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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


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