Evaluation of physician assistants in National Health Service Scotland

Abstract

Physician assistants (PAs) have medical training and work supervised by a doctor. In 2006-2008 the Scottish Government piloted use of USA-trained PAs. The aim of the paper is to evaluate the impact and contribution made by PAs to delivering effective health care in National Health Service (NHS) Scotland. Mixed methods, longitudinally, including interviews, feedback forms and activity data collection. Data analysis used nVivo, SPSS and Excel. Participants were 15 USA-trained PAs, medical supervisors and team members, 20 patients, four NHS senior managers and three trade union representatives. Settings were four Scottish NHS Boards where PAs worked in primary care, out of hours clinics, emergency medicine, intermediate care and orthopaedics. Two minor patient safety issues arose. Patients were satisfied with PAs. Scope of practice did not replicate US working. Inability to prescribe was a hindrance. PAs tended to have longer consultations, but provided continuity and an educational resource. They were assessed to be mid-level practitioners approximating to nurse practitioner or generalist doctor. Valued features were generalism, medical background, confidence differential diagnosis and communication. Interviewees suggested PAs could fulfil roles currently filled by medical staff, potentially saving resources. In conclusion, there is potential for PAs to fulfil distinctive mid-level roles in the Scottish NHS adding value in continuity, communication and medical approach.

Nurses in Advanced Roles

“…Physician assistants have to complete a degree-level academic programme of no less than 90 weeks (including 1,600 hours of clinical experience), followed by an internship of 12 months. A Bachelor's degree in a life science may also be required, although for the time being there are no common basic educational requirements across England and the United Kingdom (Farmer et al, 2009;Department of Health, 2006).…”

The case for the physician assistant

“…As with any other new component of the workforce, a bedding-in period is necessary, but, once established, physician assistants have an excellent track record as team players. 6 The career path for a physician assistant, which involves far less frequent job moves than, for example, that of junior doctors, makes the bedding-in time a worthwhile investment for the institution, as well as the healthcare team, and reduces human resources' workload in terms of advertising and appointing to posts.…”

“…The evidence supports our view that physician assistants, as stable members of medical teams, will actually provide an additional training resource for junior doctors on rotation. 6,18 They are able to provide information about organisational policy and consultant preferences, as well as training, observation and feedback in relation to practical aspects of clinical work (Fig 3).…”

“…As Farmer et al wrote in their recent report on a prospective trial of physician assistants in Scotland: 6 '…[physician assistants are] moving from the USA to other parts of the world at this time expressly because [they] can meet the world's current health workforce gaps'.…”

Les pratiques infirmières avancées

“…Les assistants de médecins doivent compléter un programme universitaire d'au moins 90 semaines (incluant 1 600 heures d'expérience clinique), suivi par un stage de 12 mois. Une licence (« Bachelor degree ») en sciences de la vie peut être aussi exigée, bien qu'il n'y ait pas, à l'heure actuelle, de formation commune de base requise à travers l'Angleterre et le Royaume-Uni (Farmer et al, 2009;Department of Health, 2006). …”