The government, recognising that the primary care workforce is under pressure, is keen to introduce medical care practitioners (MCPs) into the UK healthcare workforce. It sees MCPs as a way of improving patients' access to services by freeing up GPs' time and creating extra capacity within the medical team.
A curriculum framework, published by the Department of Health in November, has outlined the national educational and practice standards, and proposed regulatory frameworks for the new role. Several universities are currently in the process of setting up new courses.
Candidates for the training will be expected to have a science-orientated first degree, but other healthcare staff, such as nurses and physiotherapists, will also be allowed to apply.
The MCP will be trained in a medical model but with a particular focus on general medicine in community and hospital settings. The programme will be taught in three academic years, and will include theoretical training in medicine, plus more than 1,600 hours of clinical training in a range of settings, including general medicine and paediatrics.
The Department of Health anticipates that there will eventually be around 100 MCPs working in each strategic health authority area. They will earn salaries of around £39,000.
Reaction to MCPs
The Royal College of General Practitioners (RCGP), which helped to develop the curriculum framework, is enthusiastic about the initiative. Dr Nigel Sparrow, RCGP Vice Chairman, says: "The development of the MCP role will provide an opportunity to enhance further the skill mix within the primary care team, allowing GPs to be able to spend more time with patients with multiple complex problems."
"MCPs will always work under supervision of a doctor and, by having a national competence framework, MCPs will know when to refer to a GP and so will ensure that patients receive high-quality, patient-centred care."
But the British Medical Association is more sceptical. Dr Hamish Meldrum, Chairman of the General Practice Committee, says: "We will always consider anything that will help to improve access to services and the speed and effectiveness with which patients get treatment. However, we already have skilled nurse practitioners in primary care, who have taken over a lot of the more routine tasks from GPs."
"In terms of more complicated tasks, such as dealing with complex illnesses, I would need a lot of convincing that MCPs would be of added benefit and would not confuse patients as to who exactly was treating them. GPs would want to be assured that the introduction of MCPs into primary care would improve the quantity and quality of care available to patients."
Around 30–40 American PAs are already working in the UK, recruited mainly by primary care trusts to work in both primary care and accident and emergency departments.
Last year, the University of Birmingham's Health Services Management Centre evaluated the experience of a handful of PAs working in GP practices in the West Midlands. Researchers concluded that the PAs were well received and worked well with other healthcare professionals, and that their role contributed positively to primary care.
Dr Lindsay Mackenzie, who has set up a new practice in Bedfordshire that opened in June, has recruited her own PA from America. She advertised in the American Academy of Physician Assistants' monthly magazine and on their website (see Resources), and received around 100 applications. She flew to Orlando, where the Academy was holding its annual meeting, and interviewed the candidates.
Dr MacKenzie says: "These PAs have a superb knowledge level and after a short period of induction into the NHS are ready to fly. Many of them are keen to come and work in the UK."
"I chose to recruit a PA because I want to develop a multidisciplinary team for my practice. PAs work well alongside practice nurses, nurse practitioners and allied healthcare professionals complementing their roles. Seeing a doctor is not always the answer to all the problems that patients present with."
Neil Erickson, the PA recruited by Dr Mackenzie, is Chair of the UK Association of Physician Assistants (UKAPA), and says the only problem they currently face is that they cannot prescribe because they are not regulated in the UK. The UKAPA is currently working to resolve this issue.
"GPs and nurses I have worked for have been pleasantly surprised by how well my role slots in with the rest of the practice team," says Mr Erickson. But, he adds: "At the moment, because we are unable to prescribe, we have one hand tied behind our backs."
"I provide acute and chronic care and see patients from 8.30am to 5.30pm. I see about 30 to 35 patients in that time. When patients call, they are told by the front desk that they can see me on the day or wait a few days to see the doctor. There is a very high degree of patient satisfaction with my work, without a compromise to patient safety."
Dr Mackenzie says increasing numbers of GP practices and health authorities are considering recruiting PAs from America. "The MCP is an investment for the future, but many of us need workforce solutions now," she says. "Since it is going to be at least five years before the MCP has the training and experience to make a major impact in primary care, employing American PAs in sizeable numbers is the way to go in the immediate term."
American Academy of Physician Assistants
UK Association of Physician Assistants (UKAPA)