Box 1.

Selected illustrative free-text comments from the questionnaire

Views on prescribing I think a few years' (2–3?) experience and passing an exam (prescribing safety assessment) would ensure that this is carried out safely ... my PA course did not prepare me adequately for prescribing – and I would feel unequipped at present (at 2 [years since qualification]). I feel that we should work for 12 months with a free online resource to use to meet the standards required. After the 12 months we then take an open book exam similar to [doctors] when we feel ready ([which] could be any time after 12 months of practice). After 4 years of practice, I feel that I have the knowledge to prescribe but I did not feel like this initially and think it would be beneficial for newly qualified PAs to have 6–12 months of transcribing before being able to prescribe. At my university, we were taught prescribing to the same level as medical students. I feel like I would be able to prescribe the GP basics safely and easily. [The] ability to prescribe will be cost effective and allow for better outcomes for patients ie being able to prescribe antibiotics to patients with sepsis within an hour and, therefore, save lives. I believe that being able to prescribe would make such a huge difference because it would give me a higher level of autonomy. Prescribing rights will ‘validate’ our role further, especially when there are many who are still sceptical about our roles. Although I don't feel that being a non-prescriber lowers the standard of care I give, it would certainly make me a more efficient member of the team if I were able to prescribe. I work across the weekend to provide continuity on [COVID-19 care]. It's incredibly frustrating and delays care as I'm having to jump through hoops to get things done. In primary care, [a] lack of prescribing rights and not being able to request common investigations massively [affects] workflow, and occasionally hinders patient experience. It negatively impacts on career and pay progression. It's really stopping my development and progression, especially in clinics, and, due to the lack of prescribing, other professional roles seem more desirable to the trust. I am considering changing specialty as I feel my lack of ability to prescribe inhibits my role in general practice. [It has] deterred many employers from employing PAs due to [their] inability to prescribe.

Views on requesting radiological investigations: I would prefer if there was a course/exam in order to get rights to request ionising radiation. I think there is often a delay in care, especially when it comes to not being able to request scans as it means waiting for a doctor or non-medical prescriber to be free. Some colleagues, ie radiology, can be resistant to us as we have not had the training they feel is adequate and, therefore, it can be difficult to work as cohesively within a team. Sometimes it's extremely frustrating not to be able to order simple things, such as check X-rays [post-operatively] or intraoperative imaging. It really limits my scope in clinics too and interrupts my other colleagues when I have to book a scan. I think that being unable to request radiation is frankly outdated and considering that unless a CT request was in line with NICE guidance it has usually been discussed with a senior regardless of being junior [doctor]/PA.

CT = computed tomography; GP = general practitioner; NICE = National Institute for Health and Care Excellence; PA = physician associate.