Less than 30% of GPs willing to employ physician assistants
Exclusive Less than a third of GPs would be prepared to employ physician assistants, despite the Government promoting them as a way of solving the GP recruitment crisis, a Pulse survey has revealed.
A poll of more than 450 GPs across the UK found that only 32% of practices would be prepared to employ physician assistants - alternatively known as physician associates (PA), who take on a more clinical role - while over 40% ruled out any possibility of hiring them.
The pushback from GPs on the PA scheme comes less than a month after health secretary Jeremy Hunt announced that there would be 1,000 new PAs working in general practice by 2020 as part of the ‘new deal’ to alleviate the GP workforce crisis.
Pulse reported last week that the Government is going even further, considering whether PAs should be given prescribing powers.
But GPs said that the scheme, designed to alleviate GPs’ workloads in a cost-effective way, could in fact cause huge problems for practices.
GPs said that their lack of medical training were causes for concern, adding that there was little evidence to prove that the scheme would save cash.
Dr Zishan Syed, a GP in Kent, said: ‘PAs have not sat the essential (and expensive) components of the assessment trainees have to pass in order to become GPs. It is an unacceptable threat to patient safety to allow other professionals to work in GP-like roles without doing these assessments.’
Dr Syed added that PAs would pose a threat to GP jobs as the Government would ‘inevitably employ them for reasons of cost rather than quality.’
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Dr Amit Tiwari, a GP practising in Colchester, said that liability was also a key concern for practices.
He said: ‘This is going to cost more for practices in terms of indemnity and time and patients would much rather see a qualified GP who can do all this, provide a prescription and management plan.’
However, Dr Simon Gilbert, a GP at Cricket Green Medial Practice which has been employing PAs since 2008, said that if skills sets and experience were understood, PAs could work well in a practice environment.
‘Our current PA does see unselected and acute patients but also spends a lot of time seeing patients with known diagnoses, doing much of the daily home visit list and reviewing patients recently out of hospital. PAs clinical skills are valuable where there may be less time pressure to rapidly assess and prescribe,” said Dr Gilbert.
GPC chair Dr Chaand Nagpaul said that not enough was known about how the cost-effectiveness or scope of the PA scheme yet.
‘They are being trumpeted as a support to GPs before we really understand what they can do. More immediate concerns like retaining existing GPs need to be addressed,’ Dr Nagpaul said.
A Department of Health spokesperson said: ‘The GPs that are already working alongside PAs say they love them.’
Survey results in full
Would you consider employing a PA in your practice?
Yes - 148 (32%)
No - 186 (41%)
Don’t know - 125 (27%)
The survey launched on 9 June 2015, collating responses using the Survey Monkey tool. The survey was advertised to Pulse readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. Some 459 GPs answered these questions.
Readers' comments (27)
Anonymous | Sessional/Locum GP13 Jul 2015 9:18am
I think the NHS is turning in to a pile of crap. Primary care needs well trained GPS not nursed phs assistants pharmacists or F2s. Not only will they provide a second rate service they will degrade the quality of primary care and they will undermine Amy chance we have of getting a better deal as GPS. They will be another means of undercutting is to keep us on bus driver money only working more hours. In actual fact maybe not because 40k for 40 hour week may be more per hour than some sale red GPS get. I do feel that practices getting involved in this just to get an Emis upgrade are doing the profession a disservice and another example of GPs throwing themselves under the bus for a few pennies :(
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Anonymous | Sessional/Locum GP13 Jul 2015 9:18am
We should be saying that GP training is needed to do GP work and champion the mrcgp and vts. If we don't value out own skills and training then why should others.
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Anonymous | Salaried GP13 Jul 2015 10:45am
We need Physician Assistants and Pharmacy Assistants - just like the Nurse Practitioners and Health Care Assistants that we all already have, because they will do much of the work that GPs are made to do to achieve their payment targets - and also then at least GPs wont find an excuse to work part-time to avoid burn out.
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Anonymous | GP Partner13 Jul 2015 10:47am
If Govt really wanted to solve the GP recruitment crisis, they's listen to advice from those who know (GPs) about what could be done and not just impose another top-down, expensive, wasteful "solution"
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Anonymous | GP Partner13 Jul 2015 11:36am
Anon@9.45 - we don't "all" have NPs and HCAs. We have practice nurse for nursing stuff and GPs for doctoring stuff.
