WHILE’S WORD

Reviewing roles: nurses vs physician assistants Alison While Emeritus Professor of Community Nursing, King’s College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI

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American Association of Nurse Practitioners (2015) NP Fact Sheet. www.aanp.org/all-about-nps/np-fact-sheet (accessed 1 June 2015) Drennan V, Levenson R, Halter M, Tye C (2011) Physician assistants in English general practice: a qualitative study of employers’ viewpoints. J Health Serv Res Policy 16(2): 75–80. doi:10.1258/jhsrp.2010.010061 Drennan VM, Halter M, Brearley S et al (2014) Investigating the contribution of physician assistants to primary care in England: a mixed-methods study. Health Services and Delivery Research 2(16). doi:10.3310/hsdr02160 Farmer J, Currie M, Hyman J, West C, Arnott N (2011) Evaluation of physician assistants in National Health Service Scotland. Scot Med J 56(3): 130–4. doi:10.1258/smj.2011.011109 Horrocks S, Anderson E, Salisbury C (2002) Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ 324: 819–23 Royal College of General Practitioners (2015) Pharmacists set to work in GP surgeries in radical move to ease pressures on general practice and improve patient care. bit.ly/1AIYCHx (accessed 1 June 2015) Royal Pharmaceutical Society (2014) Pharmacists and GP surgeries. bit.ly/1EOvRV9 (accessed 1 June 2015) Woodin J, McLeod H, McManus R, Jelphs K (2005) Evaluation of US-trained Physician Assistants working in the NHS in England.The introduction of US-trained Physician Assistants to Primary Care and Accident and Emergency departments in Sandwell and Birmingham. Final report. bit.ly/1QkaVvK (accessed 1 June 2015)

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❛... nurses work within a regulatory framework, can prescribe unlike [physician assistants], and patients have similar health outcomes if treated by [nurse practitioners] compared with GPs and report higher care satisfaction.❜

Alison While

© 2015 MA Healthcare Ltd

rimary care is under tremendous pressure because of the ageing population, resource constraints, and technological changes that make care at home possible. Finding ways to extend the capacity of the GP service are needed if care is to be refocused in the community. A variety of solutions have been proposed, including the introduction of physician assistants (PA) to the primary care workforce. Physician assistants have a 2-year training working to the medical model, which builds upon a science degree. Physician assistants have existed for 40 years in the US, and early studies (Woodin et al, 2005; Farmer et al, 2011) of their employment in the UK were favourable in terms of their competency and greater diagnostic skills compared with nurses in extended roles. Drennan et al (2011) found that PAs were a helpful addition to the general practice team enabling the meeting of patient care demand within budgetary constraints. In more recent years, a larger evaluation (Drennan et al, 2014) reported that PAs were a flexible resource to general practice and increased clinician time for same-day appointments within their practices. Although their appointment times were slightly longer than those of the GPs and they saw younger and fewer patients with chronic diseases, there were no differences in procedures undertaken or prescriptions issued. Moreover, the patients were equally satisfied with the PA and GP consultations, and 90% said they would would be satisfied to consult a PA again. The costs of PAs was also cheaper than that of a GP. Why haven’t nurse practitioners (NPs) been championed as a potential solution to increasing the capacity of the GP service? Unlike the US where ‘nurse practitioner’ is the registered title of more than 200 000 advanced practice nurses, mostly working in primary care with Medicare and Medicaid patients (American Association of Nurse Practitioners, 2015), NP is not a recognised title in the UK. One is left to wonder whether the recent debates about whether nurses are now ‘too posh to wash’ has spilled over to create a reputational legacy that nurses cannot be both clever and capable of advanced clinical decision making, as well as simultaneously compassionate—not a charge that is levelled at GPs.While clarity about the purpose and expectations of RNs is clearly important, the ongoing debate is a distraction if we wish to see RNs as key contributors to solutions to general practice workforce capacity issues. After all, nurses work within a regulatory framework, can prescribe unlike PAs, and patients have similar health outcomes if treated by NPs compared with GPs and report higher care satisfaction (Horrocks et al, 2002). It would be good to see the potential contribution of nurses highlighted alongside the emergent role of pharmacists within GP surgeries (Royal Pharmaceutical Society, 2014; Royal College of General Practitioners, 2015).  BJCN

British Journal of Community Nursing July 2015 Vol 20, No 7

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