The role of Physician Associates within Primary Care: Are they safe and effective?

There has been scant evidence about the safety and efficacy of Physician Associates (PA) working within primary care. The recent climate created by qualitative surveys have not been helpful in understanding the use of dependent practitioners within the primary care setting.

Aim

This study aimed to compare outcomes in terms of safety of same-day requested consultations of differentiated and undifferentiated patients by PAs, Advanced Nurse practitioners (ANP) and post graduate doctors in training (PGDiT) within a large academic general practice.

Design and setting

An observational study of 4979 patient records presenting at same-day appointments at a large general practice in Leicestershire over a 6-month period between June -December 2024.

Method

PA consultations were compared with those ANP’s and PGDiT. These were sub-divided into differentiated and undifferentiated patient presentations. 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 1.35, 95% confidence interval [CI] = 0.76 to 1.89, P = 0.29) in both groups of patients. There were no differences in rates of diagnostic tests ordered (1.14, 95% CI = 0.89 to 1.30, P = 0.74), referrals (0.91, 95% CI = 0.69 to 1.63, P = 0.87), prescriptions issued (1.26, 95% CI = 0.77 to 1.43, P = 0.39) in either of the patient cohorts examined. However, patient satisfaction rates were higher within the ANP group than the other two groups (0.86, 95% CI = 0.42 to 2.36, p<0.001). Records of initial consultations of 79.2% (n = 596) of PA’s; 48.3% (n = 399) of ANP and 78.5% of PGDiTs were judged appropriate by Principal GP’s at the practice (P<0.001). There was no difference in rates of referrals onto secondary care (rate ratio 1.24, 95%CI= 0.67 to 1.77; P=0.76) between the groups for either patient cohorts. PGDiTs did have a higher utilization of imaging resources when compared to the other two groups (RR 1.78 95% CI= 1.01 to 2.8; p<0.001).

Conclusion

The processes and outcomes of PA and other dependent practitioner consultations for same-day appointment patients are similar and appear to be safe within primary care for all patient types. PAs offer an acceptable and efficient addition to the general practice workforce.