Purpose of this Document

This Base Scope of Practice document defines the foundational competencies expected of Physician Associates (PAs) at the point of qualification. It aligns with the General Medical Council (GMC) guidance and the Physician Associate Registration Assessment (PARA) Content Map, ensuring clarity around the core clinical areas, professional skills, and procedures required for safe and effective practice.

It is important to note that previously a Physician Associate’s base scope of practice has been closely aligned to the “Matrix of Core Clinical Conditions”, which was available from 2006 and hosted by the FPA until its closure in December 2024.

In recent times, misinformation has led to a misunderstanding regarding PA scope and this document has been created to provide clarity.

To be clear: Paragraph 2 of Good Medical Practice (GMP) guidelines from the GMC states, “You must recognise and work within the limits of your competence. You must only practise under the level of supervision appropriate to your role, knowledge, skills and training, and the task you’re carrying out”. It is therefore the PAs responsibility to make sure that they work within their scope of practice at all times.
 

Context and Application

Foundational Practice: Upon qualification, Physician Associates are equipped to manage a defined range of patient presentations, conditions, and core procedures competently, under appropriate supervision.

Individual Progression: Post-qualification, each PA’s practice scope will naturally expand through continuing professional development (CPD), postgraduate education, and workplace-based learning.

Advanced and Tier 2 Procedures: This document excludes Tier 2 and advanced procedures. Those competencies will be detailed separately. However, qualified PAs who have already attained advanced competencies and can evidence these through a maintained logbook and relevant CPD may continue such practice. Employers would be encouraged to formalise these practices in local governance if they have not done so already.

How to Use These Tables

Patient Presentations: Common signs, symptoms, or concerns PAs are expected to evaluate. We have decided to keep this in to allow those triaging, whether clinical or non-clinical, to be able to rapidly understand and apply what a PA can see.

Core Conditions: Key diagnoses that PAs should be able to manage, in collaboration with clinical supervisors where indicated.

Uncommon but Critical Conditions: Less frequent but high-risk conditions that every PA must be aware of, ensuring prompt identification and escalation.

Important Note: This document does not limit a PA’s ability to encounter additional clinical scenarios or conditions, especially as their experience grows. Instead, it outlines the minimum scope for safe initial practice at qualification.

1. Teaching and Learning
   1. Participate in the teaching and training of other healthcare professionals (e.g., sharing knowledge, and supervising students under guidance).
   2. Support less experienced colleagues.
2. Healthcare Service and Structure
   1. Understand the structure of the NHS and the PA’s role within it.
   2. Appreciate differences across the four UK nations (if relevant to practice location).
3. Research and Evidence-Based Medicine
   1. Understand the application of research, audit, and Quality Improvement Processes (QIP).
   2. Manage information and data safely, respecting confidentiality and governance.
   3. Use evidence-based guidelines appropriately to inform clinical decisions.
4. Health Promotion
   1. Promote health and prevention of illness through patient education and public health awareness.
   2. Tailor advice to individual patient needs and broader population health strategies.

Generic Requirements for All Procedures

• Introduce self and role; verify patient identity.
• Explain the procedure and gain informed consent.
• Use appropriate infection prevention measures and personal protective equipment (PPE).
• Label samples correctly, document accurately, and ensure confidentiality.
• Interpret results and escalate where necessary.
• Arrange aftercare and monitoring.

• Measure and interpret baseline physiological observations (temperature, respiratory rate, pulse, blood pressure, oxygen saturations, urine output). 
• Perform surgical scrubbing. 
• Participate in cardiopulmonary resuscitation to Immediate Life Support (ILS) level.

