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NHS offering £50k per year for US physician associates to practise in underdoctored areas

The NHS is recruiting 200 physician associates from the USA to GP practices and hospitals on an annual salary of £50,000 in a bid to immediately alleviate workforce issues in the hardest hit regions of England.

On Thursday, the new ‘National Physician Associate Expansion Programme’ began advertising vacancies across four English regions to experienced US physician associates (PA), including for 20 GP practices across North West London, practices in Leicester and for primary care positions in Sheffield Teaching Hospitals NHS Foundation Trust.

The positions will start immediately, and will continue for two years while the first cohorts of UK PAs are being trained.

It comes after health secretary Jeremy Hunt’s ‘new deal’ promised that the NHS would recruit 5,000 PAs, nurses and pharmacists to work in primary care by 2020.

Physician assistants are dependent practitioners who is able to undertake delegated medical work, supervised by a qualified GP, such as obtaining medical histories, conducting comprehensive physical exams, requesting and interpreting tests, diagnosing and treating illnesses and injuries, and advising on preventive health care.

Earlier this year Pulse found that NHS Leicester City CCG had spent £600,000 to bring over ten US trained physician associates to work the city’s general practices.

However, this wide-ranging programme - led by Hillingdon Hospitals NHS Foundation Trust and not connected to the Leicester scheme - will also introduce US-trained PAs to different regions of England.

The job application states candidates must have significant clinical experience as a PA and/or completion of a post-graduate residency or fellowship program, as well as valid US or UK registration and evidence of CPD.

The £50,000 salary is based on a 48-hour week, but the positions come with 33 days paid leave plus bank holidays, ‘generous protected non-clinical time’ for CPD and working with PA leadership programmes, and a financial contribution to relocation.

It will also reimburse membership costs for joining the Royal College of Physicians, and costs of registering with the voluntary commission for PAs in the UK.

North West London, Yorkshire, Humber and Newcastle, the East Midlands and North West England are all set to benefit from an influx of PAs, to support GPs and hospital doctors.

Pulse has already shown that the latter three areas have been among the worst hit by problems recruiting newly qualified doctors to GP training.

In the East Midlands more than 40% of places for this August’s intake of GP training were left unfilled, and the North East had almost half of its places vacant.

Dr Nick Jenkins, the programme director, said they hoped to have the first PAs in place by the end of the year, adding: ‘The whole raison d’etre of NPAEP is to do ourselves out of business. We’re not here for any long-term purpose. I’m an A&E consultant, and I can tell you the problem is now, we’re spending a lot of money on locums, we’ve got patients whoneed seeing, and I think PAs are part of the solution to many of the challenges we face.’

‘But you can’t train them overnight, so to help in the short-term we need to bring in experienced people from elsewhere.’

Dr Richard Vautrey, deputy chair of the GPC, has previously told Pulse that PAs weren’t a substitute for employing GPs, but added: ‘We do need to recognise there aren’t enough GPs or junior doctors wanting to be GPs so we do need to look for alternatives to meet the need. Physician associates, or assistants, aren’t GPs but they can certainly provide some support

PAs in America also have prescribing powers, which are currently not available to UK PAs.

However, Pulse has already revealed that the Department of Health is evaluating the introduction of powers in future.

Readers' comments (61)

  • This must be the world's most expensive sticking plaster.

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  • I don't think American PA's are likely to come to the third world, except for a prolonged holiday!

    The soln is easy, pay the market rate for doctors and they will come.

    For ideologically obsessed free marketeers the current regime forget all this very easily

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  • Let them come, let them see and they will go back in 2 months flat. I would if I could.

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  • Wow with those conditions no responsibility etc I will swap my partner status and work as a PA. If I had one they would be earning more than me relatively speaking. US PA Just want to deliver high standard hands on care. No tick box counting or rest of uk rubbish hoops we spend hours jumping over and through when they realise how awful bureaucratic the nhs is they will be off too like many of my GP friends plan to do in the next year.

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  • I agree. When salaried GPs are being offered 70-80k per year but play roulette and double jeopardy via the GMC and will be paid to supervise them, why not just work as a PA and get someone else to carry the can.

    I'm sick of the RCGP endorsing other professionals to come in and undermine our status, the aim being clearly to reduce the number of doctors in the NHS to a bargain basement service. There is no way I will ever supervise or oversee a nurse practitioner or a PA or their prescribing. If they want my opinion then the patient is booked in withy me for a full assessment, or not at all.

