In July 2005, a new era in the United Kingdom began as the UK Association of Physician Assistants, Ltd (UKAPA), was incorporated. Our mission is to serve as the official organization of PAs and future medical care practitioners (MCPs) in the United Kingdom.* UKAPA held its first annual meeting in July 2006, which was deemed to be a success. CME was available, and our first slate of officers was elected: Neil Erickson, president; Frank Crosby, vice president; Todd Guiton, treasurer; Helen Serbousek, secretary; Kirsten Gipson and LauraFolts, directors-at-large; and Chris Green from Wolverhampton University, student representative.

UKAPA progress to date

Bylaws were submitted to the membership for review in October 2005 and were approved in November. UKAPA has applied for approval as an official charitable organization under UK law and has thus far recruited about 40% of PAs working in the United Kingdom as members.

One of the first items of business was to ensure that no physician will be allowed to become an MCP without appropriate and specific training. Mary Ettari, current president of AAPA, and leadership from the Florida Academy of Physician Assistants worked with UKAPA to provide information on the legal issues the State of Florida faced when forced to accept foreign-trained physicians into the ranks of PAs. The Royal College of Physicians (RCP) assured UKAPA that only appropriately trained PAs/MCPs would be allowed to practice in this country.1

A site for UKAPA has been established on the Web, and www.ukapa.co.uk has been online since September 2005. Since that time, both www.ukapa.org and www.ukapa.org.uk have become available and have been secured by the organization. Pointing your browser to either of these sites will take you to our front page for the most up-to-date happenings in the United Kingdom, as well as to a listing of job opportunities.

Leadership and members of UKAPA have attended meetings with UK policy makers and have begun the important process of being “invited to sit at the table” as decisions affecting the MCP profession are being made. Several small victories have been achieved as we confront challenges in this new environment.

Working for recognition

As with any new organization or profession, recognition is the biggest challenge. For example, documents relating to the training of MCPs leave out US-trained PAs entirely, even as mentors or preceptors for students, although recent communication from a representative from the British Department of Health indicated that PAs are now included as potential trainers of MCPs.2

UKAPA strives to remind the UK educators of future MCPs that PAs already practicing in the country should be given the opportunity to participate in clinical mentoring and/or classroom teaching of the MCP students. Unbeknownst to UK medical educators, the majority of PAs in this country have PA and/or medical school-level teaching experience. More importantly, all understand the concept of the physician-PA team. Clinical mentoring will be important for home-grown practitioners, as it is they who will determine the long-range future of this important development in the National Health Service workforce.

Before the development and incorporation of UKAPA, the Department of Health appointed two PA representatives to the medical care practitioner steering committee, allowing PA input into the development of the Curriculum and Competencies Framework3 for the development of “home-grown” MCPs. The Curriculum and Competencies Framework is a comprehensive listing of the educational knowledge and clinical skills that a student must acquire before becoming an MCP. It also provides the basis for institutes of higher education to develop their training program in a standardized manner.

Acceptance of the Curriculum and Competencies Framework will be the next step in the development of the MCP in Britain. For 3 months, an online, public consultation was available, which allowed individuals and organizations, including UKAPA, to comment on the proposed Curriculum and Competencies Framework. On July 3, a summary of responses to the consultation was published and became available online.

Challenges for UKAPA

Registration The biggest challenge for us is the acceptance of the PA/MCP as a registered entity, which is necessary for prescriptive privileges. Registration is the official recognition that the profession exists within the country. Without that, prescriptive privileges cannot be considered. At this point, we do not know if PAs will gain registration in our own right, if our registration will be tied to that of the first graduate MCPs, or if registration could come with the acceptance of the Curriculum and Competencies Framework within the next several months. Current discussions include the possibility of separate registrations of the PA and the MCP.

Strategies to encourage registration of the PA/MCP in the United Kingdom are unclear and different from tactics that have been successful in the United States. PAs and MCPs in Britain cannot petition state legislators or go to the state medical board. Rather, we must quietly make ourselves known, show our benefit, and be invited to participate in meetings of the organizations that make decisions about health workforce planning.

Competition Overcoming the fears that general practitioners (GPs), nurse practitioners (NPs), and nurses have about competition will be difficult. UKAPA does not support PAs/MCPs' replacing any medical or nursing professional. Over the medium to long term, MCPs will be an addition to the current medical system, not a replacement for nurses, NPs, GPs, or any other medical professionals.

The NP organization in the United Kingdom indicates that NPs are sufficient to fulfill current needs. It states in its response to the Curriculum and Competencies Framework, “But a more fundamental question is how ‘new' these new roles really are? The education and competencies described in the consultation document match those of the RCN-approved nurse practitioner programmes that have developed in the United Kingdom over the last 16 years and are now well established. We have looked at the competencies suggested for the MCP education curriculum and these match those of nurse practitioners.”4

The training for NPs in the United Kingdom has not been standardized or even mandated. According to the Royal College of Nursing (RCN), “Until the NMC (Nurse and Midwife Council) takes this step (of regulating those nurses who work as nurse practitioners), any nurse is free to use the title ‘nurse practitioner' and it is difficult to identify what a nurse practitioner really is.”5 The RCN is working to standardize, and UKAPA is willing to work with them to ensure that only qualified NPs use that title, just as only qualified PAs and MCPs will use those titles.

