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More assistants to work with GPs

Practice nurses could soon find themselves with new colleagues following a successful pilot scheme using US-trained physician assistants in GP surgeries.

From January 2008, budding healthcare workers will be able to work towards a two-year Postgraduate Diploma in Physician Assistant Studies.

They will be trained to take medical histories, perform examinations, diagnose illnesses, and analyse test results.

Physician assistants will work alongside doctors in hospitals and GP surgeries, supporting them in diagnosing and managing patients.

Though the role is well established in the US, it is hoped the new training programmes at the universities of Birmingham, Wolverhampton and Warwick, in partnership with Coventry, will help to establish it in the UK.

Jim Parle, professor of general practice from the University of Birmingham's medical school, said: "This new profession will supplement the existing NHS workforce, increasing the number of frontline clinicians available to treat patients.

"Physician assistants will always support the work of doctors, not replace them.

"However, having an additional clinically-trained member of staff has the potential to really benefit patient care. Certainly the experiences of general practices which are already using US-trained physician assistants have been very positive." 

There are currently more than 20 physician assistants already working in the West Midlands, and a total of 50 across the UK.

The Medical School at the University of Birmingham

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Related story: Nurse uproar over new GP assistants

Will you be looking forward to the recruitment of new GP assistants? Do you think it will impact on your workload? (Please supply your comment, name and location. Your details will not be published if you so request.)

Your comments: (Terms and conditions apply)
“I am an English nurse who is an American nurse practitioner and have worked with physician assistants and physicians. I found physicians assistants were people who often started in different careers wanting to become health professionals, and didn't want to spend the time or cost that it needs to become a physician or nurse. They had a clearly delineated role but were different from nurse practitioners in that they were not autonomous. They worked under the direction of the medical professional and had a focus of practice.  We basically did the same work and with experience you couldn't tell the difference. I think it is a great opportunity for mature students who want to change their profession in mid career. Their pay was often higher than NPs and I think that might be because doctors are better at negotiating pay awards than NPs” - Jane Bickerton RN, HVA, WHNP, MA, Visiting lecturer at City University currently working to complete a PhD

"As a practice nurse I do not object to any step towards improving patients' care. My suggestion is that why can't the government train current nurse practitioners and experience practice nurses to take up this so called GP assistants role we have been labouring and helping out GPs for so long with less financial rewards. Most of us are educated to degree and masters levels. Why can't we get further training to assist GPs. Is it not another way of wasting money. We have the knowledge, vast experience we only need free funding do get there" - Name and address supplied

"Give the UK trained doctors this particular role as fist step to assessment of hands on until considered to be fully competent in the skills required to further improve the delivery of primary and secondary medical services in this country. Some Nurse Practitioners are well able knowledgeable and competent to take on this role and should be given first priority in applying" - NP V Henry

"We do not need or welcome this new role in this country. It will undermine the nurse practitioner and practice nurse role, they are trying to be a 'cut above' us in the scheme of things. I would not wish to work alongside one. We have plenty of skills, master's degrees and independent prescribing. We should not confuse the patient even more with pseudo-medical/assistant title" - Karen, Derbyshire

"Over the past 30 years practice nurse specialists and nurse practitioners have worked hard to develop their roles, often self-funding and without support of employers or PCTs. GPs have come to appreciate teamwork, but why do we need yet another thread of training to confuse both clients and other health workers" - Jackie Burns, Manchester

"Sounds like another attempt to meet government targets for patient access. Wouldn't it be better to recruit more practice nurses and nurse practitioners who already do this kind of work?  Who is paying for the new assistants? As a practice nurse I had to find my own funding for specialist courses to manage long-term conditions. Will GPs pay for similar training for their assistants?" - Name and address supplied

"I like the idea think its should be rolled out more widely across the UK. I have worked within this capacity for years so could fit into the new role quite easily with or without the relevant training. My employers have always supported me in my role as a senior nurse practitioner and prescriber. It will be another way of recognising the very important role that qualified experienced nurses have played and continue to play within the medical team in both primary and secondary care" - Name and address supplied

"Whilst I welcome skill mix and diversity within healthcare provision, the continued development of an ever increasing number of 'new' roles and 'new' titles is I believe, becoming frustratingly confusing not only for our clients but for colleagues in partner organisations. I am sceptical of the 'value' of PAs in the British healthcare system. While the role has been established in the States for many years, the culture and ethos of the systems is completely different and my concerns are who will be the legislative body for these practitioners? Who will provide professional regulation? One respondent has already stated that in the States NPs and PAs 'end up doing the same things' so what is the purpose? In a health service where educational opportunities and development have become increasingly difficult to access for current professional groups, is it appropriate to spread the 'jam' even more sparsely by training another practitioner whose functions are already adequately fulfilled by existing professional groups? - Barbara Scanlon, Gloucestershire

