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  • Community pharmacy care model could free up 18 million GP appointments

    Community pharmacy care model could free up 18 million GP appointments

    Wednesday, 04 July 2018 15:18
  • New CAVGP website launches highlighting general practice jobs around Cardiff

    New CAVGP website launches highlighting general practice jobs around Cardiff

    Friday, 29 June 2018 15:25
  • £10,000 ‘golden hellos’ announced to entice nursing post-grads into ‘difficult-to-recruit’ sectors

    £10,000 ‘golden hellos’ announced to entice nursing post-grads into ‘difficult-to-recruit’ sectors

    Tuesday, 15 May 2018 12:13
  • Scotland announces £6.9m investment in primary care staff training targeted at nursing

    Scotland announces £6.9m investment in primary care staff training targeted at nursing

    Wednesday, 09 May 2018 16:15

physician-associatesApril 29 2015

Physician assistants “offer a potentially acceptable and efficient addition to the general practice workforce,” researchers have concluded.

“No significant differences were found in rates of re-consultation or process measures (diagnostic tests, referrals, or prescriptions) between patients who had consulted a PA or GP for a same-day/urgent appointment, when adjusted for confounders and practice-level clustering.”

They observational study was conducted using 2,086 patient records presenting at same-day appointments in 12 GP practices in England. The study has been published in the British Journal of General Practice.

Among the findings were that:

  • PAs generally attended younger and medically less complex patients than the GPs
  • there were high levels of patient satisfaction with PA consultations
  • a higher percentage of PA records of re-consulting patients were judged appropriate than GP records by independent GPs successfully blinded to the professional
  • in the view of the GP reviewers at debriefing after being unblinded, PAs made more thorough consultation records.
  • the reviewers did not identify any unsafe practice by PAs.

On average, PA consultation times were longer than with GPs, but this “reflects appointment times set in the study practices, which were 10 minutes for GPs and 15 minutes for PAs (20 minutes in one practice), and may account for why PAs were able to provide fuller records and document significantly more advice-giving than GPs,” says the report.

“As salary and related costs of GPs are higher than those of PAs, the cost of a GP consultation exceeded that of a PA by some £6.22.

“In adjusted analyses that controlled for variations in the case mix of GPs and PAs, no significant differences were found between the professionals in rates of re-consultation, referral to secondary care, prescribing, ordering investigations, or undertaking procedures, so no attempt was made to cost these activities.”

Commenting on the report, Dr Helen Stokes-Lampard, Honorary Treasurer of the Royal College of GPs, said: “Physician Associates must never replace GPs, but they can play a vital role in supporting doctors and other practice team colleagues.

“Widening the general practice team to include more PAs and other roles - such as pharmacists working in practices as we proposed last month - is beneficial for patients and for general practice.”

Dr Stokes-Lampard pointed out that many tasks take up a huge amount of GPs’ time but are things that PAs can do. However, she added that the sample size was low and each case involved robust systems to triage which patients needed to see a GP or who could be seen by a PA.

“We would need to see more evidence of the effectiveness of these schemes, before they can be rolled out more widely,” she said.

Dr Chaand Nagpaul, BMA GP committee chair, agreed there is some scope for physician associates to take pressure off GPs by performing some defined clinical tasks. “However, they are not a substitute for a GP who undergoes years of medical training that enables them to provide complex, highly skilled care to their patients,” he said.

“GPs play a particularly important role in diagnosing serous conditions, a task that that can only be done with an appropriate level of medical expertise and experience.

“At present, we do not have enough GPs to provide effective care to patients, with many areas of the country facing acute shortages. We should be focusing on drawing together a long term, sustainable plan that provides enough GPs to meet rising patient demand.”

Links:

‘Physician associates and GPs in primary care: a comparison’. VM Drennan et al. BJGP. May 2015     

RCGP comment    

BMA response    

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