Physician associates offer valuable asset

PHYSICIAN associates (PAs) provide a same-day consultation service comparable to GPs and at a lower cost, according to a new study published in the British Journal of General Practice.

Researchers from Kingston University and St George’s University of London found that after adjusting for case-mix, there was no difference between PA and GP consultations in the rate of investigations, referral to secondary care, prescriptions issued or the rate of patient re-consultation for the same or a closely related problem within 14 days. Both PA and GP consultations scored high levels of patient satisfaction with the average PA consultation longer and cost per consultation lower.

Physician associates (known as physician assistants in the US) are not doctors but have been educated and trained to diagnose, treat, and refer autonomously within certain boundaries. Physician assistants have been practicing the US for the past 50 years but the role is relatively new in the UK with training courses producing the first graduates in 2009.

The research involved a comparative observational study of 2,086 patient records detailing same-day appointments in 12 general practices in England. PA consultations were compared with those of GPs and the primary outcome was re-consultation within 14 days for the same or a linked problem. It was found that there were no significant differences in the rates of re-consultation. It was also found that records of initial consultations of 79.2 per cent of PAs and 48.3 per cent of GPs were judged appropriate by independent GPs.

The researchers concluded that: "The processes and outcomes of PA and GP consultations for same-day appointment patients are similar at a lower consultation cost. PAs offer a potentially acceptable and efficient addition to the general practice workforce."

Responding to the research, Dr Chaand Nagpaul, BMA GP committee chair, said: "Physician associates 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. 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."

Dr Helen Stokes-Lampard, Honorary Treasurer of the Royal College of GPs, said: "GPs are highly trained medical doctors, and our skills at being able to diagnose and treat the ‘whole person’ through initial consultation and the unique relationship we build up with our patients over time cannot be substituted.

"But there are many tasks that take up a huge amount of GPs' time that PAs can do, thus enabling family doctors to spend more time with patients with multiple and complex needs, for whom the standard 10-minute consultation is not enough."