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Peter Swinyard | GP Partner13 Jul 2015 11:39am
Take yourself not as a GP but as a patient. If you were worried about your own health and rang your practice, where you are registered, asking for an appointment and were told you could only see a physicians assistant, would you be happy with this as you are concerned about possible differential diagnoses?
No, me neither.
And don't tell me you can always be transferred to the real GP - that's not how it may happen if the government pulls the con trick on patients of fobbing them off with a lesser service.
(incidentally Anonymous | Salaried GP | 13 July 2015 9:45am should perhaps understand that not all doctors want to work full time. We do have a choice, you know! Stop sniping and think of what the real problems are in practices.)
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Anonymous | Sessional/Locum GP13 Jul 2015 12:10pm
This is just a diversion. They government know how to fix the problem since they are the ones who cause this. They want the system to fail whilst shifting the blame.
And we should let it fail rather that trying to keep it running at the cost of our personal incomes, family relationships and sanity.
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Anonymous | Salaried GP13 Jul 2015 12:20pm
Health Care Assistants do not attend University / College to start working as HCA in a surgery. So why will there be a problem for Physician Assisants.
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Anonymous | GP Partner13 Jul 2015 12:38pm
Majority will is clear- like the vote in Greece- so what... if it goes against THE PLAN if goes down the pan
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Anonymous | Other healthcare professional13 Jul 2015 12:51pm
I think we need stop blaming all these other professions! They are just trying to do a job and in the majority they are doing a good job that helps us in Practice.
ANPs, NPs, PAs, HCAs, Pharmacists in practice - none were an invention of this government, so we need to stop seeing them as Jeremy Hunt's bright idea and rejecting them outright.
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Anonymous | GP Partner13 Jul 2015 12:56pm
Anon@11.20 - the name, patient expectation, patient confusion, role, prescribing authority.....etc. How many patients think they have seen the consultant orthopod when the letter is from consultant physio or pass on opinion from gastroenterologist when it was nurse practitioner they saw?
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Anonymous | GP Partner13 Jul 2015 12:58pm
OHP?11.51 - but they are being used by Hunt as his solution for GP recruitment/retention crisis instead of addressing cause of crisis: that's the problem
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Gurdave Gill | GP Partner13 Jul 2015 1:29pm
The manufactured GP crisis always had PAs a an intended solution. Given the blueprint we are following is from the American Kaiser Permenente. Goal is to dismantle high quality evidence based primary care and replace GPs with telemedicine, HCAs and PAs. Our compliance is nolonger required. We have served our purpose which was to shaft our hospital colleagies by tendering out perfectly good hospital services. By building in conflicts of interest we have also being painted as self serving and overpaid. The scapegoats for the demise of the NHS ready to be rescued by the Private Health Insurance industry. As for our leadership, with friends like these who need enemies. No doubt many of them will enjoy for fruits of their betrayal in the form of gongs and directorships.
Start telling your patients we are being screwed and where we are heading. Only public opinion can save the NHS from corporate capture.
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Samuel Lewis | GP Partner13 Jul 2015 1:59pm
we have an Advanced Paramedical Practitioner - neither done nursing nor doctoring, but worth her weight in Gold.
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David Brownridge | Sessional/Locum GP13 Jul 2015 2:17pm
Anyone opposed to PAs should explain how they would solve the GP manpower crisis. The realpolitic is that there is neither the will nor the money to stop all those early retirements and defections abroad.
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Anonymous | Salaried GP13 Jul 2015 2:49pm
In an ideal world:
Patients would prefer to see a specialist instead of a GP
Patients would prefer to see a GP instead of a Nurse Practitioner
Patients would prefer to see a Nurse Practitioner instead of a Physician Assistant / Pharmacy Assistant
Patients would prefer to see Physician Assistants instead of seeing nobody.
Seeing somebody is better than seeing nobody.
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Anonymous | Salaried GP13 Jul 2015 3:08pm
General Practice is a Medical SPECIALITY.
Patients should only see a SPECIALIST when it is mandatory.
Before seeing a GP they should first be seen by Physician Assistants, Pharmacy Assistants, Practice Nurse, Health Care Assistant, etc.
Simples.