• Venepuncture
• Intravenous cannulation
• Arterial blood gas (ABG) sampling from the radial artery, including interpretation of acid-base results
• Blood cultures (taking samples for microbiological testing)
• Capillary blood glucose measurement
• Peak expiratory flow measurement (instructing the patient, assessing adequacy, interpreting results)
• Urine dipstick testing (interpretation of results)
• 12-lead ECG (performing and interpreting)
• Swab-taking (or instructing patients how to swab)
• Male and female urinary catheterisation

• Nasogastric tube placement (assessed in simulation only)
• Oxygen therapy (appropriate recommendation and administration)
• Inhaled medication devices (patient instruction in correct use)
• Basic drug dose calculations
• Setting up an infusion
• Preparation and administration of parenteral medications (subcutaneous, intramuscular, intravenous)
• Use of local anaesthetics (topical, subcutaneous infiltration, urethral)
• Wound care and closure (including suturing and dressing)

Note: Tier 2 or advanced procedures (such as advanced airway management beyond ILS scope, central venous line insertion, etc.) are explicitly excluded from this Base Scope but can be pursued post-qualification via additional training.

Under section 13 of GMP, the GMC state that “You must take steps to monitor, maintain, develop, and improve your performance and the quality of your work, including taking part in systems of quality assurance and quality improvement to promote patient safety across the whole scope of your practice”. It goes on to state “regularly taking part in training and/or continuing professional development”. Below we have explained how, through complying with the standards set out in GMP in section 13, a PA’s scope of practice will naturally expand over time to include the knowledge and experience gained by taking part in training and/or CPD.

This section provides a comprehensive, condition-based self-assessment tool for Physician Associates (PAs). Depending on the specialty and scope of their current or intended role, a PA need only fill out the relevant clinical domain(s). If a Physician Associate moves to a new specialty, they should complete (or update) the entire self-assessment relevant to that new domain to highlight:

• Which conditions they already manage autonomously or with minimal oversight.
• Which conditions they require supervision to manage.
• Areas where they lack confidence and need focused CPD or induction training.

This approach maintains a live awareness of each PA’s scope of practice and ensures that clinical and educational supervisors can optimally plan supervision and CPD by regularly reviewing or updating this assessment at annual appraisal:

• Employers can see the PA’s baseline competence.
• Supervisors can tailor learning opportunities.
• PAs can track progress and target areas for further development.

For Physician Associates who are members of UMAPs & CMAPs, use of this Scope Mapping/Self-Assessment Tool should be considered an essential practice. It enables structured documentation of individual competencies and supports both local governance and professional development. While it is not strictly mandatory, it is strongly recommended to maintain a consistent standard of competence tracking and to facilitate meaningful supervisory and appraisal discussions.

Requires Development (1) – Recognises the condition but requires structured academic revision and controlled clinical exposure before managing it independently. This rating should trigger prioritised learning and remediation.

Requires Supervision (2) – Can recognise and manage the condition but requires supervision to ensure safe decision-making. Supervision may be direct or indirect depending on case complexity, but the PA feels they need oversight. This is the expected starting point for most conditions when a PA enters a new specialty or returns from absence. Even experienced PAs may briefly revert to this level in a new setting while their supervisors gain assurance before reinstating them to their established level.

Supervision Available (3) – Recognises and manages the condition confidently without requiring routine supervision but needs access to support when encountering unexpected complexity. This rating must be substantiated through workplace-based assessments (WBAs) before being assigned.

Semi-Autonomous (4) – Confident to manage independently within the defined scope of practice and supervision framework, recognising when to escalate or seek input. While supervision is not routinely required, good medical practice and delegation principles still necessitate engagement with supervisors when appropriate.
 

Baseline Expectation

Level 2 (‘Requires Supervision’) is expected for most conditions when a PA begins working in a new specialty or returns after a period of absence.

Supervisors must gain confidence in delegating safely to a new PA. Even when an experienced PA transitions into a new role, a brief period at Level 2 may be necessary while supervisors substantiate their competence through workplace assessments. In this case, the PA should maintain a record of their perceived scope of practice whilst the supervisor has a copy of their documented scope at level 2. As trust grows at 1, 3 and 6-month reviews, the PA’s perceived scope of practice will be slowly graduated.

Any Level 1 (‘Requires Development’) ratings for essential conditions should prompt structured CPD, shadowing, or formal training to ensure safe progression.

