The NIHR physician associates in primary care in England study 

Physician Associates in Primary Care In England

About our published NIHR study on physician associates working in primary care Investigating the contribution of physician assistants to primary care in England: a mixed-methods study
Drennan V, Halter M, Brearley S, Carneiro W, Gabe J, Gage H, et al Health Serv Deliv Res 2014;2(16)
The study started in 2010 and was completed in 2013. The report was published in 2014 and is free to download or view on the NIHR Journal website

The main  paper on acceptability , patient safety and patient outcomes of PA consultations compared to general practitioner consultations was published in the British Journal of General Practice in 2015 . Drennan VM, Halter M, Joly L, Gage H, Grant RL, Gabe J, Brearley S, Carneiro W, de Lusignan S. Physician associates and GPs in primary care: a comparison. Br J Gen Pract. 2015 May;65(634):e344-50. doi: 10.3399/bjgp15X684877. 

The findings from this study have been used to inform the NHS plans to support training for a multidisciplinary primary care team since 2015, the primary care workforce review undertaken by the Health Select Committee , House of Parliament (2016) and the Department of Health public consultation on whether to regulate physician associates and other medical associate professions (2018). 

A brief summary of the study and the findings

General practice is changing and employing different types of staff in response to changing needs and delivering more care outside hospitals. One such type of staff is physician assistants (PAs), who are trained in a medical model over 2 years at postgraduate level and work under a supervising doctor. This study looked at the contribution PAs could make and whether or not they were acceptable and provided safe care. We answered this through multiple research activities including investigating the patient experience. We found that PAs were mainly deployed to provide same-day appointments for patients. They were in the main acceptable to professional groups, patients and health-care and workforce planners, although patients wanted to ensure that they had choice in who to consult. The PAs worked in ways to complement the general practitioners (GPs), seeing patients who had less complex and medically acute problems. There was no difference between PAs and GPs in the rate of patients returning with the same problem within 2 weeks. A clinical review of PA records and consultations judged them competent and safe. Consultations with PAs were on average longer than those with GPs and cost the health service less, although we could not account for all costs. We concluded that PAs are an asset in primary care and could offer a flexible addition to the staffing. This has implications both for health professional workforce and education planning and for the inclusion of PAs in regulatory processes. 

What other publications are there from this study about physician assistants in primary care?  

Drennan, V.M., Gabe, J., Halter, M., de Lusignan, S. and Levenson, R., 2017. Physician associates in primary health care in England: A challenge to professional boundaries?. Social Science & Medicine, 181, pp.9-16.

Halter, M., Drennan, V.M., Joly, L.M., Gabe, J., Gage, H. and Lusignan, S., 2017. Patients’ experiences of consultations with physician associates in primary care in England: A qualitative study.Health Expectations.

Drennan VM, de Lusignan S, Gage H, Gabe J, Halter M.Building an evidence base for the primary care workforce.BMJ. 2018 Jan 25;360:k248. doi: 10.1136/bmj.k248.

Halter M, Joly L, de Lusignan S, Grant RL, Gage H, Drennan VM. Capturing complexity in clinician case-mix: classification system development using GP and physician associate data. BJGP Open. 2018 Jan 9:bjgpopen18X101277.

de Lusignan, S., McGovern, A.P., Tahir, M.A., Hassan, S., Jones, S., Halter, M., Joly, L. and Drennan, V.M., 2016. Physician associate and general practitioner consultations: A comparative observational video study. PloS one, 11(8), p.e0160902.

The contribution of physician assistants in primary care: a systematic review.Halter M, Drennan V, Chattopadhyay K, Carneiro W, Yiallouros J, de Lusignan S, Gage H, Gabe J, Grant R. BMC Health Serv Res. 2013 Jun 18;13:223. doi: 10.1186/1472-6963-13-223. Review.

Drennan, V.M., Chattopadhyay, K., Halter, M., Brearley, S., de Lusignan, S., Gabe, J. and Gage, H., 2012. Physician assistants in English primary care teams: a survey. Journal of interprofessional care, 26(5), pp.416-418.

Acknowledgement & Disclaimer
The research reported here was funded by the HS&DR programme or one of its proceeding programmes as project number 09/1801/1066. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health.