Nurses accused of professional protectionism

Steve Field told Nursing Times he was disappointed that only a small number of training positions for assistant physicians have been commissioned. He said nurses had been unsupportive of the new post because they believed they could do it themselves.

We need a really focused urgent look about what we need in primary care and what the workforce should be

Training for physician assistants – who undertake a two year post-graduate degree and do roles similar to junior doctors but under strict guidelines and protocols – was introduced three years ago. The first cohort are due to graduate in January.

Physician assistants are viewed by some hospitals as a solution to the reduction in junior doctors’ working hours following the introduction of the European working time directive.

Professor Field also wants the assistants used in primary care where they could take on more of the routine patient care, allowing GPs to have longer consultations with individual patients.

He said: “Nurses have not been generally supportive of this new role because many nurses believe nurses can do this role so why do we need a new workforce? The roles aren’t being commissioned from the medical schools. My hunch is it’s a lot about professional protectionism.”

The GP leader called for a “big honest debate” about the skills needed in primary care. “[Nurses] haven’t been looking creatively about how we can deliver primary care. It’s more about not being creative than actually blocking.

“We need a really focused urgent look about what we need in primary care and what the workforce should be.”

Queen’s Nursing Institute director Rosemary Cook said she would be surprised if there was any “organised opposition” to physician assistants. But she said there was “concern” that “we try to bring a new role in to solve every problem rather than change the way we work.”

But Ms Cook said there was already a “very large number” of nurse practitioners and skilled practice nurses working in GP practices which made it “difficult to see who does what role and what’s the role there for physician assistants”.

Assistant physician training places are commissioned by strategic health authorities. Ms Cook said that rather than wait for SHAs, individual GP practices that wanted to use assistant physicians should “spot purchase” their own training direct from universities.

Royal College of Physicians policy adviser Stuart Abrahams denied Professor Field’s charge. “Nurses have been at the forefront of developing new roles [but] it is vital to ensure that appropriate arrangements for education, training, support, supervision, accountability and delegation are in place. These are issues of safety and quality not professional protectionism,” he said.

One senior doctor told Nursing Times part of the attraction of employing assistant practitioners was that the role was relatively tightly defined around general clinical and medical duties and would have a limited career path. The source said this contrasted with nursing, which had an ever-extending career ladder into more specialised duties, higher pay and managerial responsibilities.

Ms Cook said she could see why some might see that as a problem but she questioned whether it was good employment practice to “employ people with a cul-de-sac career so they don’t leave you.”

NHS Institute productive ward programme associate Lizzie Cunningham agreed. She said: “If you curtail [people] they will leave. Intelligent people want to progress their careers. They won’t want to stay.”

St George’s NHS trust in London is planning to introduce assistant physicians – as well as surgical care practitioners - to fill the gap created in its junior doctor staffing levels.

A recent planning paper from the trust states: “The value of these roles is created through the increased likelihood for longevity in post, being able to use their local knowledge and experience to provide high standards of care to patients.”

But trust transformation work stream lead Matthew Barker, himself a former nurse, told Nursing Times that the “longevity in post” was in contrast to junior doctors, not specialist nurses.