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Independents' Day

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.’

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.

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Readers' comments (27)

  • 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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  • 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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  • 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

    we have an Advanced Paramedical Practitioner - neither done nursing nor doctoring, but worth her weight in Gold.

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  • 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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  • 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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  • 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.


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  • Well gab hold of one of the unqualified trainess who are going to be let loose on unsuspecting eldrly and frail those easily exploited

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  • 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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  • 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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