Investigating the contribution of physician assistants to primary care in England

Physician assistants (PAs), a relatively new group of healthcare professionals, support doctors in the diagnosis and management of patients. They undertake physical examinations, investigations, diagnosis, treatment and prescribing within their scope of practice as agreed with their supervising doctor. This study aims to investigate their contribution to the delivery of patient care in primary care services in England.

The research questions being explored are:

1. How are PAs deployed in general practice?
2. What is the impact of including PAs in general practice teams on the organisation of the practice, the working practices of other professionals, relationships between professionals and the practice costs?
3. What factors support or inhibit the inclusion of PAs as part of English general practice teams at the local and macro level?

The study has several elements including a comparative case study of 12 general practices, six employing a PA and six not. The research team bring multiple perspectives including those of the public and patients.

The study (NIHR SDO PC 245-09-1066) is funded by the National Institute of Health Research Service Delivery and Organisation (NIHR SDO) programme and reports in September 2012.

Project background - physician assistants in the UK

PAs have been working in the UK for about ten years and were initially trained in the USA, where the profession originated. Two pilot projects in England¹ and Scotland² found that USA trained PAs were well received by patients and colleagues, and worked at either the level of a nurse practitioner or a generalist doctor in training. However differences between US and UK practice and a lack of prescribing rights in the UK were an issue. PA education programmes have since been developed in England ³ with four univeristies currently offering postgraduate diploma courses. A small but growing number of general practices are currently employing US and UK trained ⁴ PAs. With growing interest in the role, more information is needed about the effect of introducing PAs into general practice on patient outcomes, service efficiency, and safety in the context of the NHS. This study is investigating these issues with general practices who have chosen to have PAs as part of their normal staff team.

The research team

• Kingston University and St George’s, University of London: Professor Vari Drennan(PI), Mary Halter, Robert Grant, Jenny Yiallouros.
• University of Surrey: Dr Simon de Lusignan, Professor of Primary Care and Health Informatics, Dr Heather Gage, Reader in Health Economics.
• Royal Holloway, University of London: Professor Jon Gabe
• Sally Brearley, patient and public involvement representative
• Wilfred Carneiro, NIHR SDO management fellow in research (attached to the project from St George’s NHS Hospital Trust).

Opportunities to join the study

The research team would welcome hearing from any of the following who may be interested in participating in the study.

• GPs or practice managers in a general practice employing a physician assistant
• Physician assistants in primary care
• Stakeholder in health service workforce development such as a education commissioners or representatives of an occupational or patient organisation
• Public or patient representatives

Please contact Professor Vari Drennan or Mary Halter for more information.

Information for practices interested in participating in the study

We aim to undertake the research with minimum cost or disruption to participating practices and at times of the practices' choosing. We are able to offer practice specific feedback such as data from patient surveys and opportunities and material for evidence of continuing personal and professional development. The study has been adopted by the United Kingdom Clinical Research Network and is eligible for NIHR NHS service support for research funding.

Find out more

• Contact Vari Drennan or Mary Halter
• Subscribe to the project newsletter
• Visit the UK Association of Physician Assistants website

References

1. Woodin J, McLeod H, McManus R, Jelphs K (2005). Evaluation of US-trained physician assistants working in the NHS in England. Final Report, University of Birmingham
2. Farmer J, Currie M, West C, Hyman J, Arnott N (2009). Evaluation of the physician assistant pilot study in Scotland: Final Report. University of the Highlands and Islands Millennium Institute, Inverness.
3. Department of Health, England (2006). The competence and curriculum framework for the physician assistant.
4. Drennan V, Halter M, Levenson R, Tye C (2011). Physician assistants in English general practice: a qualitative study of the employers’ viewpoint.

Disclaimer
The views and opinions expressed on this webpage are those of the research team and do not necessarily reflect those of the NIHR SDO programme or the Department of Health.

 

The research partners are: