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Gold, incentives and meh

CCG to recruit physician associates from USA to address GP shortages

A CCG is spending £600,000 on bringing over ten US-trained physician associates to work in local GP practices, in a bid to address its recruitment crisis.

NHS Leicester City CCG said the move comes in response to the city’s shortage of GPs and because many of the current GPs are set to retire over the next few years.

The £600,000 investment will pay the salaries of the physician associates for the first three years, with individual practices to pick up costs themselves the next two years, the Leicester Mercury reported.

The CCG recently said it is considering abandoning its pilot scheme giving ‘golden hellos’ worth £20,000 to new GPs who agree to work in the city after it failed to attract enough candidates.

The associates are being recruited by Health Education England East Midlands and will receive training on the UK primary care system, the CCG said.

It comes after Health Education England announced it was to commission hundreds of new ‘physician associate’ roles to support GPs, as part of a £5bn plan for the coming year.

The CCG said the physician associates will not be able to prescribe but they ‘will be able to take on a substantial amount’ of clinical work now being done by GPs’.

CCG chair Professor Azhar Farooqi told Pulse the CCG decided on the groundbreaking move after realising that the workforce shortage problem ‘is not about to diminish’ due to impending retirements.

Professor Farooqi said the move to employ the assistants from the US was ‘purely because there are not sufficient physician associates in the UK’, where he said there are ‘only around 250 of them’, whereas from the US there ‘is a ready supply of these staff available to us’.

He said: ‘This will enable GPs to focus on patients that specifically require their particular skills. The physician associate role is also significantly cheaper than a GP, however this is not the primary consideration for us as commissioners; the prime benefit is in enabling us to fill a staffing gap quickly and effectively…

‘Taking into consideration the current demand levels for primary care, the shortage of GPs and the move to seven day working set out by the Government, we need to develop a new model of primary care and deliver differently in order to deliver better.’

But Dr Saqib Anwar, medical secretary of Leicestershire, Leicester and Rutland LMC, criticised the plans.

He said: ‘While I accept that physicians assistants could play some role in primary care in the future I think we need to look at this proposal with extreme caution.

‘There is no strong evidence to support their effectiveness in primary care and I remain unconvinced that recruiting a handful of from America and spending over half a million of NHS funding in the process is the best use of a finite NHS budget.’

Relieving GP workload via the recruitment of physician associates also forms part of a Government 10-point plan to resolve the GP workforce crisis.

The RCGP had lobbied the Government to pilot a new similar but different medical assistant role, although some GP leaders have argued that these GP assistant roleswill not work.

Londonwide LMCs chief executive Dr Michelle Drage argued on the Pulse website that physician associates will not be able to work in the UK system, and they will not be able to save practices time.

She said about the Leicester scheme: ‘NHS Leicester CCG needs to ask itself how a supposedly GP-led organisation can prioritise USA-styled solutions to USA problems over the blindingly obvious need to hold on to experienced GPs and nurses providing the style of service Leicester patients deserve.’

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Readers' comments (50)

  • The CCG said the physician associates will not be able to prescribe but they ‘will be able to take on a substantial amount’ of clinical work now being done by GPs’. What planet????? And I presume the CCG is run by GPs too....Please tell me which bit of clinical work I do, that doesn't at some point involve prescribing??

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  • Pure desperation . You can smell the fear from here .

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  • Vinci Ho

    Mmmmm
    Why America?
    'The physician associate role is also significantly cheaper than a GP, however this is not the primary consideration for us as commissioners; the prime benefit is in enabling us to fill a staffing gap quickly and effectively…'
    What is your understanding of this? Come on , folks, send in your comments.

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  • Long overdue.Hopefully PAs will form the bulk of primary care in a few years

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  • Can't help feeling that the £600 000, would have been better invested in the local practices and training, there is no guarantee these people will stay even if we can find them a role. They might be able to fill out insurance reports, screen blood results and manage letters but a lot of this work is unnecessary anyway and some practices are better than others at delegating back office work. It's only appropriate for doctors to manage clinical risk.

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  • The CCG in Leicester should first meet all the GP surgeries in their locality and find out why the existing partners are making it so difficult for GPs to join their practices. Why is there no such recruitment problem in the neighbouring CCGs of Leicester. They may as well scarp all the GMS and PMS contracts in Leicester and allow APMS providers to take over and then all this recruitment problems will automatically come to an end.

