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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)

  • 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 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)....

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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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