28.04.15
Physician associates ‘as good as GPs but cheaper’
Patients seen by physician associates have similar health outcomes as those seen by GPs, but cost less, new research suggests.
A study in the British Journal of General Practice found that a new type of ‘mid-level’ primary care professional could offer a helpful addition to the general practice workforce at a time of rising patient demand and lacklustre GP recruitment.
The mid-level care professional could come in the form of a nurse practitioner or a physician associates. Previously known as physician assistants, physician associates are used widely in the US and have recently been introduced in other countries such as Canada, Australia, the Netherlands, Germany, and India.
They have the education and training to diagnose, treat, and refer autonomously within practice boundaries, as specified by their employing practice or local clinical commissioning group.
Researchers led by Professor Vari Drennan, from Kingston University and St George’s University London, set out to look at evidence on their outcomes and costs for the first time in the UK.
The study 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 two weeks for the same or similar problem and whether there were any differences in the quality of care.
The researchers found 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.
Patients also reported high levels of satisfaction with both consultations with GPs and physician associates.
Additionally, while the average physician associate consultation lasted nearly six minutes longer than a GP’s, each consultation cost £6.22 less.
The study concluded: “The findings of this study suggest that PA [physician associate] consultations, for same-day appointment patients, in general practices in England, result in similar outcomes and processes for similar consultations by GPs at a lower consultation cost.
“Deployment of PAs to attend patients, aligned with their competencies, could free up GP time to concentrate on more complex cases.
“PAs have the potential to be an asset to the primary care workforce in healthcare systems looking to strengthen their primary healthcare provision in the face of shortages of doctors, increasing demands, and financial stringency.”
Dr Helen Stokes-Lampard, honorary treasurer at the Royal College of GPs, said physician assistants could never replace GPs but could alleviate some of their burden.
She 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 physician assistants 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.”
Dr Chaand Nagpaul, chair of the British Medical Associations’ GP committee, also supported the idea that physician associates could help ease the burden in general practice.
He 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.”
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