Table 1 Similarities and differences on the major themes regarding PAs and ANPs

Career

 Employment

• Both see employment demand rising

• Job content depends on specific posts and role definition is unclear

• PAs are primarily employed in secondary care, compared to the majority of ANPs in primary care

• PAs have less variation in titles compared to ANPs

 Career progression

• No clear career progression for both roles

• ANPs emerged from nurses so they are already at an advanced level in career development, whereas it is not the case for PAs

 Job satisfaction

• Both are generally satisfied with their roles

• PAs encounter more issues with lack of recognition and lack of prescribing rights

Competency

 Education

• Both are recommended to be educated to a master’s level or equivalent

• PAs are educated on a medical model, whereas ANPs are on a nursing model

•PAs generally have a master’s degree, whereas for ANPs master’s degree is recommended but not essential

 Key skills

• Both have a mixture of nursing and medical skills

• ANPs’ skill sets are nursing-oriented, whereas PAs are medicine-oriented

•Skills for ANPs depend more on the specific specialities, whereas PAs are educated to a similar level

Effectiveness

 Patient outcomes

• In simple tasks (minor illnesses), patient outcomes are comparable to GPs in primary care for both roles

• In secondary care, PAs have similar patient outcomes as FY2 doctors, whereas no evidence is identified for ANPs in secondary care

 Cost-effectiveness

• In simple tasks, there are studies suggesting that both are regarded as cost-effective compared to GPs

• Cost-effectiveness is less clear for ANPs due to variability in roles compared to PAs

Perceptions

 By colleagues

• Colleagues appreciate the added values and task-sharing from both roles

• Both have unclear professional boundaries

• PAs could be subject to more negative perceptions due to a lack of prescribing rights and the fact that the role is not based on existing professions in the UK

 By employers

• Employers view both roles as cost-effective and contributing to the work required within the NHS

• ANPs were mostly employed by doctors to undertake specific work, whereas PAs were employed by hospitals in more generalist roles

 Self-identity

• Both face lack of clarity with regard to role definition

• PAs seem to encounter more identity crises due to the relative novelty of their roles in the UK

Regulations

 Policy

• Both have lack of formal regulation

• ANPs are credentialed and have prescribing rights, although their prescribing rights are based on nurse prescribers, whereas PAs do not have prescribing rights

• ANP regulation is rooted in nurse regulation through the Royal College of Nursing (RCN)

• PA regulation is relatively new and is expected to be regulated by the General Medical Council

 Governance agencies

• Health Education England has control over the competency framework and education for both roles

• ANPs are governed by RCN, whereas PAs have a Faculty of Physician Associates and are regulated by the General Medical Council