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Physician associates may be given prescribing powers, says DH

Exclusive The Government is considering whether physician associates should be given prescribing powers as part of its ‘new deal’ to relieve the pressures on GPs, Pulse has learnt.

The Department of Health has told Pulse this was one of ‘a range of issues’ it was considering ahead of recruiting 1,000 new physician associates to work in practices by 2020.

Jeremy Hunt promised the physician associates as part of a plan to recruit 5,000 new practice support staff over the next five years.

Giving them prescribing powers would add to their working role - as currently listed by NHS Careers - that includes taking medical histories; performing examinations; diagnosing illnesses; analysing test results and developing management plans.

But GP leaders have warned that adding prescribing to this list is unlikely to make much difference to the ongoing workforce crisis.

Mr Hunt recently watered down his committment before the election to recruit 5,000 more GPs saying that this was ‘a maximum’, but a Department of Health spokesperson told Pulse it was pressing ahead with plans for 1,000 more physician associates.

He said: ‘Together with NHS England and Health Education England we are considering how to ensure 1,000 physician associates will be available to work in general practice by September 2020. A range of issues and possible solutions have to be considered, including prescribing responsibilities and whether and how they need to be regulated.’

Physician associates are currently science graduates who have completed a two-year training course, however, it is not mandatory for them to be officially registered.

Research from Kingston University and St George’s University of London this year claimed that physician associates can take on some of GPs’ daily work without any harm to patients and at lesser cost to the NHS.

But Family Doctor Association chair Dr Peter Swinyard, a GP in Swindon, warned offering them prescribing powers could result in a ‘real deception pulled on the public’ if they thought they were seeing a medically qualified member of staff.

He added: ‘If they can also prescribe then we have even more of the potential mismatch of what people think they are getting and what they actually are getting.’

GPC prescribing lead Dr Andrew Green said he supported ‘in general’ the extension of prescribing rights, when used responsibly.

He added: ‘However it would be a nonsense to suggest that the promise of 1,000 PAs in five years, even with prescribing rights, will make any difference to the crisis we are in right now. The underlying reasons must be addressed as to why today’s young doctors are not becoming GPs. Improving skill-mix within primary care might help, but people can forget how difficult it is to do our job well, and complex and undifferentiated care needs the most highly trained professionals available.’

Amid the Government drive to boost numbers, Sheffield Hallam University will become the 10th institution to provide the course from January next year and last week Royal College of Physicians launched a new arm, the Faculty of Physician Associates, especially for the staff grade.

Meanwhile, NHS Leicester City CCG is spending £600,000 on bringing over ten US-trained physician associates to work in local GP practices, in a bid to address its recruitment crisis.

Readers' comments (39)

  • Who will pay the indemnity costs.

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  • This will be seen by medical students as a further round of undermining general practice . It will make Primary care seem - medicine lite . It may be that PA's are excellent prescribers but why bother with the slog through medical school. Perception and image is very important - that's why billions are spent on advertising . I predict there will be a massive drop in recruitment for gp's

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  • Having Physician Assistants will suit those holding APMS contracts. Already they employ a lot of Nurse Practitioners, and now with the introduction of Physician Assistants, they need not bother employing more GPs to run their businesses and thereby cutting their costs significantly - but all this at the expense of providing quality and safe care to its registered patients.

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  • I thought it was a given that prescribing was in their job description.Otherwise what's the point.They'll end up queuing outside your door with prescription requests and just adding to the workload.Indemnity is crucial.They prescribe,they're responsible.You can't have GPs combing through all their cases.We have neither the time nor the manpower.

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  • Bob Hodges

    I visited Worcester University a week or so ago, as they have a 2 year MSc course for Pas. I was very impressed with what I saw. This is not an underhanded way of replacing GPs, but one of the ways in which primary care teams can be augmented.

    Remember - hospitals not only get 80% of all the cash, they have 80% of all the junior doctors as well. Some of the functions of the old fashioned 'firm' need to replicated within the community. GPs can't do all that on their own.

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  • If Nurse Practioners are going to need £4.5k of indemnity insurance what are these PAs going to pay?

    Don't see a lot of evidence based approach to this either, wouldn't it be better to get pharmacists involved, rather than Physicians Assistants.

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  • "Bob Hodges | GP Partner | 07 July 2015 10:29am
    This is not an underhanded way of replacing GPs, but one of the ways in which primary care teams can be augmented. "

    We know that it should be used to augment GPs but we all know that it WILL be used by the Govt as an underhanded way of replacing GPs.

    Please, nobody be naive about why JH wants this.

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  • this is what will happen. they write 'd/w GP' at the end of their consults. Liability back to GP when the brown stuff hits the fan. yet another nail in the coffin of this profession in the UK

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  • Leicester is re-inventing the (square) wheel. Heart of Birmingham PCT imported US "Physician's Assistants"; all but one left.

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  • @ Anonymous | GP Partner | 07 July 2015 10:26am
    "I thought it was a given that prescribing was in their job description...."

    Me too. PA will be of virtually no benefit if they do not prescribe and will actually increase our workload.

    If PAs will see and treat patients autonomously and their medical indemnity is funded then this should be a positive step.

    As others have said we need a team of autonomous professionals with GP supervising in a role similar to the consultant firm in hospital.

    The days of the GP acting as consultant, registrar, house officer will end soon (one way or another).

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