The PA experiment has failed – now invest in GPs

With the publication of the review into physician associates, editor Sofia Lind reflects on the end of this chapter and how its time for the Government to turn its attention to GPs

I was impressed by Professor Gillian Leng when I interviewed her at Pulse Live in Birmingham last month. Despite the delay in publishing her review into the safety and effectiveness of physician associates, she and her team made sure the questions I asked were ones she could answer. In fact, our preparation meeting was refreshing – instead of limiting what I could ask, Professor Leng suggested questions that would be most useful for GPs. That dedication and thoroughness clearly comes through in the report.

But while the review is thoughtful and clearly takes GPs’ concerns seriously, it isn’t exactly a quick fix that will solve the mess overnight. It rightly limits the role of PAs, renames them more-appropriately as ‘assistants’, and proposes a fairly narrow job description. At the same time, it recognises the career challenges PAs face and offers some options for progression, including a fast-track route to becoming doctors.

It’s a complicated picture, and the review is honest about the shortcomings in how PAs have been used. Professor Leng makes a strong case that PAs should never have been introduced simply as replacements for doctors – but that, unfortunately, they have been.

This approach goes back over a decade. Then-health secretary Jeremy Hunt was impressed by the team-based model at Kaiser Permanente in the US and seemed convinced he’d found a way to stretch the GP workforce. But what followed wasn’t careful planning – it was a rushed attempt to reshape general practice without proper structures or safeguards. Instead of investing in more GPs, the Government poured money into expanding a new role, hoping it would serve as a cheaper alternative. The lesson is clear: general practice can’t be done on the cheap.

The 2023 workforce plan called for a big increase in PAs across the NHS, especially in primary care. That plan now needs urgent rethinking. The focus should shift to properly increasing GP training numbers and expanding training capacity, so the workforce can meet the real demands of primary care. Recruiting and retaining GPs is a long game that requires real investment and commitment – not quick fixes or piling on new roles to an already stretched system. The Government needs to rethink the whole workforce strategy, and crucially, invest properly in GPs, not just rely on ‘workforce on the cheap.’

The employment challenges that practices now face – including tribunal claims brought by PAs – are the Government’s to solve. Practices were told – and funded via ARRS – to take on this role, often without a clear national or local plan. Now that the Government has accepted the review in full, it’s their job to clean up the mess.

As Professor Leng writes, these recommendations ‘represent a pragmatic solution that aims to bring cohesion and clarity.’ ‘They won’t be universally popular,’ she admits. ‘But we must now close the debate and move forward constructively, focusing on excellent teamwork and delivering world-leading patient care.’

The review closes a chapter, but the real work starts here. There’s little point in healthcare professionals continuing to bicker among themselves over this. It has been a pretty unedifying episode for all concerned and while a middle-ground report like this inevitably won’t delight either polarised faction, it might douse the respective flames ever so slightly. This mess was created by policy – and it’s policy makers who must step up now. For GPs, it means managing a difficult situation thrust upon them. For the NHS, it means properly planning and funding a workforce that supports, not undermines, general practice.

Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn 

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