The first study into the impact on the NHS of a new type of health worker in hospitals, Physician Associates, has found that they benefit medical and surgical teams and their patients over a wide range of specialities.

Researchers found that Physician Associates safely supported the workloads of clinical teams and helped provide team continuity, as well as positively contributing to patient experience and patient journey.

Researchers funded by the National Institute for Health Research (NIHR) set out to investigate the use, acceptability and impact of Physician Associates within a hospital setting in a sample of six acute care hospital organisations in England. The Physician Associates, or PAs, worked in 13 adult and paediatric specialities, including emergency departments. The researchers carried out the study by interviewing medical staff including consultants, managers and nurses; interviewing patients and relatives; reviewing PAs’ work diaries, and observing them at work.

PAs were mainly deployed in hospitals to undertake inpatient ward work during core weekday hours. They were reported to positively contribute to: continuity of staffing and knowledge within their medical or surgical team; patient experience and flow; inducting new junior doctors; and supporting their teams’ workload, all of which released doctors to attend to more complex patients and training.

Physician Associates are medically trained generalist healthcare workers. They train at post-graduate level to work in all settings and undertake medical histories, physical examinations, investigations, diagnosis and treatment within their scope of practice as agreed with their supervising doctor. While they are able to carry out medical procedures such as taking arterial bloods, and taking and interpreting electrocardiograms, they are at present not allowed to prescribe medicines or to order x-rays. As well as working in hospital settings PAs may also work in primary care in the NHS supporting GPs.

Vari Drennan is Professor of Health Care and Policy Research at the Faculty of Health, Social Care and Education, run jointly by Kingston University and St George’s, University of London. She said: “We found that the relatively new role of Physician Associate can make a valuable and flexible contribution to medical and surgical teams in hospital, and they were found to be acceptable, appropriate and safe members of the teams by the majority of doctors, managers and nurses. In particular, patients responded very positively to PAs; the PAs were likely to be constantly present on a ward and therefore easy to approach, and would follow up items from the doctors’ ward rounds as well as explaining care plans and decisions to patients and relatives.”

She continued: “The recent announcement by the Secretary of State for Health & Social Care that PAs will be regulated by statute has the potential for allowing them to prescribe medicines and order ionising radiation, both of which would strongly enhance their contribution in hospital teams.”

Professor Jim Parle, of the University of Birmingham's Institute of Clinical Sciences and Director of the largest Physician Associates programme in the UK, said: “We are delighted to be part of this major study. It is essential we measure the impact of Physician Associates as this workforce is set to grow to as many as 3,000 graduates by 2020.”

Stephen Hammond MP, Minister of State for Health, said: “This research highlights the invaluable role Physician Associates play in the NHS, supporting doctors to deliver safe, high-quality care to patients. Our decision to regulate Physician Associates is not only a recognition of this enormous contribution but will empower them to work to their full potential and place them on a firm foundation for a long and successful career in the NHS.”

The study was funded by the National Institute of Health Research’s Health Service & Delivery Research programme.
‘What is the contribution of Physician Associates in hospital care in England? A mixed methods, multiple case study’ was published in BMJ Open on 31 January 2019.

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