Momentum is building around physician associates (PAs), although their role is not yet well known in UK primary care. The UK only has 250, with a small proportion of them working in primary care but there are likely to be 450 qualifying in 2018. An IN website poll asking whether PAs were a threat showed the majority weren't sure, probably because they don't know much about them. And that is the problem. We know they are mid-level, dependent practitioners whose scope of work is set by a supervising doctor. But how will they fit into a workforce that already has advanced nurse practitioners (ANPs), many of whom are also prescribers and consult independently?
The British Journal of General Practice recently published an observational study on the outcomes of PAs working with GPs in 12 practices in the UK (Br J Gen Pract 2015; 65:246-47) together with an editorial written by staff at Birmingham University on the positive role PAs can play in primary care. These are interesting but shed little light on how PAs fit into the existing GP structure.
After work has gone into raising the profile of practice nurses and ANPs, the increase in the number of universities offering PA courses in the UK has caused consternation among senior nurses. And rightly so. ANPs are already doing the job that PAs are being trained for. Surely this is just tinkering around the edges of workforce planning by HEE? Why not commission more nurse places and use levers and drivers to ensure more of them choose primary care.
The editor of BJGP made a good point in his editorial: if practice nurses had 'proper' pay, terms and conditions, and career development, this might be a more effective way of solving general practice's problems.