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Gold, incentives and meh

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)

  • 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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  • 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

    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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  • Money hai to Honey hai !

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  • 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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  • 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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  • 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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