We were saddened to read Iona Heath's editorial ‘The medical care practitioner: Newspeak and the duping of the public’.1
Iona has failed to look at the evidence base concerning the physician assistant (PA) role both in the US and the UK. If she had done so she would have found that PAs are both clinically safe, and positively received by patients.2,3 She would have also discovered that the PA role is not particularly a primary care practitioner role. PAs are generic medical practitioners working to assist physicians in all areas of medical practice, not independently of them. Rowley Regis & Tipton PCT was the first primary care organisation (PCO) in the UK to employ PAs trained in the USA to undertake clinical work, after the first of our two nurse-led PMS practices appointed one and suggested the role might be generalisable within the UK. Now we know of at least six other trusts (PCOs and NHS hospital trusts) that employ them in a number of diverse roles. Before recruiting we carried out extensive research, including visits to US universities delivering PA educational programmes. Two of us who went on these visits both felt that the level of skills, knowledge and experience of the US trained PAs was similar to that which we had had as GP registrars. We now have almost 2 years experience of PAs in general practice and plenty of data, both quantitative and qualitative, on all aspects of care provided by PAs and patients' experiences of them. We have also recruited PAs to work in our local A&E departments and our GP co-op out-of-hours service. One of us is an RCGP member (as are many of our doctors who have PAs working alongside them) and the lead director for the PA project for the PCO, the other is the PCO Professional Executive Committee (PEC) chair. Both of us are practising GPs.
Iona has failed to be critical of her sources. There are a number of so-called mid-level practitioner projects being developed in the UK at the present time involving various medical specialties and the professions allied to medicine. The Changing Workforce Programme (CWP) has, indeed, led some of these projects, but others have arisen spontaneously in advance of the CWP's project in response to local need, as ours has. I wonder whether Iona has really thought about whether there is no role for a mid-level practitioner in general practice at all, or whether it is just the CWP's model she doesn't like.
- © British Journal of General Practice, 2005.
Author's response
A number of correspondents appear to have misunderstood the nature of my objection to the training and deployment of medical care practitioners. I welcome unequivocally the extension of skill-mix and team working within primary care, but I am profoundly suspicious of the change of name from physican assistant to medical care practitioner. The former describes a role that can be clearly understood, the latter seems designed to mislead and to suggest to the patient that the professional they are consulting is medically qualified. I note that none of your correspondents offers an explanation or a justification for the change of name, and until such is forthcoming, I will, with regret, remain profoundly sceptical about the whole initiative.
- © British Journal of General Practice, 2005.
