Many general practitioners would welcome having physician assistants

EDITOR—The possibility of creating an American style, intermediate medical practitioner or physician assistant role has been too long ignored in debates about shortages of trained medical staff in the NHS. In casting doubt on the appropriateness of this particular approach, however, Hutchinson et al lamentably fail to appreciate the scale of the problems currently faced by the NHS in providing effective primary medical care.1

They state that more than half of all doctors are general practitioners. Not so. Half of all medical graduates may eventually finish their careers as general practitioners—an artefact of the way the medical labour market is organised—but general practitioners currently make up about 31% of all doctors.2 The number as a proportion of the medical workforce has been falling for years; and research examining the career preferences of junior doctors suggests that the difficulties may soon get worse.3

Problems of recruitment in general practice, as the authors observe, are particularly acute in inner cities, which have never had much “doctor …