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  • Salaried GP @9:49 am- I am sure that GP Partners could take further partners if they could to lighten their own burdens. If you feel that they are causing a problem, I invite you to join me as a partner with a view to taking over the GMS Contract from 1st of April 2016 in historical Rochester. Check us out at www.marloweparkmedicalcentre.nhs.uk
    Will happily lease or sell the freehold if you can afford it.

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  • 600,000K for 10 PAs - that's 60,000/PA

    Not sure if this is over 3 years (the article seems to suggest so), so £20,000/PA/year

    Seems to be about the same as (ok, a little cheaper when you consider on costs) full time HCA. Can they do more then a decent HCA? Mine does everything from taking bloods, ECG, BP, 24 hour BP, Spirometry, lifestyle advice, urine dip, resus trolly check, stock cupboard and PPA claims.

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  • Salaried GP @9:49. The recruitment in Leicester City is really in crisis, mainly due to demographics of GPs and lack of appeal to many GP of working in inner city. However surrounding CCGs also in trouble. I know of several good surgeries in Leicestershire leafy suburbs with sensible partners who have had 0 applicants to recent job adverts.
    Leicester City is just the start. I don't think PAs are the answer but golden hellos haven't attracted anyone and in a few years there will be surgeries with no one left to see the patients. At least they are recognising this and trying something.

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  • £600k for 10 PAs for 3 years. Who would want to do such a shite job for £20k/yr??? And if what an actual PA said in another article is true, takes MORE work to be one than a nurse?! I would put a bet on now that NONE of them stay after 3 yrs, after experiencing the shite that it is

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  • I have learned not to prescribe based on other's assessment.
    Once you signed the script its your call its your responsibility.
    Desperate move but it will not be the answer.

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  • I suppose the GP who host the PA will provide indemnity cover. Do you think our MPS subscription will come down if we have PAs?

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  • Here it comes, here it comes
    Here it comes, here it comes
    Here comes your 19th nervous breakdown

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  • well they could probably do a lot of the pointless crap the Government makes us do liek NHS health checks, dementia screening, asthma reviews(although would need to advise to see doc if not well controlled). ie all the stuff that we pester patients about bbut not the stuff they come to see us about. This is already done by nurse practitioners and practice nurses but I guess PAs are cheaper. Someone suggested in another thread that PAs have science degrees then do 2 year course then hands on training in hospital. How can they be happy on 20 grand?? Perhaps the american ones dont do all that training. Anyway well see if they are useful but as suggested i wouldnt want to sign their scripts other than for repeat inhalers. I have trouble keeping up with what I need to know I just dont know how these people will do a good job and I wouldnt want my family to see one with an actual concern of illness

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  • I feel sorry for the poor sods that fall for this. 600,000 / 10 / 3 = 20k a year to work in Leicester. No thanks.

    They won't even be able to prescribe, so surely a good HCA could do the role.

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  • Why not treat the GP's we have with a bit more respect, perhaps then they wouldn't all be looking for early retirement!

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  • Hopefully they will be given a fair chance to do a good job

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  • I certainly wont be signing any prescriptions generated by an american assistant with no grasp of the UK medical system and prescribing guidelines without seeing the patient or making my own judgement! ie the time it takes for me to sort it on my own without their help........why not just pay GPs what they deserve: for a specialist trained professional with over 15yrs of medical training. Make it an attractive role to newly qualified doctors and stop the government and media berating us and guess what you wouldnt have a recruitment issue at all......what i would give for a 11% payrise Rt Hion Jeremy Hunt!?!?!

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  • Leicester is a small island in the middle of the Pacific Ocean, and hence this difficulty by its local surgeries to find doctors who are willing to work there.

    The local GP surgeries in Leicester should introspect as to why they are in such a pathetic situation regarding GP recruitment.

