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Rapid response to:

Editor's Choice

Clearing up the PA mess

BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q2099 (Published 26 September 2024) Cite this as: BMJ 2024;386:q2099

Rapid Response:

Re: Clearing up the PA mess

Dear Editor

In defence of Physician Associates

I refer to the articles in the recent BMJ (between 28/09/24 – 05/10/24) pages 335, 337, 348, 349, 357 and 360 which all relate to the inappropriateness of Physician Associates working in primary care. There is no reference to their work in secondary care and I am surprised that no one in secondary care has expressed concerns regarding the PAs working in hospitals. There are 2000 PAs at present working in primary care and I accept that 1 patient’s pulmonary embolism was missed, which unfortunately caused her death. The Royal Colleges of Physicians and General Practitioners have not given any reasons for their concerns.

As Clinical Director of a Primary Care Network, I have had PAs working in 5 different practices for the past 4 years and we have not had a single complaint from a patient or concerns from any of the supervising doctors regarding their work. They have been an asset to primary care and have been mentored appropriately by the supervising general practitioners. They are informed who their supervisor is before they start the session and they will seek advice when appropriate. At the end of the session, they always see their supervisor, especially if they want to discuss the patients' care, arrange radiology requests and issue sick notes. The supervising doctors are given dedicated time to supervise the PAs.

I am not too sure how many of the members of the Royal College of Physicians work with PAs to form an opinion that they cannot work in primary care as they may not be aware of how primary care currently organises itself. Similarly, how many of the 61% of general practitioners who voted in the recent survey carried out by the Royal College of General Practitioners and opposed the role of PAs working in general practice have trained or worked with PAs to form their opinion. My practice is involved in year 1 and 2 of the PAs training and I find that the year 2s, who spend 6 weeks in our practice, require the same amount of support as the year 5 medical students.

The 2 doctors who have recently qualified and worked in the past have obviously had a 5-year training programme and will need another 3 years training to become general practitioners and still need some supervision when they start working in practices. I have not openly criticised their training to become PAs and Adam Calthrop, who worked 4 years as a PA in emergency medicine and primary care reflected positively on excellent PA training.

I do appreciate the BMA's view on PAs and the concern is that they are working instead of GPs, but I wonder if the RCGP and The Royal College of Physicians have looked at the work of nurse practitioners in primary and secondary care. In my practice we have 4 nurse practitioners who also need supervision and will continue to have supervision as they are not qualified GPs, but no one has criticised them. In secondary care there are nurse consultants who have achieved that post without the 5-year training to become a doctor.

I feel that the criticism of PAs working in primary care is unfair and everybody has jumped on the bandwagon instead of reflecting on the care in primary care and the service they provide to patients along with nurse practitioners and GPs to cope with the increasing demand in primary care.

Competing interests: No competing interests

02 October 2024
Iftikhar A Lone
GP/Clinical Director of Primary Care Network
Middlesbrough