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Only six PAs imported


from America Despite a £50k salary, the NHS is failing to attract enough recruits, finds Alex Matthews-King


An ‘expansion programme’ intended to recruit 200 experienced physician associates (PAs) to the NHS from the US through offering a salary of £50,000 and generous benefits is unlikely to meet its target, its leaders have admitted. The London trust leading the recruitment drive has said the national target to recruit 200 PAs across primary and secondary care for the two-year role has recruited just 35 individuals, including only six who will work in general practice.


The figures come despite a drive to increase the presence of PAs in general practice, with health secretary Jeremy Hunt’s ‘new deal’ pledge of 1,000 PAs to work alongside GPs by 2020, and moves to boost non-medical staff numbers in NHS England’s 10 point GP workforce plan.


GPs said the scheme was ‘gimmicky’, and demonstrated the Government had no ‘real commitment to proper workforce development’. Last August, Pulse revealed the scheme – called the National Physician Associate Expansion Programme (NPAEP) – had begun advertising for experienced candidates from the US to work in the NHS, offering salaries of £50,000 a year, 33 days’ paid leave and a relocation grant.


Handful of offers


Pulse has learned from Hillingdon Hospitals NHS Foundation Trust that 184 applications had been received by early last November, leading to 35 provisional offers being made by 15 January. Only six candidates were identified for work in general practice. The spokesperson said: ’The NPAEP


positions were advertised between 24 August 2015 and 7 January 2016 and the selection process is ongoing. A full update will be available in March, but the board papers from


34 February 2016 Pulse


It seems like a lot of money to spend Dr Louise Irvine


Hillingdon Hospitals’ December meeting conclude: ‘It is likely that NPAEP will continue to run, with smaller numbers than originally envisaged.’ PAs are dependent practitioners who are able to undertake delegated medical work, supervised by a qualified GP, such as obtaining medical histories, conducting physical exams, requesting and interpreting tests, diagnosing and treating illnesses and injuries, and advising on preventive healthcare. The guidance for applicants states they must have ‘significant clinical experience’ as a PA and/or have completed a postgraduate residency or fellowship programme, and have valid US or UK registration and evidence of CPD.


The original NPAEP advert aimed to recruit PAs for four regions: north-west London; the East Midlands; Yorkshire, the Humber and Newcastle; and north-west England.


This included roles in Leicester –


Should I employ a PA? Three experts advise pulsetoday.co.uk/ associates


where the CCG has already invested £600,000 in recruiting 10 PAs from the US to work in general practice – as well as in GP practices in Sheffield and across seven London GP practices. The expansion programme will run until the end of 2017 and NPAEP director Dr Nick Jenkins said he hoped it would show the benefits PAs can bring, and create a blueprint for the roles of the first cohort of PAs trained in newly expanded UK university postgraduate courses. But BMA Council member and south London GP Dr Louise Irvine told Pulse: ‘I don’t see what a physician associate can do that a good practice nurse or nurse practitioner couldn’t do. I think this is gimmicky. It seems like a lot of money to be spending on people for whom the role is very indeterminate. ‘I don’t think the Government’s shown


any real commitment to proper workforce development,’ she added.


Expert view ‘Physician associates remain an unknown quantity’


The position for general practice is absolutely dire. There are practices that cannot recruit or are grotesquely


understaffed, and demand is soaring. Physician associates remain an


unknown quantity and only six physician associates have actually been recruited for the pilot, so any evaluation will be at best inaccurate and at worst misleading. If scarce resources are to be invested in a UK-trained PA workforce, we must be sure they can deliver. It would be an error to think GPs are


replaceable; even in a 10-minute consultation they perform minor miracles that would be hard to replicate without the skills, continuity and trust that UK GPs have. If a PA can earn up to £50k a year


and a GP partner is on £100k – though few of those are left in London – they have to deliver at least half of what a GP partner does, or do it in less than twice the time or the money is wasted. But if PAs are a short- or medium-


term solution, are you going to be diverting funds, expertise and impetus from that absolute need to increase the GP workforce? We can’t just re-plaster a damp wall. My concern is that PAs can only do


so much – the dwindling GP workforce will still have to do most of the work.


Dr Tony Grewal is medical secretary of Londonwide LMCs


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