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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)

  • 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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