The NW London row has broken as tensions rise across the NHS over perceived efforts by government and NHS England to squeeze out fully qualified GPs and consultants and replace them with much less well qualified Physician Associates and equivalents. The Lowdown reported on this brewing controversy at the end of November, but since then we have seen growing concerns of rising levels of under-employment among GPs as practices face a tightening financial squeeze. One practice in Surrey offerred voluntary redundancy to all its 11 salaried GPs, with three to be made “redundant” in April – although in this case PAs are not involved, and the GP role is carved up between pharmacists, first contact practitioners for musculoskeletal conditions, advanced nursing and paramedic practitioners and paediatric nurses.

Data from a survey of 600 doctors by Doctors’ Association UK (DAUK) suggests that doctors are being replaced by PAs on the rota at over half of England’s hospital trusts. Other allegations include PAs exceeding their license by prescribing drugs and requesting ionising radiation (X-rays).

Extracts from Trust business cases arguing for the use of PAs as a way to reduce the costs of medical staffing have been published on social media, along with adverts for PAs to work at salaries as high as £68,000-£90,000 per annum, suggesting they are seen as replacements not just of junior doctors (whose starting pay for several years is less than the starting pay for PAs) but for consultants, too.

Physician associates – who are they and why are they in the media

Ideas for the future of General Practice


In December the National Institute for Health and Care Research published a helpful breakdown of the various new and emerging roles that are becoming more visible in primary care.

It noted that 17 of these new roles are covered by the Additional Roles Reimbursement Scheme (ARRS) which gives Primary Care Networks a financial incentive to hire them rather than registered nurses or additional GPs, resulting in a significant dilution of GPs in a much wider mix of staff:

“Ten years ago, around 36,000 full-time equivalent (FTE) GPs (including GP trainees and retainers) made up 60% of the direct patient care workforce in general practice in England. Today, 37,000 FTE GPs (including GP trainees and locums) make up around 40% of the direct patient care workforce.”

It also notes concerns over how community pharmacists are expected to work, and dispels illusions of easy savings from using paramedics in primary care:

“There is so far little evidence that paramedics save costs in primary care. Concerns include the amount of supervision necessary, the length of their consultations, and the potential need for additional consultations with GPs if they can’t resolve a problem.” It also raises doubts and concerns over the “lack of evidence on the impact of social prescribing on clinical outcomes and costs.” It goes on: “A 2019 study of care navigation in England.”

PA job ad for roles in NW London

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