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GPs go forth

Physician associates ‘can do GPs' work more cheaply’

Physician associates can take on some of GPs’ daily work without any harm to patients and at lesser cost to the NHS, researchers have claimed.

The team, from Kingston University and St George’s University of London, looked into urgent and same-day appointments with 2,086 patients at 12 GP practices in England, six of which employed physician associates to focus specifically on these kinds of appointments.

Allowing for differences between the two groups in potential confounders such as age of the patients, rates of re-consultation after the initial consultation were similar for the physician associates and GPs, as were rates of diagnostic test orders, referrals and prescriptions.

Patient satisfaction was also just as good at the practices using physician associates as at those employing only GPs, according to the report, while a group of independent GP observers – who were blinded to the consulting clinician – judged that physician associates had dealt with the initial consultations at least as appropriately as GPs.

And, although the average physician associate consultation lasted nearly six minutes longer than a GP’s, each consultation cost around £6 less.

The researchers concluded: ‘The processes and outcomes of physician associate and GP consultations for same-day appointment patients are similar at a lower consultation cost.

‘Physician associates offer a potentially acceptable and efficient addition to the general practice workforce.’

Physician associates – or physician assistants as they are known in other countries – are most widely employed by the USA health system but have more recently been adopted by Australia, Canada, the Netherlands, Germany and India.

Relatively few are currently employed in the UK, but Health Education England announced plans to create over 200 more physician associate training posts next year to help support GPs.

This followed news the RCGP had lobbied Government to create a new ‘medical assistant’ role in line with the US model as a short-term solution to the GP workforce crisis. The RCGP has also called for pharmacists to work within practices.

Dr Helen Stokes-Lampard, honorary treasurer at the Royal College of GPs, said physician assistants could never replace GPs but could alleviate some of their burden.

Dr Stokes-Lampard said: ‘GPs are highly trained medical doctors, and our skills at being able to diagnose and treat the “whole person” through initial consultation and the unique relationship we build up with our patients over time cannot be substituted.

‘But there are many tasks that take up a huge amount of GPs’ time that physician assistants can do, thus enabling family doctors to spend more time with patients with multiple and complex needs, for whom the standard 10-minute consultation is not enough.’

She added that more evidence would before the positions could be rolled out more widely.

Dr Richard Vautrey, deputy chair of the GPC, said that alternative roles would be needed to meet the need in general practice but agreed physician associates could not replace GPs.

Dr Vautrey said: ‘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.’

Dr Vautrey added: ‘Patients want to develop a long-term relationship with their GP – you still need trained GPs to manage conditions where the diagnosis is not clear and there is a degree of risk, working beyond guidelines and taking into account patients’ holistic needs.’

Br J Gen Pr 2014; available online 27 April

Readers' comments (71)

  • Fine if you don't need a diagnosis .

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  • no - I genually think we need to embrace this idea - and not be afraid of it. If we truely want things to improve - we need to be open to options like this. GP's will still always be needed for BIG decisions - but there is tons of work we could deligate. I am only annoyed by the ridiculously small numbers of training posts being discussed here - 200 is not even a 'drop'in the ocean

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  • looks like a highly profitable model for big business. Treating lots of self limiting presentations and fostering the consumer culture. a vote winner no doubt.

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  • I also think we should roll this out since there aren't enough GPs.

    Obviously I'd want a proper GP for my family, but this could be fine for other people.

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  • anonymous 8:83

    Very apt !

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  • That's great physicians assistants for the "plebs" and proper GP's the the ones who know anything or willing to should loudest. will go down a treat!

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  • ?Is their indemnity cover provided by their employers or by the GP supervising them.if it is the GP how much will it increase the GPs indemnity.

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  • We've tried so many types of 'practitioner' with varying degrees of success but for some reason it's never really taken off.

    Who is going to train them?
    How do you get them to the same standard as a GP in less time?
    Who is going to regulate them?
    Who is going to indemnify them?
    Why would anyone want to shoulder the responsibilities of a GP for less pay?
    How do you measure their performance?
    How do you prevent them increasing demands on existing medical staff?
    Does this reduce funding available for doctors and nurses?

    Too many unanswered questions.

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  • Very Good Idea. I cant wait to see the physician assistants working in General Practice. At least they will work full-time

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  • Buy cheap.....Pay twice!

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