Table 3 Applicability of review findings to current UK context. Preliminary review findings were presented remotely to the advisory group with comparisons between UK and US contexts (table) to stimulate discussion
| Â | US | UK |
|---|---|---|
History | Introduced in 1960s. | Introduced 2003. 1st UK graduates in 2007 [33]. |
# of PAs in primary care | In England: 359 (March 2020), up from 25 in 2015 [35]. | |
Regulation & powers | · Subject to statutory regulation · Can prescribe & order ionising radiation. | · Regulation planned, not yet in place [7] · Not yet licensed to prescribe or order ionising radiation. |
Healthcare system context | · Variable spend within & between states [5] · 76% of Americans have access · Co-payment & costs increasing [36] · Degree of gatekeeping varies between health care providers · Professionals: two models · Physicians only (family medicine, general internal medicine, general paediatrics) · Multidisciplinary team of nurses, nurse practitioners, PAs, OB/GYNs, psychiatrists, psychologists, and social workers. | · Spend determined nationally · Access almost universal · Free at point of delivery · Gatekeeping role controls access to specialist care and diagnostics · Professionals: two models · Until 2020: typically comprised general practitioners, practice nurses. · From 2020 in England: primary care networks include district nurses, PAs, physiotherapists, pharmacists, social prescribers, paramedics, podiatrists, geriatricians, social care & voluntary sector [37]. |
|  | · Acute and growing shortage of primary care physicians common to both. | |
Roles in cancer recognition & care | · Advice on screening eligibility, organising referrals for and delivering screening tests. · Guidance varies at national, professional and state levels [30]. | · Screening lies outside of primary care except for delivery of cervical screening. · National guidance for suspected cancer referrals [38]. |
Training | · Similar skills/knowledge: cancer risks, ‘red-flag’ symptoms, physical examinations [39]. | |
· Similar pre-qualifying training: ~ 2 years intensive core curriculum + national exam [40]. | ||
Themes from advisory group discussion to support interpretation of findings comprised: Implications of ‘new’ workforce: - PAs in the UK are a young profession. Most PAs entering primary care have little prior clinical experience so will need intensive support. However, freshly graduated, young PAs are often very ready to learn. - Many new graduates – not just PAs - feel unprepared for General Practice and initially need close clinical supervision. The ‘learning curve’ in competence may be observed for other professions too. Regulation: - Lack of regulation is recognised as a significant barrier to recruiting PAs into primary care. Lack of prescribing rights noted as a particular barrier. - Some PAs experienced few barriers to their own practice but noted attitudinal barriers from other staff. - Regulation may influence standing with doctors & open discussion about prescribing rights. Other US/UK contextual differences: - The US healthcare system is fragmented between and within states and providers. Variation in PA performance in the UK, therefore may be less variable than in the USA. - US patients have greater power to ‘shop around’ than in the UK which affects the clinician-patient power dynamic. Also, patients’ perceptions of PAs may be different to GPs which may also result in a different dynamic of PA-patient consultations. This is unexplored in the review. | ||