The National Health Service (NHS) of the United Kingdom (UK) was created in the 1940s to meet the growing medical needs of the population at that time. But needs have changed and advances in technology and health care delivery have increased patient expectations. It is generally acknowledged that medical service needs to be more efficient to meet both the increased demands of medicine in the 21st century and the challenges posed by changing demographics. How this might be achieved was proposed in a government paper, “The NHS Plan for England.”1 A subsequent document, “Health Resources in the NHS Plan,” suggested that there should be less rigid boundaries between the different health professions with respect to skills delivery, to allow staff to fulfill their true potential and allow flexibility and accessibility with respect to career pathways.2 Successive policy papers have had the same message: that the NHS needs to provide patient-centred health service with more choice and speedier access to high-quality services. A significant issue for the NHS workforce is the overall decline in numbers. The Office for National Statistics has predicted that by 2010, there will be a reduction of around 700,000 in the workforce from the present 1.25 million employees.3 The decline in the number of school-leavers to replenish the existing traditional medical workforce, and the postwar “baby boomers” approaching retirement age, exacerbated by an increasing demand for services, are seen as the significant factors. But this medical supply-and-demand constraint has also been compounded by the requirement of the UK to adhere to the European Working Time Directives, which have effectively reduced the working hours allowed for medical and other practitioners. Together with an increasing number of doctors selecting part-time medical careers, these changes have put considerable pressure on the entire health care system.4 In response to the current and future skills shortfall, a significant effort is under way to introduce new ways of working within the NHS, and the physician assistant (PA) model is one example of this workforce redesign.