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- Page navigation anchor for Hold the bunting!Hold the bunting!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...Show MoreCompeting Interests: None declared.
- Page navigation anchor for RE: Physician associates in primary careRE: Physician associates in primary care
Recent years have seen discontent in general practice, particularly under the influence of the coalition government of the past 5 years. The net effect appears to be a shortfall in junior doctors choosing to become GPs, as well as established GPs — particularly women in their 30s — leaving the profession.1 Thus, it is laudable that alternative avenues — hopefully alongside work to increase GP recruitment and retention — are explored. Physician associates (PAs) offer, perhaps, a tried, tested and attractive (cheaper, a cynic might add) alternative to GPs and so it follows that this particular option should be studied.
As valid — and important — as the aims of this particular study are, there are some flaws which, to my mind, preclude quite such a strong conclusion from being reached on its basis alone. For example, a primary outcome measure of re-consultation within 2 weeks does not seem to control adequately for confounding factors: the patient who presents non-specifically for whom a clinician may need more than one consultation to diagnose/refer, to name but one potential scenario. Additionally, patients who consulted PAs in this study had made less use of their respective practices and had fewer chronic diseases than those who consulted GPs; surely decreasing the likelihood of this group to re-attend with the same problem. Furthermore, and perhaps most surprisingly given the rather definitive conclusion reached by the authors, PAs were allowed longer consultation...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Physician Associates and GPs in primary careRE: Physician Associates and GPs in primary careI am delighted to see this subject taking a prominent position in discussions on human resources for the NHS and in particular in Primary Care. It was back in 1981 that I and Ian F M Saint-Yves wrote about this subject.1 However at that time the reaction from the profession was mainly derided and considered unnecessary.I hope the observational studies continue to show GPs how effective this additional resource will be to support primary care now and in the future.References1. Stephenson J P. Rethinking the Primary Health Care Team. Primary Care 1981, 9: 5-62. Saint-Yves I F M. Need General Practitioner be patient's first contact with Health Service? Lancet 1980; 316(8194): 578–5803. Saint-Yves I F M. The training of Paramedics for Primary Health Care, J R Soc Health, 1983; 103(4): 135-37.Competing Interests: None declared.