The absence of a framework on the use of physician assistants in the Irish health service has created “considerable variability”, uncertainty and “avoidable risk,” a report has found.
Today, the Health Service Executive (HSE) will publish an independent review of physician assistants (PA), outlining the findings and recommendations of the role within the Irish public healthcare system.
Also referred to as physician associates, they assist doctors and surgeons by taking medical histories, performing examinations, making diagnoses and analysing test results, under the supervision of a consultant.
The introduction of the PA role to the Irish health system began in 2018 on a two-year pilot basis, but has expanded since then with the HSE subsiding course fees for PAs in recent years.
RM Block
The Irish Times last year reported the HSE paused recruitment of PAs pending the review, after safety concerns were highlighted in the UK.
According to the report, there are 38 PAs employed in publicly funded services, and they are “consistently described as providing valuable continuity, coordination and organisational support within consultant-led teams”.
“Their permanent presence contributes to safer care through consistent documentation, reliable follow-up processes, and support for multidisciplinary communication, while freeing NCHDs [non-consultant hospital doctors] to focus on training and clinical decision-making,” the report said.
However, the review also found the PA role in Ireland has “evolved without a clear, nationally agreed definition of its purpose, scope of practice, or governance framework”.
“This has resulted in considerable variability across sites, 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,” it added.
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The review recommended five levels of governance arrangements, such as day-to-day clinical operations whereby a PA works under the direction of the responsible consultant, as well as oversight at a local, institutional and national level.
The report recommends that initial deployment should be focused within 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,” it added.
The review explicitly states the role is “not a substitute for a doctor and must not be employed, rostered or deployed as such”.
It recommended the establishment of a “core” PA scope of practice, an “extended” scope of practice for higher-risk activities that require more training and an “exclusions list”, which are activities that must not be delegated to PAs due to legal restriction, required medical expertise or patient safety considerations.
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In a statement, the HSE said it will actively work with stakeholders to implement the recommendations of the review.
“The HSE wishes to acknowledge the professionalism, dedication, and valuable contribution PAs currently working within the system provide to patient care,” the statement said.
“Engagement is actively ongoing between the HSE and the Department of Health to develop an appropriate mechanism to facilitate the recruitment of PAs into the services.”
