As the GP lead for the organisation employing the longest serving American physician assistant in this country, you may be surprised that I am in agreement with your editorial writer Iona Heath,1 that our patients need and deserve highly trained and skilled professionals on the front line, to ensure the welfare and safety of patients. You will find that I have frequently voiced my concern about the direction of the Change Workforce Programme's (CWP's) pilot programme for the development of a medical care practitioner grade. Fortunately, I believe there has been …