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  • I am a PA, I am a PA, I am a PA................sounds like ape, ape, ape
    Did you see the yout ube clip on i-diots use i-pids
    https://www.youtube.com/watch?v=NCwBkNgPZFQ

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  • We had several American PAs. They were fairly well trained and willing. They had a tendency to overinvestigate and overtreat but so do some GPs. They were able to see quite a lot of the acute minor illness with confidence and manage simple long term conditions.
    Signing their prescriptions was a problem, we were not comfortable trusting them until they had been with us for a while.
    The major problem was they were short term and all went back home after a short time, so continuity can be a problem. A bit like nurses recruited from Europe

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  • Mmmm..... can't see how this will work myself
    They're new to the NHS, they can't prescribe and they'll be gone after the 3 years if they're on 20k

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  • my partner worked with PA's in theatre in US & found them very efficient & competent within their realm of expertise. he still had to take responsibility for their decisions and I think the larger insurance payments reflected this. i imagine its similar to having students and registrars ... Helpful but time, $, liability.

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  • Just received a discharge letter fro a child with chest infection from the local APMS Walk in centre. Was prescribed Trimethoprim for this and Mum was sure thatchild had been seen by a GP. On the discharge there was the name of a retired Nurse.....who is now a Nurse Practitioner I guess. God forbid if I take my kids to a walk in centre where you don't even know who is examining your near and dear ones!

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  • 1231 Not sure if that is an argument against walk in centres or saying that everyone, GPs included, should follow formularies.Woudl hate to think you were following the Daily Mail way of taking one case and making a gross generalisation. Or in the former case, would you like to have a walk in service at your own practice assuming you have the ability for patients to be seen on the same day?

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  • i'm an ANP . Surely 20 K salary is laughable ? We already have this resource available in the form of N/Ps etc who can prescribe , see, assess, refer , do results , letters , reports etc etc etc . Invest in Nurses and train them . Downside to that is Nurses are also leaving Primary care in high numbers due to burnout and lack of support , pressure etc and lots of us are retiring soon or even taking early retirement to get out as quickly as we can . 😔

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  • Is this not slightly short sighted? Physician associates don't have autonomy and can't prescribe. Why not look to the existing workforce to help out? Great examples of advanced practice physiotherapists being first point of contact for MSK patients in Wakefield and Nottingham - 25% of the GP caseload is MSK (according to RCGP website) - reduced referrals onto secondary care, less imaging and less prescribing. Why not make use of the expertise in this area, who can also independently prescribe. Also self-referral to physio could save up to 100million GP appointments a year. Need to make use of the existing workforce - physios, nurses, pharmacists etc before looking elsewhere.

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  • '' workforce shortage problem ‘is not about to diminish’ due to impending retirements''

    Could ''impending retirements'' also be the reason why no GP wants to join these surgeries ??

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  • Primary care has an illness and this is a symptom of terminal decline . Prognosis 2 yrs tops . This is a plasma expander but without real blood it's doomed Seven day working the coup de gras.

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  • hmm
    maybe some attempt to fnid out sme facts before commenting woudnt come amiss?/
    Actually there is good evidence that PAs are effective and safe and liked by patients
    We need more help in geneal practice, don't we? the increasingly elderly population, more interventions etc etc arent going to go away
    American PAs are a bit of a short-term measure, but actually many have been (and still are) very succesful in various practices across the UK. And we are training more people, who are new to the health service (ie not stealing from other professions) and so numbers will rise.
    I suggest that PAs could be a huge help to GPs and others within the medical world.
    Declaration: I run a PA course at Birmingham medical school

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  • There is also good evidence that GPs are effective and safe and liked by patients and...they can prescribe. Unfortunately, if we expect PAs are going to be the knights in shining armour for the crumbling NHS - we are deluding ourselves. I have no doubt there is a place for PAs, in the same way as there is a place for HCAs instead of nurses. However, for a clinician to really help out in GP land at the moment, then they need to be able to independently manage a patient and that includes prescribing. Out of interest and perhaps James can enlighten us, are the home grown PAs able to prescribe?

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  • I have been a practice nurse since 1999 and trained in mid 70's. I too have studied for over 15 years, mostly in my own time and at my own expense because I wanted to help patients and have more work involvement and knowledge.
    The problem for me has been working for GPs who judge, without finding out, what some nurses could actually do to be more useful and also make the role more interesting.
    I am not a GP, I am not medically trained BUT I have done many modules outside what some GPs have done in their training.
    Sadly, being a nurse in general practice is restricted to what their employer perceives what nurses should be doing and effectively blocks many of us from developing professionally.
    I think whoever has decided to take on yet another "role" in general practice has not explored what is wrong in some employers of the present system.

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  • I think that we need to address how much risk GPs are exposed to. It is a big factor in why there is a recruitment and retention crisis in General Practice.

