The Government’s latest proposed solution for managing the spiralling demand it has created in general practice is to build a posse of US-style physician associates.
But as universally accessible UK general practice is vastly different to the insurance-based US primary care physician model, I don’t believe this role will be useful in Britain.
Care is so formulaic and compartmentalised in the US that physician associates are able to do aspects of the general physician’s job. US primary care physicians are essentially internal physicians following a medical model similar to that practised in our hospitals and outpatient clinics.
This is not the case in Britain, where we train GPs to be expert generalists to a registered population – preventing illness, dealing with the social and psychological components of ill-health, sorting undifferentiated symptoms, diagnosing and managing complex multimorbidity, managing uncertainty, and delivering continuity of relationship as a key part of care.
Slaves to protocol
US doctors deal principally in medical issues, while we approach the care of our patients more holistically. I envy their 30-plus minutes of consultation time, but not their pre-packaged, protocol-driven, ready-sifted, ready ‘clerked’, sterile processing of patients. It is an approach that turns patients into bit-part packages to be overtreated and pandered to.
Through our therapeutic relationships with patients, UK GPs are themselves the treatment as well as prescribers and gatekeepers – and physician associates would put this under threat.
There’s no reason why GPs should employ physician associates when we already have practice nurses and advanced nurse practitioners (features that don’t appear on the US primary care physician landscape).
Creating yet another new role is a distraction that we can’t afford, unless of course the intention is to drive down clinician costs and wages, in an approach similar to that adopted with teaching assistants or police community support officers.
What’s more, for physician associates there is at present no professional regulation; their membership of a register is voluntary. But this is being taken over by that veritable bastion of generalism, the Royal College of Physicians, which is setting up a faculty incorporating the UK Association of Physicians Associates (and is planning to accredit courses and hold the register).
This hardly bodes well for general practice, and neither does the plethora of such courses that are now springing up, funded by Health Education England grants, with the number of centres offering courses rising from two to eight this year alone.
Worryingly, these budding physician associates are not even necessarily placed in recognised GP training practices for the GP aspect of their clinical training.
I’m also concerned about what the indemnity costs will be and who will pay them. Physician associates need space and longer appointments, and it’s not clear what conditions they will be able to deal with as they cannot treat complex illnesses.
And to crown it all, there is at present no study or evidence to show whether employing a physician associate in a practice will actually save GPs any
This initiative is a band-aid at best, rather than a concrete solution for reducing demand on general practice. That lies in the Government being honest with patients about what the NHS is for.
That, alongside creating strong incentives to enter and stay in the service to increase the supply of staff.
Dr Michelle Drage is chief executive of Londonwide LMCs.