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Physician associates as good as GPs, only cheaper

Health outcomes the same for same day appointment patients, study shows

Caroline White

Monday, 27 April 2015

Patients seen by physician associates—known as physician assistants in the US—have similar health outcomes as those seen by GPs, but cost less, reveals research* published in the British Journal of General Practice.

These professionals might help plug the current gap in GP recruitment and relieve the strain of rising patient demand in primary care, say researchers.

The study authors reviewed more than 2,000 health records for patients who made same day appointments at 12 general practices in England.

Consultations with physician associates and GPs were compared to find out if the patient came back to the surgery within 2 weeks for the same or similar problem and whether there were any differences in the quality of care.

There were no significant differences in the rates of re-consultation, diagnostic tests ordered, referrals made, prescriptions issued, or in levels of patient satisfaction, the findings showed.

Records of initial consultations of 79.2% (n = 145) of PAs and 48.3% (n = 99) of GPs were judged appropriate by independent GPs. The adjusted average PA consultation was 5.8 minutes longer than the GP consultation, but each consultation was £6.22 cheaper.

In a linked editorial**, Professor Jim Parle and colleagues from the University of Birmingham, which runs a training programme for PAs, point out that these professionals have to have a degree in life sciences or health before they can complete their intensive two year postgraduate diploma, which follows the medical model, and is frequently done in medical school.

And they are required to retake their national exam every six years to keep their knowledge base up to date.

But although there are upwards of 80,000 in the US, there are only about 250 in the UK. Around one in four work in general practice, which includes face to face urgent and non-urgent consultations, reviewing test results, and the management of long-term conditions, although as yet, they are not regulated to prescribe or order x-rays.

Their numbers are set to increase, however, as there are now eight training courses across the country, six of which started this year.

“We suggest that the PA model has a lot to offer GPs both in the short and long term and indeed is part of a permanent solution to ever-growing work pressures,” write the editorialists.

“The pressures on general practice are not going to go away and PAs are one of the groups that can help support GPs to manage complex caseloads and reduce burnout, without drawing clinicians away from other similarly pressured professions such as nursing,” they add.

“Our outdated workforce model has to change, and PAs can help offset the problems of recruitment and retention to general practice while ensuring that the key issues of continuity and partnership in patient care remain central to the primary care endeavour,” they conclude.

Dr Chaand Nagpaul, BMA GP committee chair agreed that PAs “can perform a valuable role as part of a wider health team and there is some scope for them to take pressure off GPs by performing some defined clinical tasks.”  

But he cautioned: “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. 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.”

He insisted: “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.”

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

There were many tasks that take up a huge amount of GPs' time that PAs could do, freeing up family doctors to spend more time with patients with multiple and complex needs, for whom the standard 10-minute consultation is not enough, she suggested.

“But the sample size [of the study] is 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 insisted.

* Vari M Drennan, et al. Physician associates and GPs in primary care: a comparison. British Journal of General Practice, May 2015. DOI: 10.3399/bjgp15X684877

** James Parle, James Ennis. Physician associates: the challenge facing general practice. British Journal of General Practice, May 2015. DOI: 10.3399/bjgp15X684685

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