Friday 1 May 2015

Physician Associates: hold the bunting!

Letter to the editor of BJGP in response to Drennan et al's paper "Physician associates and GPs in primary care: a comparison."

Dear Sir,

It is premature to hang out the bunting, declare the primary care workforce crisis over and allow GPs to retire to the golf course en masse.

Parle and Ennis are to be congratulated that the effectiveness to which they trained Physician Associates (PAs) for two years has been demonstrated by Drennan et al. It does make one wonder why we would bother spending 10 years training every new GP!

The stated headline "consultations carried out by physician associates, compared with GPs seeing comparable patients are associated with similar processes and outcomes at lower consultation costs" is inaccurate. The results state the average PA consultation was 5.8 minutes longer than the GP equivalent. The cost per consultation was £6.22 less for the PA. This equates to 2 fewer patients per hour, fully negating the £24 saved in direct consultation costs.

This cost also does not include additional issues including prescribing time for non prescribing PAs, an activity which, more often than not, will have to be carried out by a GP. Another significant cost that has not been accounted for includes the medicolegal risk (and associated financial cost) supervising GPs will have to bear.

Furthermore, it is unfair and unreasonable to expect PAs to work beyond their competencies and comfort zones to replace people they were never intended to replace.

The closing statement of the article "PAs potentially offer an acceptable, appropriate, and efficient addition to the general practice workforce" is therefore misleading on all counts. If you want someone to do a doctors job appropriately, efficiently, and acceptably then you should employ a doctor. We desperately need more GPs, but if demand exceeds even a generous new supply of doctors, then it is demand and whoever is whipping it up that must be addressed.

By all means invest in primary care provision but PAs, based on this evidence, represent a false economy.

Yours faithfully,