All core and uncommon-but-critical conditions are listed below for completeness. Only domains relevant to your current or upcoming specialty placement, as set by your Educational Supervisor, are mandatory. However, it is good to keep track of your opportunities for learning and weak spots. If you change specialties, revisit the document to fill in or update the relevant sections.

Note: Each table below includes columns for Core Conditions (or Uncommon but Critical Conditions) and a column for Self-Assessment (1–4).

N.B. Baseline vs. Extended Practice
The conditions listed below represent a baseline scope of practice aligned with the GMC-approved PARA content map for newly qualified Physician Associates. This table should not be viewed as a scope ‘ceiling.’ As PAs develop additional knowledge and experience—acquiring new competencies or managing conditions not explicitly featured here—they should add these to the list, thereby documenting their evolving practice scope. This ensures the self-assessment remains a live record of clinical growth and extended practice.

Progression to Level 3 and 4

A PA should only transition from Level 2 (“Requires Supervision”) to Level 3 (“Supervision Available”) or Level 4 (“Semi-Autonomous”) when their competence is evidenced by:

• Case-Based Discussions (CBDs)
• Mini Clinical Evaluation Exercises (Mini-CEX)
• Multi-Source Feedback (MSF)
• Acute Care Assessment Tools (ACAT)
• Patient feedback
• Completion of relevant external training or certification

Supervisors must ensure that progression is based on verifiable workplace evidence and aligns with patient safety principles.
 

Tier 2 Skills and Procedures

Advanced (Tier 2) procedures require additional governance and structured supervision. PAs should maintain a logbook documenting case volume, supervisory input, and patient outcomes.

CMAPs will provide further guidance on Tier 2 competencies following the Leng Review.
 

Ongoing Review and Development

This assessment should be reviewed annually or whenever a PA undergoes a significant role transition.

Employers should use self-assessment ratings to ensure structured development opportunities, safe practice, and alignment with patient and service needs.

By adhering to this structured framework, we uphold patient safety, promote progressive competence, and ensure PAs are appropriately supported and developed within their professional roles.

Structured Competency Development: In their first year, a PA should focus on gaining a breadth of exposure to the required pathologies within their specialty, progressively building a bank of Case-Based Discussions (CBDs) and Mini-CEXs. This ensures a structured and evidence-based approach to competency progression.

All users of this document should be aware that it is a live record of the Physician Associate’s individualised expanding scope of practice. Each time the Scope Mapping/Self-Assessment Tool is updated, whether to reflect newly acquired skills or changes in supervision, users must create and save a new version of this document. This ensures there is a clear, auditable history of the PA’s progression and evolving competencies. In due course, we intend to incorporate this tool into the new portfolio system, allowing for a unified approach to recording clinical competencies, supervision levels, and professional development milestones.

For additional guidance regarding the development of PAs, please refer to the “College of Medical Associate Professionals CPD Physician Associate Framework”.

Primary Competency Goal: The primary focus in the first year is to achieve Level 3 (‘Supervision Available’) in all specialty-required pathologies. This signifies that the PA can confidently manage these conditions with indirect supervision available as needed.

Managing Additional Knowledge Requirements: If a specialty requires knowledge or competencies beyond this framework, the supervisor should identify these and record them in the “Additional Knowledge” template. The PA should then self-assess their competency level in these areas, and the supervisor should support developing a structured training pathway to bridge any gaps.

Evidence-Based Proficiency: PAs should substantiate their proficiency in additional knowledge areas using the same methodology as for their core competencies—through workplace-based assessments, supervised experience, and structured training.

Supervisor Considerations

PAs should undergo a structured induction into their employing organisation, ensuring familiarity with local policies.

Routine appraisals and guided supervision support continuous development.

PAs must remain informed about changing national guidelines, GMC updates, and any modifications to local scope-of-practice regulations.

By following this framework, Physician Associates, supervisors, and employers can confidently ensure safe, effective, and progressive practice from day one—and well into the future.

For additional guidance regarding the governance of Physician Associates in Primary or Secondary Care please see the Map Employers Guidelines: Primary Care Handbook or Map Employers Guidelines: Secondary Care Handbook.