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  • Will they be required to undergo NHS Induction and Refresher for being foreigned trained and never familiar with the NHS? Are they going to be subjected to any assesment exams? Will they be paid £2,300/month during their induction period? Or is it only our GP colleagues from Australia and New Zealand that have to be subjected to these?

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  • This is not generous and I would be surprised if hundreds flock to uproot themselves.
    All BMA salaried doctors' contracts and nurse practitioner contracts are based on 37.5 hours a week ( although I know many doctors voluntarily do more)
    This offer equates to approximately £38 000 a year for a "standard" working week. Hardly massive!

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  • Govt is happy to give their yankee friends 50£k for a PA but they won't give me the 26k of MPIG they took off in one stroke which would have allowed me to have a full time GP - a real GP and not a half baked US import from Minnessota !

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  • This is the most ridiculous solution and ill thought solution ignoring your own market of doctors. The way to do this is to induct those trainees who are not able to pass GP assessment exams but have completed the clinical rotations and have experience of working locally and know the system. They should be allowed to work as PA.
    What is the assement exam for foreign PAs. they know nothing about NHS and would take double amount of time and energy and money to train them to suit the needs of primary care.
    RCGP should seriously think in a modern way rather than sticking to old fashioned way and utilize the local doctor s here who have good experience but not full GP training.

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  • most of these will end up in hospital clinics and wards - very few will wnat the stress of primary care

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  • This is just the beginning....very soon we will have PAs, paramedics, NPs, pharmacists doing most of the consultations. Government is aware that public will always want to see a Specialist and nothing much can be changed in hospitals. But GPs can be easily replaced by non doctors. All of that will come at a much cheaper price and with time patients will get used to consulting non doctors. It will also benefit the Government because GPs will have less bargaining power once cheap alternatives are available. Salaries are increasing in every part of the world but unfortunately for us here it is going down. I believe we all need to have alternate plans in place and keep our options open to move to countries like Aus/NZ/ CAN. I don't see conditions improving in near future. The way things are, in 5 years time our salaries here will be similar to what a doctor gets in India...a developing country!! Good luck

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  • Many full time partners here in Lewisham are earning £60 -£75 K so they may well want to swap their roles for the much easier and less risky life of a PA. Plus as an employee they won't have to pay locum insurance, cover each others' holidays, indemnity and so on. The people behind this have no idea of the actual reality for most GPs.

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  • So, with on costs we're looking at £13m on this?! Not sure that's good value.

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  • AT THESE SALARIES AND CONDITIONS, ALOT OF GPs WILL BE THINKING ABOUT BECOME PHYSICIAN ASSOCIATES. AFTER ALL THE EXPENSES AND COSTS THE DIFFERENCE IN SALARY BETWEEN THESE AND GPs WHO WORK MUCH LONGER HOURS AND THE LACK OF RESPONSIBILITY MEANS THE RATE OF PAY FOR "ASSOCIATES" COULD BE BETTER THAN THEIR BOSSES.

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  • Nurse practitioner - highest band 6 pay is £34k/annum, band 7 (not may nurse practitioners are on this scale) £40k/annum

    So PAs with no responsibility (in uK) and no accountable/regulatory body, no licensing needed and much less qualifications and experience needed to be nurse practitioner, will earn 25% more then band 7 nurse.

    No disrespect to american PAs but this is plain ridiculous.

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  • p.s. at above condition this job equates to £20/hr and 5.5 weeks of holiday with "generous" PDP time.

    I can't see any nurse practitioners/practice nurse wanting to do their current job if this comes into force. We'll have mass exodus of these profession soon.

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  • What people don't realise is that Amercians work very differently from us. Headache=ct scan before going any further. Chest pain = angio. Cough=ct scan. They practice defensive medicine which is largely investigatin based. When you go to a+E with anything, they tick every box on the blood form irrespective. They will have a shock when they realised they can't get an mri for every condition, their tick boxing of every blood form will get them a snotogram from the powers that be, and they won't have the training to make diagnosis and differentials like real doctors. Won't last long, a very expensive excercise for the DOH who are clutching at straws. I'm out. I'll stick to my all doctor practice with nurses and HCA's all doing jobs they are suitably trained for. I pay enough for my indemnity to even bother taking on more liablity. Thanks and good luck

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  • - 50 k for a dependent practitioner who is able to undertake delegated medical work, supervised by a qualified GP - that's too expensive, I am not sure even a junior hosp SHO gets that kind of salary !

    - also will the physician associates from the USA be formally examined / assessed by GMC or RCGP before joining GP practices, I dont think just having
    ' significant clinical experience as a PA and/or completion of a post-graduate residency or fellowship program in USA ' is sufficient criterion.

