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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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  • "Anonymous | GP Partner | 07 July 2015 10:06am
    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"

    that's a good point. why spend 10 years of your life and 5 figures of money to be a glorified nurse.

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  • 2 years to do a diploma in physician associate. A lot are doctors who cannot get on the register. Let them help, it will be good.

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  • Bring it on. I've had 22 years of sweeping up after others. Let's see how the patients take to seeing the assisstant rather than the doctor.
    The main issue is that they are not addressing the real problem Dr/pt ratio is out of control as are pt/appt/year.
    A few PAs ain't going to help that.

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  • well its a 2 year fulltime post grad diploma AFTER a bioscience degree not JUST 2 years
    and the evidence shows that PAs can be effective members of the team supporting doctors
    they are dependent practitioners who will work much like ju7nior doctors do in hospitals currently, with consultants supervising and training and (yes) dealing with the more difficult cases.
    Anyone not feeling overworked? Anyone not want someone who you get to know over a period of time and who can see at least some of the patients for you?
    Jim Parle
    Declaration of interest: former full-time GP and senior partner, now academic and director of Birmingham’s PA programme

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  • Why is is that all of these other roles that are brought in to try and "augment" doctors, also seem incredibly expensive?
    I can remember being an FY1 on nights, being given work that the nurse practitioner "wouldn't do", only to find out they were on double my salary.

    Likewise whilst an A&E SHO, I remember the day light hours A&E Nurse Practitioner telling me what type of people he would and wouldn't see, and then finding out he was on more money than me as well.

    I'm all for diversifying and different roles but it seems every time we bring one of these roles in it highlights what good value an actual trained doctor (of any grade) is.

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  • 'Likewise whilst an A&E SHO, I remember the day light hours A&E Nurse Practitioner telling me what type of people he would and wouldn't see, and then finding out he was on more money than me as well. '

    I also remember being on with experienced nurses in A&E when an SHO, and they deserve all they get. I can think of several cases where they saved my bacon and were welcoming and helpful at all times.

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  • The GPs numbers would not have dwindled if GMC MPTS were given resilience training not take NHS complaints as sacrosanct and investigate them before torturing Gps to distraction and resignation.
    Four years ago there were more GPs than could be absorbed.It is mismanagement of bullying of GPs pointed out by prof Brian Jar-man ,David Hands,also cost effective approach to treatments by Tony Barnet that has led to our sad situation.

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  • I'm surprised it's taken so long to even consider introducing physician assistants into the UK.I've long argued that they should form the backbone of primary care.Let's be honest here:most of General Practice is crud.It is work that can be done alot cheaply by non GPs.

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  • The trick is of course spotting the serious problems amongst the " crud " . That takes training skill and experience . Not everyone can do it .

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  • Often people think of PAs in primary care as someone to do the unselected 'minors' or acute list.
    This is a mistake as the best clinicians to deal with undiagnosed, uncertain diagnoses rapidly yet safely are GPs.
    Our PA sees new patients but also spends a lot of time following up patients with known diagnoses, such as the housebound visits or those recently out of hospital, where their clinicial skills can be put to work yet there may be less time pressure to rapidly assess and prescribe.
    If you employ specialist nurses you should have no worries about working with PAs. Their medical knowledge and 'language' is much more aligned to the medical model doctors use than nursing training.
    A PA can take a history, examination, differential diagnosis and produce a management plan in a very similar way to a medical student or junior doctor. They are trained by doctors, including GPs.

    They are not GPs, but then nor are junior doctors in hospital specialties the same as their consultants.

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