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Physician associates – the answer to the workforce crisis?

PhysicianMuch continues to be said and written about staffing within GP practices. While the chronic GP shortage continues, practices are being encouraged to look to alternative staff ideas, including pharmacists and physician associates.

The latter arguably has greater potential to ease workloads within practices and the NHS is to spend £15m on training 1,000 GP physician associates by 2020. But what exactly are physician associates?

The Faculty of Physician Associates at the Royal College of Physicians (FPARCP) says they are:

Collaborative healthcare professionals with a generalist medical education, who work alongside doctors, GPs and surgeons providing medical care as an integral part of the multidisciplinary team. Physician associates are dependent practitioners working with a dedicated supervisor, but are able to work independently with appropriate support.

What can physician associates do?

According to the FPARCP, physician associates work within a defined scope of practice and limits of competence. They:

  • take medical histories from patients
  • carry out physical examinations
  • see patients with undifferentiated diagnoses
  • see patients with long-term chronic conditions
  • formulate differential diagnoses and management plans
  • perform diagnostic and therapeutic procedures
  • develop and deliver appropriate treatment and management plans
  • request and interpret diagnostic studies
  • provide health promotion and disease prevention advice for patients

The FPARCP adds that although physician associates are dependent practitioners, they can also practise independently and make independent decisions. This is enabled by collaboration and supportive working relationships with their clinical supervisors, meaning that there is always someone who can discuss cases, give advice, and review patients if necessary.

Writing for the CQC’s popular mythbusters series, Jim Parle, Professor of Primary Care and course director for the Physician Assistant programme at University of Birmingham, adds that physician associates can supplement and complement GPs and nursing staff. “Under the supervision of a doctor, they can see a range of patients whose cases vary in complexity. As with any practitioner, the amount of supervision they need depends on their level of knowledge, skills and experience.”

In a GP surgery, physician associates see patients of all ages for acute and chronic medical care. Physician associates can refer patients to consultants, the EAU or to A&E when clinically appropriate. Other duties include home visits, prescription reauthorisation, review of incoming post and laboratory results. Physician associates are an additional health care team member to help the practice reach Quality Outcome Framework targets.

It’s worth noting here that physician associates cannot prescribe. Many doctors give them ‘proposal rights’ like medical students or non-prescribing nurses. If the profession becomes statutorily regulated, physician associates may be able to take prescribing courses to add to their skill-set.

Studies

Studies from general practice in both England and Scotland have shown physician associates to be safe, effective and liked by patients, which ties in with CQC inspections; specifically the section that relates to staff having the skills, knowledge and experience to deliver effective care and treatment (key line of enquiry E3).

Indeed, a team from Kingston University and St George’s University of London found that Physician associates can take on some of GPs’ daily work without any harm to patients and at a lesser cost to the NHS, researchers have claimed. They looked into urgent and same-day appointments with 2,086 patients at 12 GP practices in England, six of which employed physician associates to focus specifically on these kinds of appointments.

Allowing for differences between the two groups in potential confounders, such as age of the patients, rates of re-consultation after the initial consultation were similar for the physician associates and GPs, as were rates of diagnostic test orders, referrals and prescriptions.

Patient satisfaction was also just as good at the practices using physician associates as at those employing only GPs, while a group of independent GP observers – who were blinded to the consulting clinician – judged that physician associates had dealt with the initial consultations at least as appropriately as GPs.

Qualifications and registration

According to the CQC, physician associates must have a:

  • relevant degree (for example bioscience or healthcare-related) and
  • postgraduate diploma which takes two years of full time study to complete

Physician associate courses in the UK all follow a national curriculum and competence framework and physician associates must pass a national examination of knowledge and skills. Interestingly, they must recertify in the knowledge component every six years to ensure they keep up to date.

The register of physician associates

The Faculty of Physician Associates at the Royal College of Physicians keeps a managed voluntary register. This acts like a General Medical Council or Nursing and Midwifery Council register, although is not statutory. Practices should only employ physician associates who are on this register.

The register gives assurance that physician associates:

  • have qualified from an appropriate UK or US programme
  • have passed the national exams (and recertification exam if appropriate)
  • are maintaining their continuing professional development (50 hours a year)
  • do not have any code of conduct, scope of professional practice, or fitness to practise concerns

Physician associates are not statutorily regulated, so they work under the ’delegation clause’. This means they are the responsibility of the supervising doctor. According to GMC guidance, doctors can delegate tasks to non-clinicians but must be sure that person is capable. Physician associates are indemnified in the same way as doctors.

While it’s still early days in the development of physician associates in GP practices in the UK, they could well be worth further consideration. More information is available from the Faculty of Physician Associates.

What are your views on the role of physician associates? Let us know by commenting below or head along to the Practice Index forum thread here.

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One Response to “Physician associates – the answer to the workforce crisis?”
  1. Lindsey Says:

    Both have the potential to ease the workload in general practice for GPs but there needs to be an acknowledgement by GPs that neither are stand alone silver bullets. Both professionals should be supervised by a GP and really work more as part of an MDT. There needs to be a recognition that these are not going to be the same as stand alone ANPs but since there is a severe shortage of nurses too then other roles have to be fully embraced. General practice needs to let go of some of the old ways of working where the GP does all and look to a new model of GPs acting as team leader and expert clinical adviser.

    Reply

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