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The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review

Dmytro Babelyuk Orcid Logo, Vladyslav Kulikov Orcid Logo, Llinos Haf Spencer Orcid Logo, Deborah Fitzsimmons Orcid Logo, Rhiannon Tudor Edwards Orcid Logo

BMC Health Services Research, Volume: 25, Issue: 1

Swansea University Author: Deborah Fitzsimmons Orcid Logo

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DOI (Published version): 10.1186/s12913-025-13626-4

Abstract

BackgroundHealthcare staff planning in the NHS in the UK has undergone significant changes in recent years, driven by declining productivity, staff shortages, and rising patient demand. Innovative staff planning decisions include implementing new non-medical roles, collectively referred to as “Medic...

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Published in: BMC Health Services Research
ISSN: 1472-6963
Published: Springer Science and Business Media LLC 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa70945
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Innovative staff planning decisions include implementing new non-medical roles, collectively referred to as &#x201C;Medical Associate Professions&#x201D; (MAPs). The MAP roles were established in 2014 and encompass Physician Associates (PAs), Anaesthetic Associates (AAs), and Surgical Care Practitioners (SCPs). This systematic review has been conducted to evaluate and synthesise international evidence on the impact of MAPs on health system productivity, quality of care, patient satisfaction, perceptions of the healthcare workforce regarding roles, and the budget implications of their implementation in various healthcare settings.MethodElectronic database searches were conducted using the Medline, Embase, CINAHL, Web of Science, and PubMed databases for studies published between 2004 and 2024. Blinded parallel processes were used to screen abstracts and full text of the studies that met the inclusion criteria. Data extraction, narrative synthesis and quality assessments were undertaken for the included studies. The impact on productivity, quality of care, patient and colleague perceptions, and cost-effectiveness of the roles were chosen as the key outcomes of interest.ResultsA total of 8725 papers were identified following the systematic searching of the databases, and 69 papers were included in the review. These included cost-effectiveness analysis (n&#x2009;=&#x2009;1), cross-sectional studies (n&#x2009;=&#x2009;18), cohort studies (n&#x2009;=&#x2009;29), qualitative studies (n&#x2009;=&#x2009;9), case series studies (n&#x2009;=&#x2009;1), case-control study (n&#x2009;=&#x2009;1), and mixed-method studies (n&#x2009;=&#x2009;10).ConclusionsMAPs have the potential to complement traditional workforce configuration to support productivity and quality of care. There is evidence that they are acceptable to patients, and there is mixed evidence about their contribution in the eyes of clinical colleagues. A modest amount of data is available on PAs and much less on SCPs and AAs. Despite most of the papers being of moderate to poor quality, our rigorous and innovative systematic review reflects the evidence that incorporating PAs and SCPs into healthcare can have a positive impact on productivity and the quality of care provided, reduce overall personnel and care costs, and elicit positive feedback from both patients and colleagues when appropriately implemented.</abstract><type>Journal Article</type><journal>BMC Health Services Research</journal><volume>25</volume><journalNumber>1</journalNumber><paginationStart/><paginationEnd/><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1472-6963</issnElectronic><keywords>Physician Associate (PA), Anaesthetic Associate (AA), Surgical Care Practitioner (SCP), Quality of care, Costeffectiveness, Patient satisfaction, Healthcare workforce perceptions, Productivity</keywords><publishedDay>19</publishedDay><publishedMonth>11</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-11-19</publishedDate><doi>10.1186/s12913-025-13626-4</doi><url/><notes/><college>COLLEGE NANME</college><department>Health and Social Care School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HSOC</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders/><projectreference/><lastEdited>2026-01-07T10:39:37.3503169</lastEdited><Created>2025-11-19T19:42:12.5086871</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Public Health</level></path><authors><author><firstname>Dmytro</firstname><surname>Babelyuk</surname><orcid>0009-0003-0030-0476</orcid><order>1</order></author><author><firstname>Vladyslav</firstname><surname>Kulikov</surname><orcid>0009-0002-3502-5737</orcid><order>2</order></author><author><firstname>Llinos Haf</firstname><surname>Spencer</surname><orcid>0000-0002-7075-8015</orcid><order>3</order></author><author><firstname>Deborah</firstname><surname>Fitzsimmons</surname><orcid>0000-0002-7286-8410</orcid><order>4</order></author><author><firstname>Rhiannon Tudor</firstname><surname>Edwards</surname><orcid>0000-0003-4748-5730</orcid><order>5</order></author></authors><documents><document><filename>70945__35905__540257c9e5d14421a3ece4ddf3aa92ab.pdf</filename><originalFilename>70945.VoR.pdf</originalFilename><uploaded>2026-01-07T10:37:00.2775499</uploaded><type>Output</type><contentLength>2326097</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s) 2025. 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spelling 2026-01-07T10:39:37.3503169 v2 70945 2025-11-19 The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review e900d99a0977beccf607233b10c66b43 0000-0002-7286-8410 Deborah Fitzsimmons Deborah Fitzsimmons true false 2025-11-19 HSOC BackgroundHealthcare staff planning in the NHS in the UK has undergone significant changes in recent years, driven by declining productivity, staff shortages, and rising patient demand. Innovative staff planning decisions include implementing new non-medical roles, collectively referred to as “Medical Associate Professions” (MAPs). The MAP roles were established in 2014 and encompass Physician Associates (PAs), Anaesthetic Associates (AAs), and Surgical Care Practitioners (SCPs). This systematic review has been conducted to evaluate and synthesise international evidence on the impact of MAPs on health system productivity, quality of care, patient satisfaction, perceptions of the healthcare workforce regarding roles, and the budget