Physician Associates pilot scheme – October update

  • 04 Oct 2023
  • RCOphth

The College is undertaking a pilot scheme to determine whether Physician Associates (PAs) are an appropriately skilled and financially appropriate addition to the ophthalmic workforce.

This pilot has been funded by NHS England and will include 4 two-day training sessions in areas specific to ophthalmology, such as use of the slit lamp, to examine the eye, and common acute presentations such as ‘The Red Eye’. There will be no surgical component to the PA pilot, and PAs will not be trained to perform intraocular surgery beyond intravitreal injections.

We are mindful of how contentious this issue is for many of our members, and we are aware of the difficulties other specialties that already have PAs within their salaried workforce have encountered.

Ophthalmology is the most common outpatient service in England, and we already have highly trained allied health professionals to deliver and support the delivery of ophthalmic care. The NHS Long Term Workforce Plan has committed to expanding the number of PAs in the healthcare workforce and we will use this pilot to determine if PAs are a safe and cost-effective addition to the current Ophthalmology workforce. For example, there are eye units in the UK who have been unable to recruit optometrists or nurse specialists to perform high volume service roles such as intravitreal injection lists and stable glaucoma clinics and may look to employ PAs for this work in the future.

The pilot will be undertaken by 5 trusts who have applied to be part of the initiative, and who have previous experience of PAs within other departments. The pilot offers the opportunity to determine both suggested timetables and scope of practice for all PA participants.

The pilot should allow us to define the scope of practice of PAs in an informed way and to ensure that there is no disadvantage to the training of our current trainees or the increasing numbers of trainees we are expecting following the NHS Long Term Workforce Plan.

We undertake this pilot with patient safety as our primary focus, and PAs within this pilot will not work unsupervised or be able to make independent decisions regarding patient care. Any potential impact on ophthalmology trainees is being actively monitored.


Ben Burton, President, Royal College of Ophthalmologists

Louisa Wickham, National Clinical Director (NCD) for Eye Care