    - In USA I don't think having significant clinical experience or post graduate qualification from UK allows somebody to practice as a healthcare professional unless they sit and pass all their exams, USMLE etc.

    - '' It will also reimburse membership costs for joining the Royal College of Physicians '' if physician associates are working in GP practices, shouldn't they be registered with RCGP instead ?

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  • So a PA who trained for 2 years gets more pay than a band 7 nurse (40K region) from the UK: , Despite the fact that she probably is better qualified, regulated by the NMC and is fully aware of the functioning (or non functioning) of the NHS.

    Is a GP replacement by either a PA/Nurse practitioner a sensible option any way.

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  • Wow what a clever thing to do.Pay salaried GP 70-80000 £,get patients,admin,visits,meetings etc.PA only £ 50000-no admin,visits,under supervision of GP. Anything in doubt-forward to GP-increase their workload.
    I am though confused about medical indemnity so apologies for ignorance-could be from supervising GP.God help with antibiotics/QOF/targets. Can they be referred to GMC- of course not-the supervising GP will be.
    Of course quality of care-Excellent for people as per Mr Hunt and DOH.Congratulations to them

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  • U.S. PA's? I'm not sure this will help the budget when they turn up and scan everyone with a sore throat or belly ache American style.

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  • As a junior doctor it is galling that PA out earn me by a significant margin, are entitled to more annual leave, a more generous and inevitably better protected CPD programming and will be working less hours. Whilst I am certainly not a fully qualified GP/ consultant how on earth am I worth so much less.

    Throw in the impending Jeremy hunt pay review/ cut and all of a sudden the NHS is looking very toxic.

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  • somehow i dont think we are going to get the cream of the crop coming to work over here from across the pond.

    absolutely disgusting that the situation has come to this. have the powers that be have no shame.

    I agree with one commentator, we lost 30k in mpig a few months ago which employed a part time salaried GP in our (rough) area - who we could not afford to keep. Now they want a PA?!!

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  • Any GP that 'supervises - read takes medicolegal responsibility' must be mad.

    This is a ridiculous idea.

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  • its a very short term fix, will not solve anything. Working in states is very different, its more defensive with very little stress on clinical acumen / skills, so I think we will be looking at more expensive / inappropriate investigations been requested by these PAs !

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  • Dr Nick Jenkins should be ashamed undermining the indigenous
    Locum staff get no sick pay no maternity leave no pension and I bet work out cheaper in the long run
    Americans will love the holidays but will they love the tax and cost of living in rip off Britain!

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  • I wonder how long NHSE will be willing to pay for them. the cost will be passed back to general practice eventually. Their market rate will probably be closer to 20-30k per annum full time. I hope the PA's realise this that their eventual salary will be halved with risk of redundancy. it is not fair to them.

    - anonymous salaried!

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  • North Americans have a "can-do" attitude - they don't sit around wasting time moaning incessantly like their British counterparts.

    Plus I'm sure they'll be impressed with the generous holidays - given they're used to getting 10 days off a year tops.

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  • Of course they will be subject to proper supervision and debriefing on every case as they will have very much less knowledge than ST1 GP trainees or nurse practitioners. Of course they will only be placed in practices where staff have had training in supervision skills, perhaps only in practices with educational ethos? I DONT THINK!!
    What a crazy idea, almost as crazy as thinking paramedics will acquire GP skills in a few weeks.
    GP is still a great job, but practices need huge investment now after years of governmental doing us down. Show the FY2 doctors how GP IS A CHALLENGING BUT REWARDING career choice and get the training places filled. Stop expanding hospital consultant numbers.

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  • I'm completely confused by the PA role if I'm honest. Surely GP-lite supporting roles are better fulfilled by pre-existing, regulated HCP roles (nurses, pharmacists etc).

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  • Good luck to all the GP's who end up supervising these physician assistants . Also who is going to indemnify them ? The salary seems better than that offerred to a final year GP registrar .So they will get the chance to play GP knowing that they can easily deflect any responsibility on to the hapless partner who is supervising them .

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  • This is for a 48 HOUR WEEK.
    Registrars, salaried doctors and nurse practitioners are not contracted for 48 hours.
    My worry is that the government are heading in this direction.

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  • Sorry to be blunt about it, but it seems my slacker mates from school who are allied health professionals (who have enjoyed every minute of slacking) are rising up the ranks to a better position than me. Doh!

