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At the heart of general practice since 1960

Physician associates allow us to offer 60 more appointments a week

Dr Trisha Wildbore explains how replacing partners with physician associates has paid off

What we did

In 2012, like many practices, we were (and are) underfunded and overstretched. We had heard that a local practice was employing a physician associate (PA) on a locum basis, seeing patients in a similar way to a GP, so we decided to offer him a temporary position with us for one day a week. We audited his notes and were impressed with his knowledge, efficiency and patient feedback. So when we placed an advert for a replacement partner, we agreed that he could apply.

We were looking for someone with strong business acumen and the PA gave the best answers to the business questions. To our mutual surprise, we agreed to take him on as a partner.

When another partner left (we currently have four GP partners) we decided to recruit a second PA. We found an experienced PA who was looking to make the move from hospital to general practice and we were delighted when she decided to join us. Because she had less general practice experience than our first PA we screen the patients she sees, which is easy because we use a telephone triage system and are able to book patients directly with our PAs, GPs, registrars or nurses. After seeing the patient she comes to us with a short history, examination and treatment plan and only rarely needs any additional advice.

PAs are trained using the medical model in diverse areas of medicine, which means they are mouldable to any position, but particularly suited to general practice. They have their own indemnity, but the supervising GPs take ultimate responsibility (as they do with nurses).

Challenges

Although PAs have a professional body (Faculty of Physician Associates, Royal College of Physicians) they are not yet regulated so cannot sign prescriptions, Med3s, X-ray requests, and cannot confirm or certify death so you always need a GP available for this. They can independently take a history, perform an examination and make a treatment plan.

It was also a challenge for receptionists to explain the role to patients. We have used a crib sheet explaining PAs are not doctors but can see patients in a normal appointment and can deal with most things. If patients are not happy they can be offered appointments with a GP or nurse.

Results

Taking on PAs resulted in more positive patient feedback, probably because it was easier to get appointments with them, we had a younger and more dynamic team and because of the personality and efficiency of the PAs themselves (patient feedback often names them particularly). We moved from two stars on NHS Choices in 2012 to five stars in 2015. We have found that our PAs are happy seeing patients every 10 minutes (although many take 15) so we have been able to increase the number of appointments by around 60 per week within the same budget (as the PAs work more sessions than the GPs who left) and increase our flexibility to deal with staff shortages.

PA salary varies with experience from band 7 (starting at £31,383) to band 8a (upper limit of £48,034), meaning it is possible to employ a full-time PA for a similar cost to a half-time GP.

The future

We wouldn’t take on another PA at the moment, because you need to make sure there is at least one GP as the responsible clinician and to be available to sign off any paperwork. However, if you are interested, you could try networking at the annual PA conference, advertising on NHS Jobs or contacting the Faculty of Physician Associates at the RCP. Arguably though, one of the best methods may be to ‘try before you buy’. Because of the massive increase in numbers of PAs being trained, many universities are searching for practices that are willing to teach a trainee PA.

Dr Trisha Wildbore is a GP in Coleshill, Warwickshire

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Readers' comments (18)

  • If I understand correctly, a person doing a similar job to a GP but for lower cost? Are you not just part of the overall scheme to lower wages? Arent we all being upskilled at every level so that more complex work can be done cheaper? GPs doing work that previously was the area of specialists etc. On one level this works as many people have genuine interest in taking on a different role but I believe this may be incredibly short sighted in the long run.

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  • Of course you have made your MDO's aware that you're using a PA.

    I suspect as those who have done telephone triage have found the benefits are only temporary.

    PA's are a silly waste of time - a way of NHSE and HEE avoiding the main issues.

    would you want your relative seen by one?

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  • This is a temporary fix of the supply,the more fundamental issue is dealing with demand in a resource cost limited organisation.

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  • What people will do for money
    • give patients second best
    • serve the socialist NHS
    • really and truly prove GP's are second rate doctors
    • show in the most dramatic manner how little they think of their worth and training

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  • MPS and MDU are going to jack up premiums and turn out to be net beneficiaries as they start putting rates up. You won't be able to sack staff as employment law will screw your brains once a year of employment is over if you had initially offered them indemnity in the package. This is a dangerous path that will lead to destruction.
    Until the government does not apply crown indemnity to general practice, beware of employing staff. Indemnity providers are hovering like vultures over your heads.

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  • I think this is an excellent example of constructive and positive approach to problems we are all facing- chronic underfunding and national shortage of GPS. How do you provide more appointments when resources are not increasing to match the demand? I wish I knew the answer.
    I think most of critical posts here are unfair, and possibly represent rigid and inflexible thinking. People generally don't like changes. But changes will come anyway, austerity will continue, we will have to adapt or leave. It seems likely that in not too distant future GP will be more involved in service development and supervision of a team of nurses, PAs, mental health and other practicioners. Not everyone is comfortable with emerging role of GP-Consultant and this is reflected in the vitriol in some of the posts above.

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  • If you think this is a good idea, why have you become a doctor? Clearly you think many aspect of the job (60 appointments so about 40% of your work) can and should be done by someone with 8 years less training then you with no regulatory body or accountability to your patients.

    What we should be doing is defining what we, the medical professional should not be doing so that we can concentrate on what we can only do.

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  • I am more than happy to take on the role of a consultant, if all those consulting me have independent indemnity arrangements and are fully accountable for their actions......
    No- I didn't think so.

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  • I'm interested to know why you didn't appoint an advanced nurse practitioner to this post who is able to prescribe, manage and treat without asking a GP their permission after each consultation, is able to order tests and interpret results, has a regulatory body and is well known to the public as a professional unlike PAs. Nurse practitioners are also increasingly partners.

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