    There is too much of a culture of informing the GP about this, that and everything by other health care professionals including our secondary care colleagues.

    We need to be protected against this. We are also exposed to risk with regards to prescribing medication suggested by specialists if we do not monitor adequately e.g. amiodarone is initiated by a specialist but GPs are expected to monitor bloods every 6 months once we issue scripts. How many of us remember EVERY drug monitoring protocol required of us that isn't part of an organised enhanced service?!

    I welcome any plan to support General Practice including PAs but I will not add them to a long list of so called professionals who I am responsible for and will ultimately be the fall guy for!

    In my very early 50s and can only see an imminent future for my mental health working as a locum GP.

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  • I am an ANP in GP. I can assess , diagnose , prescribe , refer . I do all my own requests such as blood tests and report on them.
    I started as a PN in the practice...my GPs have allowed me to develop for my benefit and more importantly for the needs of the service. I am fully accountable for what I do. pAs are unregulated, can't prescribe and are dependent on th GP.
    Unfortunately I saw the writing on the wall some time back when RCGP encouraged associate membership to PA's

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  • Well said anonymous @ 8.16. I am also an ANP and I fail to see how PAs will add value. May be I am protecting my turf or may be I am protecting our patients. I love my job, value my colleagues and respect my GPs. I am not a GP in miniature or cheaper. I add a different dimension to patient care neither better nor cheaper just different. I have 30yrs of nursing experience and post grad qualifications. When I left uni with a my BSc I was in NO WAY prepared for life in general practice. I lacked the innate, expert and intrinsic knowledge that makes GPs, ANPs and practice nurses so good. How can two yrs of training prepare the persons for the vagaries of general practice.

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  • At a risk of being denigrated.......

    Is it possible that there is a problem recruiting GP's into General Practice because......

    a. There is far too much negativity by GP's on forums such as this who moan about the pressures but then moan even more whenever any suggestion is made to ease those pressures?........and

    b. Most GP Partners do not want to take on any further GP's (Partners or salaried) because it takes away a rather large slice of their profit?

    Much easier to moan moan moan and blame everyone else!

    GP's are a "large fighting force" if they could only unite as one........ make the suggestions needed to improve General Practice and Primary Care and then stick together and demand the way forward.

    Since the advent of CCG's the GP's have "been in charge" but as with all these types of position they soon become politicized and forget a. where they came from and b. what they are supposed to be doing.

    It really is time for a revolution..... so come on GP land put up or shut up.

    Fight or Die!!! Sssiiiiiimmmmmmppppllllleeeessss!!!!!

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  • The average PA salary in the US is $85,000 so good luck with attracting them to another country with a quarter of their pay and removing their ability to prescribe (which is linked to their employing physician and based on a good working relationship of trust which does time time of course)....

    http://www.payscale.com/research/US/Job=Physician_Assistant_(PA)/Salary

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  • ..."take time" I meant

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  • we have practices nurses. We also have minor illness nurses who can prescribe.
    We used to have PA who I thought was full of risk: trying to perform way beyond her ability and when challenged started asking for second opinions frequently which meant use of 'GP' appointment.

    My ideal model would be more ANPs and MINs to take way minor illnesses and some of routine initial management of other illnesses eg asthma.

    creating another category isnt useful. even If the PA are allowed to prescribe and sign their own scripts
    I would not take them on.

    There is a reason why training to be a GP takes 8-10yrs. Even after qualifying as a GP: I have postgraduate diplomas' in other specialities.

    I am the fall guy for the PN, ANP, MIN, GP trainee, social worker, district nurses: and I dont want the list to increase.

    Get more GPs (without lowering the standards to get into GT VTS training): get better qualified GPs, ask them to develop areas of interest and most illnesses will be managed adequately in primary care.

    Future should include:
    ability to perform upper and lower GI endoscopies, ECHO, 24hr ECG tapes in primary care. Better access to scans: from same day to within few weeks will save lot of referrals to secondary care.

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  • (I made the above comment)
    just to add: I sincerely do value my PN and MINs, without them my job would be unbearable. Some of the PN have been here >10years and are brilliant.

    I am going to tell them this today: dont thank them enough.

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  • Anonymous | NHS Manager | 04 June 2015 8:22am

    At a risk of being denigrated.......

