Views And Reviews No Holds Barred

Margaret McCartney: Are physician associates just “doctors on the cheap”?

BMJ 2017; 359 doi: (Published 20 November 2017) Cite this as: BMJ 2017;359:j5022

Re: Margaret McCartney: Are physician associates just “doctors on the cheap”?

I am sorry that Radcliffe feels that I have been disrespectful towards physician assistants - there is none felt or intended. I am sorry. The focus of this column was about Jeremy Hunt's claim that PAs would reduce physician burnout, and I can find no evidence that this is the case. 

I do agree with Radcliffe that GP days are long and stressful. However they contain many system problems clinical and non-clinical that (1) don't need to be done at all and (2) could be done by someone else. I don't think it's useful to train and employ more staff only to have them doing the same wasteful tick box QOF, for example - we need to get rid of this waste so that no one has to do it. Or the ongoing farce of ineffective and unfair benefits medicals - there is no point placing more staff in primary care to deal with the fallout when it is the companies providing these assessments who should be held to account and stopped from creating needless work in primary care.

These are the kinds of things that Hunt could take action on and which would be likely to help all in primary care. In terms of what could be done by others - an example is of scripts which are 'out of stock' and which can take hours to sort out - this would be far more efficiently done by pharmacy staff working to a health board agreed protocol. Primary care keeps being made to absorb the stress created by poor systems in places currently outwith our control. Rather than putting more staff in to deal with these, we should identify and remove those stresses, because otherwise the ask on primary care is infinite with no way to meet it. It is a great pity that there has been no move forward on the role of 'medical assistants' as proposed a few years ago and could have helped with much of the administrative burden on GPs and allow concentration on direct clinical care.  The work on care navigators is awaited with interest. There is no 'protectionism'  - in fact, I think it would be much better to use the talent and enthusiasm of people fully and admit vastly more people from a wider demographic to medical school - an extra three years training would create more doctors who can work autonomously, be regulated, and progress equitably in their careers. 

Drennan and colleagues provide interesting reading in their references. However I can see no data in respect of safety caused by interruptions. It may be that practices who have employed PAs, as in this study, have done so because their workload was such that this is for them a safer system. But it cannot be optimal to build national policy on the expectation that interruptions are normal without reducing GP consulting time to ensure this is safely factored in. 

Parle makes many assumptions. This is a pity. GPs are best placed to see patients - that's what we've trained for - rather than sort out Trampolining Consent Forms, commissioning, trying to communicate with Atos, or raising awareness of whatever has been in the news that week. General practice is nothing without the multidisciplinary team (as I've written often before and the reason why the fall in numbers and shortage of district nurses concerns me so much) and I think he has misinterpreted what I have written. 

Competing interests: I wrote the article

07 December 2017
margaret mccartney
c/o bmj