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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)

  • Hundreds of qualified doctors were released from GP training making their and their families lives miserable. Millions of tax payers money gone down in the drain. Not to mention that those doctors spent 5-6 years in Medical school, passed PLAB exam which is a medical knowledge and language proficiency exam conducted by the GMC, passed competitive GP recruitment selection exam in three stages(examined by GP examiners), under gone three years of GP training under a qualified GP trainer endorsed by annual ARCP panels confirming progression, passed AKT, passed work place based assessments yet failed repeatedly by ONE examiners skill to judge in 10 minutes of those doctors suitability to do a job, a PHYSICIAN ASSISTANTS POTENTIALLY CAN DO IN REAL LIFE GP LAND!!!!!
    “Every clique is a refuge for incompetence. It fosters corruption and disloyalty, it begets cowardice, and consequently is a burden upon and a drawback to the progress of the country. Its instincts and actions are those of the pack.” ―Chiang Kai-shek

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  • Hopefully they will help and not just be asking questions all the time. Al least they may be able to do all the des les qof stuff like anplanned admissions and we can see patients

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  • Half-way through the process of jumping ship to Oz, cant wait

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  • Great ...dirt cheap GPs! know you want know that's just who you want to take your sick baby to...a cut price bargain basement 'stack 'em high' 'train em quick' Dr impersonator ....marvellous ...can we get them flying planes on Ryan air too please.

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  • Damn. Wasted all those years in hospital when I could have done the same job with a 2 year diploma!!

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  • Oh no! They now have the power!!

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  • 2 sides to this one.

    I do see that PA's may appear threatening to GPs, and if government seriously thinks they can do GP's entire workload then the whole service will indeed go tits up.

    However, we have long had nurses managing all our long term conditions patients (can't remember when I last saw a routine review of COPD for example, and have to ask our nurses advice these days as so deskilled on chronic COPD). PA's seem to be essentially a similar proposition - not to be doctors but to work a bit like our senior nurses do.

    So, to take a proper history, do the jobs, come up with a differential and management plan (like a F! doctor) to discuss if it's complicated, or to sort out the UTIs and coughs etc if it isn't. And of course to do some chronic disease stuff, and the kind of thing we had telehealth in for (that's another whole story of wasted money).

    There aren't enough nurses around to do all this work, and they have to be trained mostly in house, so why not train some other people up specifically for this role?

    I think we should welcome them with open arms, and think of them more like specifically trained nurse practitioners.

    (Not in any way denigrating nurse practitioners who have a wealth of experience on top of their training which will certainly give them a big advantage until the PA's have a few years experience under their belts).

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  • Just to try and answer a few questions
    PA's work under the supervision of a qualified doctor but they have their own professional indemnity, the fee for one of the PAs in my pratice is >£2000 and we pay it. They earn from £20,000 to £40,000 dependant upon experience.
    They are trained on a medical model, have a broad breadth of experience (but maybe not the depth of a doctor), they are trained in decision making, they are not protocol driven (unless that is what you require of them)
    HEE and DH have decided they are going to be an integral part of general practice. They are coming whether you like it or not.
    This is a new (for the UK) type of healthcare professional and general practice has the opportunity to help mould this role into something that complements our needs.
    We are being battered from every direction (money, workload, workforce crisis etc) but PAs could be the silver lining to that big black cloud we are forced to be in - just a thought!

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  • Just a quick comment from a PAs perspective. I have been working in general practice for nearly 9years now and I work exactly the same list as our GPs.

    My indemnity is through the MPS and I pay the same as a GP and am held clinically responsible for my decisions. Yes I have to knock on a GPs door to get a script signed but this is not as much of a big deal as people are making out.

    I have my own patient base that prefer to only see me and are quite insistent on seeing me over some of the GPs. We are not replacement GPs, how could we be with the breadth and depth of experience that a GP has? However there are now two of us in my practice and the workload that we take on is equivalent to that of a GP each. Our practice has high ratings on NHS choices and we work all day from 8am-6pm apart from an hour off for lunch. We do not just do 3hr surgeries AM and PM and we work to 10min appointments.

    We are part of the solution, not the problem. general practice still needs more GPs and people are correct that the government needs to address why GPs are leaving but until (if) that is sorted we need people to help address the ever increasing demand for appointments. patient education could go a long way to reducing the pressure on GPs rather then people feeling they need to see a GP for every sniffle or mild cough.

    If we work together then hopefully we can help each other and make work enjoyable and not the chore it has become for many

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