When my partners and I were searching for a locum a few years ago, we heard about physician associates, who work sessions seeing patients and do home visits, and who are cheaper than GPs. Initially we employed Chris (our first PA) for a session a week. We audited his notes, we questioned his patients, we quizzed our staff. His note recording was better than any GP in the practice, and patients and staff were delighted with him in equal measure. We found that there was minimal extra work involved in signing prescriptions for him (PAs cannot sign prescriptions, X-ray requests, sick-notes, or death certificates because they don’t yet have their own statutory professional body). In 2012/13, Chris joined our practice full-time as the first PA profit-sharing partner in the UK. He sees patients at the same rate as the GPs and we consider him an asset to our team. This year we also took on a salaried PA.
We all know we are in crisis – we feel increased pressures and workload daily, we hear patient complaints about access to care, we see the increasing ageing population and the increasing multiple morbidities. We are also living with the year on year decrease in income and we know we can’t recruit into general practice.
After my experience with Chris, I believe the answer to these problems could be physicians associates (PAs). Health Education England, the Royal College of Physicians, Royal College of Surgeons and the RCGP think so too.
In fact, Health Education England recently commissioned 205 PA training posts, a 754% increase on the previous year.
PAs are trained using a medical model on a two-year intensive post-graduate programme; they have already done a science degree. They work under the direct supervision of a doctor and support doctors by taking medical histories, performing examinations, diagnosing illnesses, analysing test results, and developing management plans. Currently there is no national post qualification training programme so every PA’s experience is different, although there is a national qualifying exam.
On average PA take longer to consult than GPs but they are more cost effective.¹ With appropriate post graduate training and experience it has been shown patient management and satisfaction were similar when comparing GPs and PAs.² PAs have their own professional indemnity; they have to be re-certified every six years with a two-hour general medical MCQ and so will always be up to date.
Following seeing how helpful Chris is, we have encouraged one of our healthcare assistants to train as a PA at Birmingham medical school. Since 2013, after Chris was employed full-time, our patient access and satisfaction have improved, we are a more relaxed team and this year our income has gone up. We decided to ‘invest’ in the person and have no regrets in the slightest.
1 Drennan V, et al. 2015. Physician associates and GP’s in Primary Care: a comparison. British Journal of General Practice. Published online 1st May. DOI: 10.3399/bjgp15X684877.
2 Parle J, et al. 2012. The case for the physician assistant. Clinical Medicine: 12 (3); 200-06.