Employing professionals with different skill sets and qualifications has long been the norm in primary care. It is a setting which has a pivotal role in the NHS and is responding to the current climate of workforce pressures, and a strained NHS, by evolving and employing different types of staff in response to changing needs.
Part of the solution
The General Practice Five Year Forward View from NHS England last year declared support for training 1,000 physician associates for general practice by 2020. Given the current numbers of newly qualified physician associates choosing primary care this target is an ambitious one, and reaching it will be a challenge. But what is likely to be the impact of more physician associates being introduced into primary care?
Physician associates are viewed as part of the solution for dealing with the increasingly demanding workload pressures facing general practice. They work in ways to complement general practitioners and the whole practice team. Physician associates can see a range of patients and carry out a range of duties in general practice.
What they do will depend on what the practice needs and on the level of experience, knowledge and skills they have. For example, a newly qualified PA can see patients who have less complex/medically acute problems. GPs can then devote more time to more patients with more complex needs and patients outside the scope of the physician associate.
GPs are motivated to employ physician associates in order to increase the practice capacity to manage patient demand within government targets for access, while considering value for money and broadening the skill mix in the team.
However, there are lingering uncertainties surrounding the scope of practice of the physician associate, and exactly how they fit in to the team which tends to drive preconceptions – not all of them positive.
Who are physician associates?
Physician associates work autonomously but, as dependent practitioners, they remain under the supervision of a named GP. They are mid-level practitioners trained in a medical model to provide medical care to patients. Their training includes clinical placements in which they work within primary and secondary care settings to gain experience dealing with patients in preparation for professional practice.
Physician associates are trained to perform a range of roles in general practice, including patient consultations, diagnosis managing acute and chronic conditions, running clinics, requesting and analysing test results, dealing with administration, and facilitating patient education.
Why employ physician associates?
GPs in the UK point to increased patient demand, medical recruitment problems and cost effectiveness as motivating factors in the drive to employ physician associates. In an evolving healthcare system used by patients with a changing set of needs, innovation and adaptability in the face of the pressures currently experienced in all areas of the NHS is not only important, but necessary.
Physician associates within primary care are an asset, adding skills, flexibility and extra capacity. It has been demonstrated that consultations for same-day appointments with a physician associate, longer than the average consultation time with a GP, result in higher levels of patient satisfaction.
The extent to which the role of the physician associate can develop within the practice depends both on the interests and knowledge of the physician associate, and on the opportunities presented within the organisation of the practice. This is of course also impacted upon by the relationship between supervisor and physician associate, which is a significant factor in any workplace setting.
The profession is not without its challenges however. Lack of prescribing rights is often cited by GPs as a limitation to the role. The FPA continues to campaign for statutory regulation, which would allow physician associates to seek prescribing authority and request ionising radiation. In the meantime, the FPA runs the Physician Associate Managed Voluntary Register (PAMVR) which ensures the physician associate is both qualified and fit to practice. The FPA strongly encourages employers to ensure that all physician associates they employ are on the register, to ensure that they are fully qualified and fit to practice.
The challenge to increasing the numbers of physician associates in primary care may in part be overcome in effectively challenging the preconceptions surrounding physician associates and their value in UK primary care settings.
Raising awareness is an important part of tackling this challenge. Patients, the public and primary care professionals need more information to understand both the role and its potential contribution to the NHS – an issue which the Faculty of Physician associates is currently devoting attention to.
Any employer and physician associate should also ensure that patients, the public, administrative staff and other professionals understand the competency levels of physician associates. That all-important relationship with their GP supervisor is a crucial aspect of ensuring that the skills and experience of the physician associate are utilised effectively and to their fullest capacity, and that they experience good levels of job satisfaction in their roles.
With high levels of patient satisfaction recorded, as well as the workload of the general practice being reduced significantly with the introduction of another pair of capable hands, skills and expertise, general practice has much to gain from employing physician associates. Introduction of the role into the workforce in significant numbers could help shape the future of the GP workload in positive ways, helping to ease the challenges and pressures which dominate the experience of working in general practice today.
Drennan VM, Halter M, Brearley S, Carneiro W, Gabe J, Gage H, et al. Investigating the contribution of physician assistants to primary care in England: a mixed-methods study. Health Serv Deliv Res 2014;2(16).
Halter M, Wheeler C, et al. Physician associates in England’s hospitals: a survey of medical directors exploring current usage and factors affecting recruitment. Clin Med 2017;2:126-31.