Physician associates and GPs in primary care: a comparison.
BACKGROUND
Physician associates [PAs] (also known as physician assistants) are new to the NHS and there is little evidence concerning their contribution in general practice.


OBJECTIVE
This study aimed to compare outcomes and costs of same-day requested consultations by PAs with those of GPs.


METHODS
An observational study of 2086 patient records presenting at same-day appointments in 12 general practices in England.


METHODS
PA consultations were compared with those of GPs. Primary outcome was re-consultation within 14 days for the same or linked problem. Secondary outcomes were processes of care.


RESULTS
There were no significant differences in the rates of re-consultation (rate ratio 1.24, 95% confidence interval [CI] = 0.86 to 1.79, P = 0.25). There were no differences in rates of diagnostic tests ordered (1.08, 95% CI = 0.89 to 1.30, P = 0.44), referrals (0.95, 95% CI = 0.63 to 1.43, P = 0.80), prescriptions issued (1.16, 95% CI = 0.87 to 1.53, P = 0.31), or patient satisfaction (1.00, 95% CI = 0.42 to 2.36, P = 0.99). Records of initial consultations of 79.2% (n = 145) of PAs and 48.3% (n = 99) of GPs were judged appropriate by independent GPs (P<0.001). The adjusted average PA consultation was 5.8 minutes longer than the GP consultation (95% CI = 2.46 to 7.1; P<0.001); cost per consultation was GBP £6.22, (US$ 10.15) lower (95% CI = -7.61 to -2.46, P<0.001).


CONCLUSIONS
The processes and outcomes of PA and GP consultations for same-day appointment patients are similar at a lower consultation cost. PAs offer a potentially acceptable and efficient addition to the general practice workforce.
Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London.
Vari M
VM
Drennan
Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London.
Mary
M
Halter
Social Care Workforce Research Unit, King's College London.
Louise
L
Joly
Health Care Management and Policy, University of Surrey, Guildford.
Heather
H
Gage
Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London.
Robert L
RL
Grant
Centre for Criminology and Sociology, Royal Holloway, University of London, Egham.
Jonathan
J
Gabe
Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London.
Sally
S
Brearley
Directorate of Corporate Affairs, St George's Healthcare NHS Trust, London.
Wilfred
W
Carneiro
Health Care Management and Policy, University of Surrey, Guildford.
Simon
S
de Lusignan
D000328:Adult; D001071:Appointments and Schedules; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D010823:Physician Assistants / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D013222:State Medicine
general practitioners; observational study; physician assistants; physicians, family; primary health care