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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)

  • 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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  • 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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  • 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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  • 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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  • 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

    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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  • 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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  • 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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  • 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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  • 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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