Providers must find ways to integrate physician associates into the NHS workforce and optimise their skill sets, says Sam Roberts 

doctor nurse workforce hospital

This week saw the launch of NHS Providers’ report on the NHS workforce.

It makes for bleak reading. 

The NHS workforce faces challenges on multiple fronts. Change is required to deliver new care models within a patient centred approach in line with the Five Year Forward View, yet this must occur in an environment where the workforce gap is already the biggest challenge facing providers. 

There is a shortfall of over 10 per cent in key staff groups across the country with looming issues such as Brexit likely to exacerbate this. Whilst funding, recruitment and retention play important roles, supply shortage is identified as the key factor contributing to the workforce gap.

Various strategies are being implemented to address workforce issues. Nationally, the government has announced funding for a 25 per cent increase in medical and nurse training places, however, the initial effects of these increases are unlikely to be seen until 2020-21 at the earliest and it may be as late as 2030 before the full impact is realised. 

There is concern that shifting the acuity of the workforce gap from one profession to another will disproportionately affect traditional nursing roles

At a local level, providers are encouraged to develop extended or advanced roles for existing staff, including the development of advanced clinical practitioner roles and prescribing pharmacist positions among many others. 

Whilst these initiatives are welcome in the context of developing the workforce to deliver new models of care, they do not address the overarching supply shortage, and there is concern that shifting the acuity of the workforce gap from one profession to another will disproportionately affect traditional nursing roles.

Part of the solution

A significant part of the solution to address the workforce gap may be the physician associate role. Physician associates represent a rapidly expanding workforce and although there are currently only around 500 UK practicing physician associates, a further 1,700 are due to finish training within the next two years with an estimated UK workforce of over 3,000 by 2020. 

This group represents a distinct profession, many of whom are recruited from a biomedical background. As such, role expansion is unlikely to negatively impact staffing across other groups.

Emerging evidence demonstrates that they are carrying out tasks traditionally performed by junior doctors, allowing release of medical staff for more complex aspects of patient care

At an organisational level, the extent of roles that can be filled by physician associates continues to develop.

Emerging evidence including that from the US, where the role is already established, demonstrates that they are carrying out tasks traditionally performed by junior doctors, allowing release of medical staff for more complex aspects of patient care, training, leadership and educational activities. 

An additional advantage of physician associates is that they may contribute to the development of integrated workforce models with posts structured to bridge traditional primary and secondary care boundaries. Patient satisfaction with the role of physician associates is high, as is the satisfaction of doctors who work with them.

So, what are the barriers to this expanding workforce? 

Challenges

Physician associates are dependent practitioners – they require supervision in clinical practice. The extent of this supervision will vary depending on the experience of the practitioner and it is envisaged that as individuals become embedded in roles, supervision may become increasingly remote rather than direct. 

Physician associates are currently an unregulated profession and as a result are unable to prescribe within the UK legislatory framework. 

The Department of Health recently released a consultation seeking views on developing regulation which would be a significant step to the profession acquiring prescribing rights, however, this process may take several years to complete. 

Physician associates are currently an unregulated profession and as a result are unable to prescribe within the UK legislatory framework. 

In the meantime, organisations employing physician associates continue to develop solutions to allow the integration of the role into areas involving medication management. 

Finally, and perhaps one of the biggest barriers, is the element of the unknown. As with the development of the advanced clinical practitioner positions, clinicians in some areas remain sceptical about the role and the implications for traditional medical practice and training. 

A developing profession

It is still early days for UK physician associates. We need to allow the profession time to develop and mature, to support it in becoming established in the workforce and to trial different models of working before establishing ways to optimise the skills of this group. However, we are in a situation where we need to meet the workforce gap now. 

Physician associates are qualifying today. They are ready to work today. Many acute trusts already have established physician associate programmes and plan for physician associates to make a significant contribution to their future workforce. Other trusts are playing catching up. 

Integration into the workforce varies widely across the country and primary care is some way behind despite the investment committed to physician associates in primary care by NHS England. 

Physician associates represent a fantastic opportunity for providers to meet the key challenges identified in this week’s report.

However, in order to maximise their potential, providers must be engaged in creating ways for new healthcare groups to work effectively within their organisations to meet the demands of service provision today and tomorrow.