implications of their implementation in various healthcare settings.MethodElectronic database searches were conducted using the Medline, Embase, CINAHL, Web of Science, and PubMed databases for studies published between 2004 and 2024. Blinded parallel processes were used to screen abstracts and full text of the studies that met the inclusion criteria. Data extraction, narrative synthesis and quality assessments were undertaken for the included studies. The impact on productivity, quality of care, patient and colleague perceptions, and cost-effectiveness of the roles were chosen as the key outcomes of interest.ResultsA total of 8725 papers were identified following the systematic searching of the databases, and 69 papers were included in the review. These included cost-effectiveness analysis (n = 1), cross-sectional studies (n = 18), cohort studies (n = 29), qualitative studies (n = 9), case series studies (n = 1), case-control study (n = 1), and mixed-method studies (n = 10).ConclusionsMAPs have the potential to complement traditional workforce configuration to support productivity and quality of care. There is evidence that they are acceptable to patients, and there is mixed evidence about their contribution in the eyes of clinical colleagues. A modest amount of data is available on PAs and much less on SCPs and AAs. Despite most of the papers being of moderate to poor quality, our rigorous and innovative systematic review reflects the evidence that incorporating PAs and SCPs into healthcare can have a positive impact on productivity and the quality of care provided, reduce overall personnel and care costs, and elicit positive feedback from both patients and colleagues when appropriately implemented. Journal Article BMC Health Services Research 25 1 Springer Science and Business Media LLC 1472-6963 Physician Associate (PA), Anaesthetic Associate (AA), Surgical Care Practitioner (SCP), Quality of care, Costeffectiveness, Patient satisfaction, Healthcare workforce perceptions, Productivity 19 11 2025 2025-11-19 10.1186/s12913-025-13626-4 COLLEGE NANME Health and Social Care School COLLEGE CODE HSOC Swansea University Another institution paid the OA fee 2026-01-07T10:39:37.3503169 2025-11-19T19:42:12.5086871 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Dmytro Babelyuk 0009-0003-0030-0476 1 Vladyslav Kulikov 0009-0002-3502-5737 2 Llinos Haf Spencer 0000-0002-7075-8015 3 Deborah Fitzsimmons 0000-0002-7286-8410 4 Rhiannon Tudor Edwards 0000-0003-4748-5730 5 70945__35905__540257c9e5d14421a3ece4ddf3aa92ab.pdf 70945.VoR.pdf 2026-01-07T10:37:00.2775499 Output 2326097 application/pdf Version of Record true © The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License. true eng http://creativecommons.org/licenses/by/4.0/
title The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review
spellingShingle The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review
Deborah Fitzsimmons
title_short The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review
title_full The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review
title_fullStr The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review
title_full_unstemmed The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review
title_sort The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review
author_id_str_mv e900d99a0977beccf607233b10c66b43
author_id_fullname_str_mv e900d99a0977beccf607233b10c66b43_***_Deborah Fitzsimmons
author Deborah Fitzsimmons
author2 Dmytro Babelyuk
Vladyslav Kulikov
Llinos Haf Spencer
Deborah Fitzsimmons
Rhiannon Tudor Edwards
format Journal article
container_title BMC Health Services Research
container_volume 25
container_issue 1
publishDate 2025
institution Swansea University
issn 1472-6963
doi_str_mv 10.1186/s12913-025-13626-4
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 1
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description BackgroundHealthcare staff planning in the NHS in the UK has undergone significant changes in recent years, driven by declining productivity, staff shortages, and rising patient demand. Innovative staff planning decisions include implementing new non-medical roles, collectively referred to as “Medical Associate Professions” (MAPs). The MAP roles were established in 2014 and encompass Physician Associates (PAs), Anaesthetic Associates (AAs), and Surgical Care Practitioners (SCPs). This systematic review has been conducted to evaluate and synthesise international evidence on the impact of MAPs on health system productivity, quality of care, patient satisfaction, perceptions of the healthcare workforce regarding roles, and the budget implications of their implementation in various healthcare settings.MethodElectronic database searches were conducted using the Medline, Embase, CINAHL, Web of Science, and PubMed databases for studies published between 2004 and 2024. Blinded parallel processes were used to screen abstracts and full text of the studies that met the inclusion criteria. Data extraction, narrative synthesis and quality assessments were undertaken for the included studies. The impact on productivity, quality of care, patient and colleague perceptions, and cost-effectiveness of the roles were chosen as the key outcomes of interest.ResultsA total of 8725 papers were identified following the systematic searching of the databases, and 69 papers were included in the review. These included cost-effectiveness analysis (n = 1), cross-sectional studies (n = 18), cohort studies (n = 29), qualitative studies (n = 9), case series studies (n = 1), case-control study (n = 1), and mixed-method studies (n = 10).ConclusionsMAPs have the potential to complement traditional workforce configuration to support productivity and quality of care. There is evidence that they are acceptable to patients, and there is mixed evidence about their contribution in the eyes of clinical colleagues. A modest amount of data is available on PAs and much less on SCPs and AAs. Despite most of the papers being of moderate to poor quality, our rigorous and innovative systematic review reflects the evidence that incorporating PAs and SCPs into healthcare can have a positive impact on productivity and the quality of care provided, reduce overall personnel and care costs, and elicit positive feedback from both patients and colleagues when appropriately implemented.
published_date 2025-11-19T05:34:01Z
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