The case for the physician assistant

Abstract

The NHS is facing a crisis from the combination of EWTD, MMC, the ageing population and rising expectations; thus its tradition of high quality care is under pressure. Physician assistants (PAs) are a new profession to the UK, educated to nationally set standards and, working as dependent practitioners, provide care in the medical model. PAs are currently employed by over 20 hospital Trusts as well as in primary care. They offer greater continuity than locum doctors and at considerably lower cost. PAs maintain generic competence and can therefore be utilised as required across different clinical areas. The stability of PAs in the workforce will be an additional resource for junior doctors on brief rotations. For the full benefits of PAs to be realised, and for the safety of the public, statutory registration and prescribing rights are required. Active support from the NHS is now needed to develop the workforce required.

Fig 1.

Physician assistant posts in hospitals in the UK.

Fig 2.

Varying role of the physician assistant within a medical team. Early in a trainee's rotation (point A), physician assistants might provide more of the out-of-hours cover but spend sufficient time working with the foundation doctor during the day to help support their development. Once the foundation doctor is more familiar with the unit (point B), they will be able to provide (and learn by providing) a greater proportion of the out-of-hours cover.

Fig 3.

Supportive role of physician assistants for trainee doctors. Junior doctors develop competence in each rotation. Some clinical learning is generic and at the beginning of the next rotation they do not start from square one, but they do need to develop knowledge of a new specialist area from scratch. During foundation year 1 (FY1), even at the peak of their competence in a unit, junior doctors will not reach the level of competence of an experienced physician assistant. Later in training they may still take some time in any rotation before their unit-specific knowledge is higher than that of the physician assistant.