we train, assess and fund specialist general practitioners, but also in the development and expansion of roles played by nurses, pharmacists, allied health professionals, mental health and lifestyle change practitioners.

Physician Associates (PAs) are part of this future.

Currently there are around 50 PAs working in Aotearoa, mostly in emergency departments and primary care. They are all overseas trained and currently working as 'non-regulated' health professionals under the supervision of other clinicians.

Several of you, like me, will have worked in teams with PAs and found them to be useful additions to our teams.

PAs are trained in a 'medical model' as opposed to a 'nursing', 'pharmacy' or 'paramedic' model of care (Table 1 Models of Care) and as such are closely aligned philosophically and in their approach to patients to doctors.

Table 1: Models of care

In countries where they have specific training programmes, Physician Associates have developed an expansive suite of services from supporting anaesthetic delivery, through minor surgery, to undifferentiated patient care. 

A key difference between PAs and other health professionals is the acknowledged symbiotic professional relationship they have with their medical colleagues.

PAs always work as part of a team. Their scope of practice is determined by the scope of their supervising doctor.

I imagine the PAs I have worked with as a “mini-me” seeing patients, doing what they can, but in close communication, touching base about any uncertainties, utilising their skills to provide more access to the patients we serve.

Regulation of the profession in Aotearoa New Zealand will result in the development of NZ based training programmes. It will allow PAs to initiate some investigations and is a step in the process of being able to prescribe medications. It means they will come under the provisions of the Health Practitioners Competency Assurance Act and their training, supervision and ongoing professional development will be codified.

This will all add to the safety of the public, and help us develop the PA role within our teams.

There are always concerns about any change, it is part of the process.

The main concerns in Aotearoa

• The impact of PAs needing training and supervision on other specialist training programmes.
• Confusion about the role and what it does – the term “associate” vs “assistant” is seen to be important.
• Patient safety and the implications of the UK Leng Review.

The impact of PAs needing training and supervision on other specialist training programmes 

There will be a need for training and for supervision of PAs.

Given the expansion of population health needs, there will always be a need for expanding supervision and training of new staff.

The solution lies in working out how to do this well, rather than in planning not to do it at all.

The NZMC is seeking your views on how the training and supervision of PAs should be done, and if we are going to benefit the most from regulation of the PA workforce we need to feedback that PAs do not need continual onsite supervision once they are fully registered and that supervision can be safely provided by doctors who are not FRNZCGP, with less than six years experience in general practice.

We need to feedback that the very limited range of procedures listed in the NZMC consultation is far too short. That the NZ regulation should enable PAs to work across a very wide range of procedures as they are trained to overseas. NZ training will be limited to what the NZMC supports, we will be poorly served as a community if we don’t follow the lead of the USA, Canada, and the UK in what PAs can do. 

Confusion about the role and what it does

The term “associate” vs “assistant” is seen to be important.

This seems pedantic, but as a professional group Physician Associates do not see themselves as ‘assistants' to doctors.

The valued role of medical assistants in our teams is already established, sometimes they will be trained to provide some clinical support, checking blood pressure, performing an ECG, as well as ensuring rooms are stocked and doing the 1,001 things that make sure clinics are running smoothly, is vital.

But PAs are trained to a Master’s degree level, over a 2-3 year period, with 1,000 hours plus of clinical exposure to assess, diagnose and manage a wide range of clinical conditions, with the support of a supervising doctor. They are more than “assisting” the doctor, they are associates of them.

The NZMA are seeking feedback on the name of the PA profession and we need to share that we support the term “associate” and that any confusion about roles, and who is being seen, can be addressed by ensuring that every member of the clinical team (including doctors) wear a name badge identifying who they are and what their role is.

Patient safety and the UK Leng Review

A key issue for us, and the community at large, is whether as a regulated profession PAs are safe, and how we ensure patients are kept safe.

The “Leng review” published in the UK in July 2025 undertook a review of the safety of the PA role after high-profile media interest following some poor outcomes involving teams including PAs.

The review itself highlighted that there is no evidence that patients are less safe, or have poorer outcomes, when the team that cares for them includes a PA. It indicates that the reason for its conclusions were based in the anecdotal evidence and pressure being applied by the medical unions and professional bodies on the PA profession.

This undermines significantly the validity of the conclusions drawn, most impactfully where they recommend that PAs should not see undifferentiated patients.

The NZMC regulation currently indicates that PAs can support a diagnosis being developed; this is a reflection of the Leng review in the New Zealand context.

We need to feedback that PAs should be allowed to use their skills to diagnose and participate fully in patient care, the caveat that they "contribute” to diagnosis needs to be removed from the recommendations.