"I think we are too quick to dismiss any new roles and services in the NHS without giving it a chance first. I get very tired of professionals dismissing innovation before it has had chance to bed in. We should be supportive in these new roles, give them a chance and nurture them. Anything that can help the patient receive more effective and efficient care must be a bonus, after all that's why we are all here. The PA role has proven it's worth in the USA, and although I am aware they have a different style of health care provision to the NHS, I feel that in the current changing climate this role should be embraced. As a nurse I can understand the concerns of having a new role introduced, but having done my research into the role of the PA, and, indeed having worked with a couple, they take on more clinical responsibility for diagnosing and (potentially) prescribing than the majority of nurses I know. Their pay therefore reflects their accountability and responsibility. Many of these PAs have worked in the NHS for many years in clinical roles, and wish to expand their horizons and career pathways. Why should we berate them for career development? This role is different from that of a nurse, not better than a nurse just different. It bridges the clinical gap between nurse and doctor. Be supportive, be encouraging and develop with these roles" - Name and address supplied

"I am a Diabetes Specialist nurse and am about to complete three modules (Nature of physical assessment, applied pharmacology and non medical prescribing for nurses) once passed I will be an independent prescriber. But in all roles including this one, nurses are trained to do a complete assessment. It is often nurses who lead to diagnosis and correct treatment for patients. Practice nurses are doing all the work for GPs to obtain their targets (and financial incentives). I had to wait 18 months for an appeal to be correctly banded. Patients often say they prefer to see nurses as they listen and are more thorough. When are nurses going to get the clinical and financial recognition for all they are doing ?" - Name and address supplied

"I've spent the past 2 and a half years training to do what the new PA will be doing. As yet the GPs who let me do the course are yet to embrace it. I am in the process of completing nurse prescribing and feel that I will have to stand tall and not be used as I think they will try to use me. I am still on a G grade salary. On the horizon I have been asked to join an out of hours agency providing the skills I have been trained to do.  Do you think GPs will embrace the new PAs? I don't. Maybe I am just diappointed and fed up with being walked on by GPs" - Name and address supplied

"Whoever had this 'idea' had obviously not researched the existing skills, advanced nurse education, the willingness of nurses to explore the boundaries of practice and services already in place on their own doorstep. Cyniscm and experience tells me this scheme will be launched at vast expense and a hail of publicity claiming it to be the "new" way forward for healthcare. (As if the nurse has only ever functioned as a hand maiden!) And who will be required to mentor these people - got it in one- us of course? Oh, and as previously mentioned the salary. The majority of us at advanced level have not been financially rewarded with the glorious A 4 G or am I am being too cynical? In the meantime I'll just get on with my lowly nurse led surgery" - Geraldine, Chester

"I am an ANP working in general practice and trained to masters level. The degree course I undertook was similar to the training that our medical colleagues undergo. My job description and practice I feel is no different to that of the new PA. Although I don't want to be negative about the introduction of this new clinician, I can see problems arising particularly if pay and conditions and rivalry for jobs is going to be an issue. The government needs to think about how this can be prevented to ensure the morale of nurses does not sink even lower" - Barbara, Wirral

"Why do we need physician assistants? Patients and healthcare professionals are already confused over all the different titles, and nurse practitioners are still trying to get recognition for their role in general practice. So why introduce a similar role?"- Name and address supplied

"What will be the salary range of the PAs? If it is higher than what's being paid to Advance Nurse Practitioners it would be a kick in the teeth for those who have a Masters Degree, and  shows a lack of recognition by the establishment/government and the same old story" - Name and address supplied

"As a US PA who has worked with NPs in the states, please do not feel threatened. In the end, we wind up doing the same things and complementing each other. There is more than enough work to go around, and while I understand that adding another profession is in some eyes duplication of services, it has worked very well in the States, where both professions are colleagues. Give them a chance" - Name and address supplied
"I don't understand the difference between nurse practitioner and the new GP assistant. It will surely push nursing back in status and financial reward. I'm a practice nurse looking to develop my career within nursing not by leaving it. Shame on the government" - Gill, London

"What is going to happen to the advanced nurse practitioners who have done similar training to the physician assistants? They have a nursing background and have also worked extremely hard to get to this level. No one seems to mention them. Is the physician assistant just another fancy title that is just going to confuse doctors, nurses and more importantly patients? - Name and address supplied

"Why do we need this 'new' role? Nurse practitioners have been around for more than 15 years working alongside GPs and hospital doctors? We are trained to either MSc or BSc level and work autonomously. What we do need is for the NMC to pull itself together and recognise advanced practice qualifications" - Lynne Gray, Nurse Clinician, Skelmersdale

"We already have practice nurses and nurse practitioners who are capable of this" - Name and address supplied

"As an experienced advanced nurse practitioner, educated up to masters degree level, I have been trained to a high standard in taking histories, performing examinations, diagnosing and treating illnesses with prescribing skills, analysing results and referring on to consultant care. I have years of NHS experience. Are we the forgotten few hundred in this grand scheme of this government? Why bring in yet another layer of clinician when we are already out there just waiting for recognition for the job that we do? Or is it because we have the word 'nurse' in our title that makes the medical profesion uncomfortable, whereas 'physician assistant' is OK?" - Name and address supplied

"Yes I think PAs are a great idea in the UK. Their training is similar to those of medical doctors and less like nurses" - Name and address supplied