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  • You need 10 year of training, lot of hard work/ difficult exams to start working as a GP. Whereas 2 yr of training and you are a PA.... salary of 50K. Go for it guys , why do you want to go through all the hassle and hard work. The way things are Government is not going to invest in getting more GPs, so we will have to look for cheap options. Sadly, even the Asian doctors are not going to rescue General practice this time...as I don't see them coming to sort out recruitment crisis. Salaries are much better in India then they were 10-20 years ago. Middle East/Australia/ Newzealand are offering much better packages and unfortunately we are no more a pulling force in the global world!!

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  • As soon as they realise they cannot get MRI scans done tomorrow for every twinge and GPs decline the antibiotics they thought every patient needs they will be off

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  • Surely we just all have to say no, not a chance?

    I would sooner take on another FY2 - better qualified, proper clinical training and experience.

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  • Took Early Retirement

    I think at that salary there will be very few GOOD PAs who will want to up sticks from the USA, come to our high-tax, high-regulation country, leave somewhere like Florida for the privilege of working in Hull or Leicester. (Actually, I know Leicester a bit and as some cities go, it isn't at all bad.)

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  • i think less patients will go to A&E.
    more will go to PAs
    GPs will be left twiddling their thumbs.

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  • I am a gp partner.. How can I convert to work as a PA please . I can work 2/3 my current hours . I can increase my leave from the current 2 weeks if lucky as we cannot recruit to 6 wks. Even get CME ! No responsibility , sick pay ..... I don't even have to think too hard as can pass on everything that isn't simple. And I only have to drop £20K after tax NI works out 10K.
    I get paid to move even.

    Sounds a brilliant job Or will they turn me down as I don't have a PA certificate if I apply or even for being overqualified !

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  • Here they come again, confused NHS minders. Let us see how long the Americans will last. Welcome to NHS.

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  • NHS will keep having recruitment problem until the fundamental problem is addressed. Sticking expensive plaster over an infected wound does not heal the wound, does it?

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  • I have worked as a primary care physician in an integrated staff model HMO for many years.
    The American PAs I have worked with are excellent, know primary care inside and out, get excellent benefits (way more than 10 holidays a year, as one poster here stated), and make way more than what is being offered by NHS.
    However, even though I have long been an assiduous reader of Pulse, I didn't realize until now (from physician comments herein) how little primary docs make in the NHS. Surely your training, skill, life are worth more than this.
    Life is too short to be an indentured servant.

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  • Ronal Reagan and the ATC strike comes to mind ..Seriously can anyone else see this or atleast have the courage to say this

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  • I have just completed a 4 year GP training. I do not hold a CCT due to marginal CSA exam failure. Apparently there are at least dozens if not hundreds of trainees in my position who would happily take up non GP jobs similar to the one described in this article and work in the very field that they have already been trained. I wonder why recruiting overseas doctors is considered a better solution compare to using the readily available trained local workforce....

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  • @above I feel for you mate
    Only a few short years ago you would have got through summative assessment and been free to work.

    My advice is to leave the UK if you can an maybe get a residency in the states or something. Alternatively you could probably easily get a decent staff grade job in hospitals and coin it. That's if you want to stay in their and experience the garbage that is the NHS in the country formerly know as Great Britain. Anyone can see now just how bad things are there and that a once great country has now gone to the dogs

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  • Took Early Retirement

    Yes, SA was fine. I suppose it was scrapped to help the RCGP monopoly?

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  • At present the regulation of physician associates is done through a voluntary register. This register does not have the force of the law, meaning that physician associates can see patients even if they are not registered. This poses an unacceptable risk to patient safety in GP surgeries.

    I have therefore set up a petition to call for a proper mandatory registration process for physician associates and I encourage all who are interested in patient safety to sign it.
    https://petition.parliament.uk/petitions/105948

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  • average salaried post 72k a year (pro-rata).

    actual hours worked >> 40 hrs a week

    after defense fees, GMC (rip off artists), RCGP (even bigger rip off artists) and pensions = less than £50k

    yet full responsibility with multiple jeopardy !

    the way is clear - why bother being a GP?

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  • The salery seems aproproate for a graduate with further training. It's the rest of us who are underpaid.

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  • So instead of spending the last 4 years at medical school (tuition fees £36k), I could've spent 2 years at Hull Polytechnic and be on £50k for 2 years already? Actually have money left over for a deposit? Refer every patient to the doctor for a script or just write "discussed with GP" in the notes, not taking any responsibility at all. And paid study leave, relocation expenses, copious annual leave. And there'll no doubt be lots of bull**** conferences to attend where they present "evidence" to each other about how great their "outcomes" are and how they add something special or different because they think outside the "medical" box and Kolb cycles and multi professional teams and blah blah blah

    -- 4th year graduate student

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