UKAPA fully supports the advancement of clinical training for nurses, allowing them to qualify and proceed into NP programs. NPs, when utilized effectively, are a valuable member of the patient care team.

Dr Mary Armitage, clinical chair of the RCP, explained in The Lancet, “How will these positions differ from the roles of specialist nurses? Specialist nurses with extended roles tend to work to specified protocols, contributing greatly to patients' care in a defined specialist area. The training of medical care practitioners is broadly based and will take at least 90 weeks, equivalent to a 3-year degree course, with a minimum of 1,600 hours of clinical learning. The training is to a medical model, developing critical thinking and drawing on knowledge and skills rather than working to predetermined protocols.”6

In the same article she also writes, “The definition of the analogous American physician assistant is a ‘highly qualified health professional, who is prepared, through a demanding academic and clinical curriculum, to provide healthcare services under physician supervision.' New UK legislation in 2006 will be required to establish ‘medical care practitioner' as a new profession, accountable for their own practice and subject to the requirements of a regulator, provisionally identified as the Health Professions Council. Allied health professionals generally practise autonomously and take full responsibility for their actions.”6

In addition, other professions confuse the training and the role of advanced care practitioners. While the MCP has received the bulk of the recent publicity, it is not the only advanced care practitioner being developed in the UK. Others are surgical care practitioners, emergency care practitioners, and anesthesia care practitioners. The training of these groups does not always approach that of the MCP—some train for only 10 months.7 UKAPA is working to separate the PA/MCP from the others in the eyes of organized medicine and professional regulators.

Relationships with other organizations

AAPA The Board of Trustees of UKAPA sees it as the British equivalent of the AAPA, although we have not yet reached the point of recognition that AAPA enjoys. Because of its history, size, and prestige, the AAPA is recognized worldwide as “the physician assistant organization.” Often, when British medical groups have questions about the PA profession and how it can fit into the British system, AAPA is their first contact, as UKAPA is still a relatively unknown entity. UKAPA has appointed a member as liaison to the AAPA. UKAPA can serve as a valuable resource to the AAPA International Affairs Committee, and vice versa, for comments on the status of and/or recommendations for MCP training and utilization in the United Kingdom.

Royal College of Physicians The RCP is one of the world's oldest medical societies and a cosponsor of the MCP concept. They recently have allowed PAs practicing in the United Kingdom to become affiliate members of the college—the first nonphysician group allowed to do so since the RCP's inception in 1518 under the reign of King Henry VIII!

Royal College of General Practitioners (RCGP) One of the other cosponsors of the Curriculum and Competencies Framework is the RCGP, established in 1952. While the current leadership of this organization supports the MCP concept, future boards for the College may not regard it as favorably. UKAPA continues to court the RCGP, as most PAs and future MCPs will work with GPs and we realize that without their support, the potential success of this program is compromised.

Summary

As an organization, UKAPA has just begun its development. A handful-sized group is the beginning, just as a handful of PAs started the AAPA many years ago. The British medical system is one that can be joined “by invitation only,” and UKAPA is attempting to make ourselves known in order to garner those invitations. We have achieved some small successes, and we hope to soon gain wider recognition both in the United States and in the United Kingdom. JAAPA
*At the time of this writing, the working title for the British equivalent of a PA is MCP. In this article, the terms physician assistant and PA will refer only to the American-trained practitioner. Likewise, the terms medical care practitioner and MCP will refer only to the British practitioner. When both are intended, the term PA/MCP will be utilized.

REFERENCES

1. Letter to the author from Dr Mary Armitage, Clinical Vice-Chairman, Royal College of Physicians, November 17, 2005.

2. Personal communication from Mr. Robert Standfield, lead designer for the National Practitioner Programme, at the UKAPA membership meeting on March 28, 2006.

3. UK Department of Health. Closed consultations. Available at: http://www.dh.gov.uk/Consultations/ClosedConsultations. Accessed November 27, 2006.

4. RCN response to medical care practitioner consultation document. Available at: http://www.nursepractitioner.org.uk (under RCN NPA link). Accessed November 27, 2006.

5. Nurse practitioners—an RCN guide to the nurse practitioner role, competencies and programme approval. Available at: http://www.nursepractitioner.org.uk (updated RCN document on nurse practitioners under RCN NPA link). Accessed November 27, 2006.

6. Armitage MA. Advance-care practitioners—friend or foe? Lancet. 2006;367:377.

7. Emergency care practitioners. Sussex Ambulance Service Web site. Available at: http://www.sussamb.nhs.uk/features/ecpfeature2/. Accessed November 27, 2006.