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Sue Stevens | Other healthcare professional13 Jul 2015 4:45pm
Well gab hold of one of the unqualified trainess who are going to be let loose on unsuspecting eldrly and frail people..ie those easily exploited
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Anonymous | GP registrar13 Jul 2015 6:34pm
Why don't they take their own trained GP trainees who have passed WBA and AKT, and could pass CSA in further attempt rather than throwing them out and train Physian assistants,
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Anonymous | Work for third sector13 Jul 2015 7:00pm
I think that there may be a useful role for PA's if both they, GP's and patients are clear about just what that role is and if patients are given the choice about who they see. In practice this is unlikely to happen.There are problems with diluting the 'skill mix' in this way. Establishing the credibility of the role with colleagues and with patients will not be easy, much will depend on the training and supervision provided and their own personality. Managing and ensuring their professional development may also place an added burden on colleagues.
PA's may be tempted or obliged by circumstances to work beyond their actual skill set or simply lack the skills to provide adequate care. This is likely to be a potential source for 'reputational damage' for their employers to say nothing of the consequences for the PA and the patients concerned.
As with so much else that has happened over the past five years, it seems to be a case of push things through without considering the implications and when it goes wrong, do just enough by way of mitigating the situation....and blame the deficit.
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Anonymous | GP Partner14 Jul 2015 0:04am
Change is always difficult.It's entirely understandable why GPs feel threatened.Their gatekeeping role is being hijacked by others who can do it much more cheaply.There is no shame in admitting that.The vast majority of GPs I know went into general practice to have a better life-work balance.As partners we have been gradually reducing our clinical sessions and employing salaried docs to do the donkey work.Now we have an even better option:physician assistants,advanced nurse practitioners provide an even cheaper option and that means more profit for us or to put it in a different way more money for less work.It's a win win and we'll definitely be employing them.I've already got my eyes set on the next S class Benz
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Christopher Kent | GP Partner14 Jul 2015 0:26am
When has 32% been less than 30%.With 27% as dont know ,headline could read 60% GPs might like to have PA working with them.
With experience they will I believe prove a useful asset to our over run practices.
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Bertie | GP Partner14 Jul 2015 1:40am
Physician assistants will need careful supervision by the employing GP. Is the time available for this or is it more efficient to do the assistants work yourself.
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Anonymous | Salaried GP14 Jul 2015 7:51am
Money hai to Honey hai !
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Jamie Machugh | GP Partner14 Jul 2015 2:22pm
Having seen this system working (and working well) in USA, the PA's were used more as a "Houseman" who did all the basic history and examn of the patients, and basic tests, then presented to the GP who acted as a "consultant GP" (which is what we are) and decisions were made on this basis - it freed up GP time to look at complex cases and took away the trivial admin bit of the job. If done properly this could work very well, BUT is not a substitute for a GP. We cannot agree to most of OOH being done via nurse and paramedic triage, and then say that GP's must do all the work in the practice - there is a balance to be had here.
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Anonymous | Practice nurse15 Jul 2015 8:09pm
Publications, online services, aimed at GPs tend to only reflect an "in house" view of the profession. Self back patting comes to mind. I accept there is some diversity in opinion but it should not be a them (nurses, PA's, NP's, ANP's etc) and us (GP's) power struggle though I concede too many swimming about offering the same service can be confusing but it is increasingly become clear in evidence, that many "other health professionals" provide not only an equal service to GP's but a better one. My own view is that the medical model has some deficits and the nursing model has some advantages (and vice versa) that pays off for many patients. I cannot quote them all here but research it yourself, be open minded.
It doesn't need rocket science or straight A' s to get to medical school to actually know how to diagnose, treat and care for patients. We all need to refer to specialists sometimes when we need advice out of our area of expertise so a diverse team can actually have its advantages. We also can have poor GPs and good "other HP" where GPs might be highly educated but not be great at applying that education in practice. I trained a HCA some years ago who was herself concerned that our lead GP did not take blood pressures properly, he always recorded lower than anyone else because he had become too complacent in using his old mercury sphyg like a John Wayne quick draw. This same HCA also learned to be pro active in ECG recording, picking up AF's where GPs had not bothered to check.
Another GP I know prescribes Ibuprofen gel for swollen ankles and doesn't know his HDL from his LDL.
Many practice nurses do have the ability to support the practice much better in helping the flow of patients, but sadly and frustratingly, many GPs have a stranglehold, as the "employer" over many PN's potential development. I know, I've been there!
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Anonymous | GP registrar19 Jul 2015 3:33pm
General practitioners needs to be renamed 'family physicians' (as they are referred to in the rest of the world) and be recognised as the medical specialty that it is. If that doesn't happen, all these noctors and ANP/ENP/PNP etc (basically, doctoring on the cheap) will take over.
And to whoever said 'it is better to see someone than no-one', if that is the case shall I call my window cleaner in to do some sessions then?
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