Evolving roles in the NHS

January 1, 2014 in Archive

The health landscape within England is constantly evolving. An ageing population with ever changing needs has demanded an expansion of the roles within the NHS workforce in order for the health service to continue to provide world class healthcare.

Recently, several new roles have been created within the NHS to meet these demands with London leading the way on education and training for new staff.

Physician associates

A physician associate, formerly known as a physician assistant, is a profession founded in the USA during the sixties that now appears in several other countries around the world(1).

In the UK the physician associate provides support to doctors in the diagnosis and management of patients. Their responsibilities can include; taking medical histories, analysing test results and diagnosing illnesses(2). Although unable to prescribe medications they are able to deliver continued and expanded patient care, working closely with a supervising physician when further advice is required.

Training for physician associates is currently delivered in only a small number of higher education institutes (HEIs). One of the first to offer the postgraduate diploma was St George’s, University of London, with 37% of physician associates working in the UK having studied there(3). With two more HEIs adding the course in September 2014, and another due to start in January 2015 the number offering physician associate training will increase to six.

The two year training focuses on adult medicine in hospital and general practice settings rather than on specialty care. The role’s ability to alleviate workload pressures on other health professionals is particularly apparent in emergency medicine, where 15% of physician associates currently work(4).

The success of the programme has prompted the government to recently announce a large expansion; the number of available training places will increase from 105 to 225, four further HEIs will offer the course in autumn 2015 and a new Faculty of Physician Associates will be set up with the Royal College of Physicians London in order to support and develop the role(4).


1. UK Association of Physician Associates

2. NHS Careers: Physician Associate

3. Ritsema T (2014) 2014 UKAPA Census Results

4. BMA (2014) Call to Define Role of Physician Associate

Advanced nursing practitioners

The role of an advanced nursing practitioner (ANP) was devised and researched through collaboration with HEIs, professional organisations and service providers(1).

Today, ANPs work in a variety of healthcare settings and in a number of roles; challenging the traditional professional boundaries to meet the demands of a rapidly changing health landscape and population needs(1).

ANPs are increasingly being found in emergency departments, minor injury units, medical assessment units, night services and specialties such as paediatrics. Patients in these settings are most likely to benefit from nurses with advanced level skills and knowledge. They are able to; prescribe medicines, request and interpret x-rays and make referrals to other specialties or community agencies(2).

The ANP role is flexible in that they can provide highly skilled support to both the senior medical and nursing teams.  Their higher degree of autonomy and application of expertise has meant that they are able to reduce the hours worked by junior doctors and enhance the responsiveness and efficiency of care provision as the patient’s first point of contact(2).

Training for ANPs can vary from 18 months to five years depending on the students’ desired rate of progression. Those completing the entire programme are awarded a master’s degree with many courses offering opportunities to exit with a postgraduate certificate or diploma.  There are a number of ANP programmes across the UK, with many offering modules that cover more specific disciplines. Several schools of healthcare in HEIs across London offer an advanced nursing practitioner qualification, all of which are accredited by the Royal College of Nursing.

After several successful trials of ANPs within multidisciplinary teams their role is likely to be leading the evolution in the responsibilities of nurses in healthcare; a direct response to the changing needs of the population(3).


1. RCN (2012) RCN Competences: Advanced nursing practitioners

2. Barnsley Hospital NHS Foundation Trust (2012) Advances in nursing, meet the Advanced Nurse Practitioners

3. Barnsley Hospital NHS Foundation Trust (2011) New senior role for nurses trialled at Barnsley Hospital