    Well you took the risk so here goes

    1. Suggestions to ease those pressures? Loads that have been suggested already. Maybe you haven't been reading anything else on this site. get rid of managers who accomplish f-all, like yourself, CQC,GMC, current contract, revalidation, etc.
    The suggestions about PAs? doesn't actually solve any of these other problems does it, its a bandaid for a bullet wound.
    2. Most GP Partners, can't take on any other partners cos a. Nobody is stupid enough to want to be a partner anymore, b. What profit??? they've all been siphoned away by politicians (10.8% pay rise), and managers like yourself and lawyers...

    You are right in 1 thing, our leaders (GPC/RCGP) do not represent us as they are interested only in their own self-interest and hence, are cuckolded, in terms of any action the profession can take. If the GPC were to strike tomorrow, or vote to leave the NHS en-masse, I would do so in a heartbeat.

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  • you can get gp's from india. pakistan. mymar. malyasia
    etc .they will do good job

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  • we should be more innovative ... according to current theory - we live in a multiverse, so there are an infinite number of earths out there with an infinite number of GPs. Surely NHSE can come up with a checklist requirement mandating all surgeries need to consider hiring GPs from parallel earths. Statistically on one of those planets GPs work 24/7 for free - just recruit from that planet!

    Don't get me started about cloning.

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  • I realise this is stating the obvious but I still get the impression some don't recognise this has been the plan all along - the government recognises, and encourages the GP workforce crisis. Ultimately they want fewer of us, supervising a cheaper workforce. In fact they probably just want a much smaller primary care, particularly as we are effective gatekeepers and barriers to a lot of unnecessary medicalisation which will feed a growing private sector

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  • I am a GP and my husband is an orthopaedic surgeon, when my son had acute tonsillitis, I had to take time off work to take him to the WIC, he was seen by a nurse who kindly prescribed abx for his very obvious infection.What a waste of time and resources.

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  • Just another example of the governments insidious attempts to gradually phase GPs out , they will be able to exert control and get GP's dancing on puppet strings . Enjoy.

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  • its is astounding at to how ANP's and Physicians assistants think they can do the the same or eqivalent job as we GP. Sorry , but they did not slog through and attain high A levels and then go through rigorous clinical exams and training for 5 years minimum . They cannot have the same clinical acumen and problem solving acumen of a trained GP.

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  • Absurd
    Far better for all the gps to leave that ccg and go back to the surgeries and in fact annihilate the demonic evil of the fantastic waste of the insane internal market utterly wasting five .. Probably more like ten billion a year.... Think of how much suffering this failed national political disgrace has caused by siphoning resources from desperately needed patient care
    We must smash this system as has New Zealand with great success
    Both parties have failed us all

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  • There are many more comments and some answers to these questions on the artice 'GPs shouldn't dismiss PAs'

    I am a PA and have tried to shed some more light on the role in the comments at the end of that article. It is nice to have a discussion about things but it would be nicer if we could all work together to help the NHS and general practice in any way we can

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  • Samuel Lewis

    We might win a Welsh NHS award for our Advanced Paramedic Practitioner in our rural GP practice. :-

    http://www.nhswalesawards.wales.nhs.uk/meet-the-2015-nhs-wa…

    "The appointment of an Advanced Paramedic Practitioner in a rural Pembrokeshire GP practice is enabling more patients to receive care and reducing waiting times for an appointment.
    Preseli GP practice, which has one surgery in Newport and one in Crymych, was struggling to cope with increasing pressures and workload on its staff.
    There were challenges in attracting locum cover due to the rurality of the area which made it difficult to provide cover for annual leave and sickness.
    Research had also shown that 23% of the current GP workforce in North Pembrokeshire and 22% of nurses within practices would be retired within the next five years.
    To relieve pressure and introduce a broader skill mix, Preseli practice decided to employ an Advanced Paramedic Practitioner to deal with emergency appointments within the surgery, home visits, minor injuries and patients with chronic diseases.
    Although patients took some time to understand the new role they have now embraced it and regularly make appointments with the paramedic practitioner.
    Evaluation in one month showed that the paramedic appointment saved 279 GP appointments and dealt with 269 telephone calls for advice.
    The new role ensures more patients are seen quickly and provides the practice with the expertise to deal with pressures that would otherwise be added to the busy workload of the GPs."

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