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Introducing physician associates: a new wave of health professionals in neonatology
  1. Kristin Tanney,
  2. Hannah Tapping-Upton,
  3. Ngozi Edi-Osagie
  1. Newborn Intensive Care Unit, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Kristin Tanney, Newborn Intensive Care Unit, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; kristin.tanney{at}

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St Mary’s Hospital (SMH), Manchester, is home to one of the busiest neonatal units in the UK, with 69 cots providing all levels of neonatal care. As a tertiary referral centre for surgical, cardiac and specialist medical babies in the North West, there is a wide range of activity with many babies requiring complex care. There is therefore a need for a comprehensive and consistent workforce providing high-quality care.

This neonatal intensive care unit (NICU) has benefited from having a blended workforce of what would traditionally have been considered medical rotas, with trainee and locally appointed doctors working on tiers 1 and 2, advanced neonatal nurse practitioners working on tier 1 and band 6 enhanced neonatal nurse practitioners working in high-dependency unit (HDU) and special care (SCBU). However, rota gaps, less than full-time training and recruitment challenges led to understaffed rotas, while nurses choosing to become nurse practitioners meant losing experienced cot-side neonatal nurses.

We are aware that not many neonatal units are familiar with how physician associates (PAs) may complement the workforce. This paper sets out to describe the benefits, limitations and practical tips for those wishing to expand their workforce similarly.

History of PAs

PAs were established in the USA in the 1960s, first introduced in response to a shortage and maldistribution of clinicians. The training programme was based on fast-track training of doctors during World War II,1 and since then, the role has gone global, with many countries welcoming PAs into their workforce.2

In 2003, US PAs were deployed into clinical areas in the UK. In 2004, the Department of Health commissioned an evaluation of their impact in the NHS; …

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  • Twitter @kristintanney

  • Contributors KT led the completion of this article; HT-U contributed the physician associate (PA) background and perspective; and NE-O reviewed and edited, having been the linchpin to PA recruitment in this neonatal intensive care unit.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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