HSE Pause on Physician Associate Hiring Continues Amid Review Implementation

The HSE will maintain its pause on hiring physician associates (PAs) while implementing recommendations from an independent review. The review, published today, defines the PA role, first piloted in Ireland in 2015, and suggests a graduated scope of practice. It found positive feedback from clinical teams but noted the role evolved without clear national definitions for purpose, scope, or governance.

Since 2016, the Royal College of Surgeons in Ireland (RCSI) has graduated 112 PAs from its Masters program. Currently, 30 PAs work in HSE-funded services and another 30 in private hospitals and GP practices. The HSE paused PA recruitment in July 2024, despite earlier commitments to fund RCSI students.

The review, led by Leo Kearns, found PAs provide valuable continuity and support in consultant-led teams, contributing to safer care. However, the lack of a defined framework led to variability and risk, hindering future expansion. The report clarifies PAs assist medical teams under supervision and are not doctor substitutes. It recommends a Core Scope of Practice, an Extended Scope for higher-risk activities, and an 'exclusions' list for tasks like prescribing medications, ordering ionising radiation, diagnosis, and discharging patients.

The report also proposes a five-level governance framework and recommends initial PA deployment in acute hospital medical and surgical functions. Minister for Health Jennifer Carroll McNeill received the report and the HSE's implementation plan. The HSE is now working with stakeholders to implement recommendations but has not provided a timeframe for changes or lifting the recruitment pause. The Irish Society of Physician Associates (ISPA) welcomed the report but expressed concern over the lack of a timeframe and sought further discussion on certain 'exclusions,' such as diagnosing and discharging patients.