Independent review finds that PAs play positive role in clinical sites, but lack of national scope of practice leads to ‘considerable variability’ in their responsibilities
A lack of clarity around the role and function of physician associates (PAs) in Irish healthcare has resulted in ‘avoidable risk’, an independent review has found.
The report found that, in the small number of clinical teams here who have PAs, feedback on their contribution was positive.
“PAs are consistently described as providing valuable continuity, coordination and organisational support within consultant-led teams, particularly in environments characterised by high NCHD rotation, fragmented pathways, and operational complexity,” it said.
“Their permanent presence contributes to safer care through consistent documentation, reliable follow-up processes, and support for multidisciplinary communication, while freeing NCHDs to focus on training and clinical decision-making.”
However, the PA role in Ireland has ‘evolved without a clear, nationally agreed definition of its purpose, scope of practice, or governance framework’. As a result, the report said that there was ‘considerable variability’ across hospitals in the work PAs carried out, with ‘uncertainty for clinicians and PAs, and avoidable risk’.
“In the absence of such clarity, the future development or expansion of the PA role cannot be safely supported,” the review said.
Physician associates – also known as physician assistants – are a relatively new cohort of workers in Irish healthcare, with just 30 PAs working in Irish public hospitals.
In response to concerns over the work and responsibilities of the PA – including fears by the IMO that they may eventually be used as substitutes for NCHDs on hospital rosters – last year the HSE commissioned an independent review to examine their role within the Irish public healthcare system, with Leo Kearns appointed as its lead reviewer.
The review concluded that the primary purpose of the PA role in Ireland is ‘to assist the medical team in its provision of care to patients, by supporting the organisation, coordination and continuity of medical care, and by carrying out defined clinical tasks and procedures under a medical practitioner’s supervision or oversight’.
It emphasised that the PA is not a substitute for a doctor and should not be rostered as such. It called for a core PA scope of practice, an extended scope of practice that includes higher-risk activities that need more extensive training, and an exclusions list which details that must not be delegated to PAs due to ‘legal restriction, required medical expertise, or patient safety consideration’. These would include diagnosis, prescribing medications, and ordering ionising radiation.
Each PA should have a consultant supervisor, while there should be national oversight to ensure consistent implementation of the PA’s function.
The review recommends that initial deployment be primarily within the medical and surgical functions of acute hospitals, where the role has demonstrated value and governance structures can be consistently applied.
“Future expansion may occur following national approval and evidence of sustained governance effectiveness,” the report added.
Publishing the review, the HSE said it will be ‘actively working’ with clinical leaders, professional bodies, and stakeholders to implement its recommendations.
“This will provide PAs with a defined professional framework, ensuring clarity in scope of practice and clinical governance. This will enable PAs to continue to support the delivery of safe, high-quality patient care, aligned with the HSE’s commitment to person-centred care and continuous improvement,” a spokesperson said.
Last night the Minister for Health welcomed the publication, with a spokesperson for her department saying: “It is essential that patient safety is prioritised in the implementation of any healthcare role. The HSE is moving to an implementation phase focused on strengthening governance, role clarity and national consistency.”
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