Complexity of primary care is barrier to physician associates, say GPs

Authors: Abi Rimmer 

Publication date:  11 Oct 2017

GPs think that complexity and uncertainty in primary care are the biggest barriers to physician associates becoming part of their teams, research has found. They also considered physician associates’ inability to prescribe as a barrier to working in primary care.[1]

In 2014 Health Education England announced that it would create 205 physician associate posts to support primary care and emergency medicine.[2] And in 2015 the health secretary, Jeremy Hunt, announced that 1000 new physician associates would be working in general practice by 2020.[3]

In a paper published in the British Journal of General Practice,[1] researchers from the University of Sheffield said that they had spoken to 30 GPs, 11 advanced nurse practitioners, and 10 patients about the role of the physician associate in primary care.

They found that the GPs had “concerns about how the new practitioners would fit into their teams, particularly without the ability to write prescriptions, and there was a recurring theme about whether PAs [physician associates] could operate safely when skills dealing with complexity and medical uncertainty were required, with related concerns about supervision requirements.”

Some GPs were “clearly concerned about the lack of prescribing rights, which was repeatedly mentioned, and led to concern that the level of supervision required and additional responsibility was unattractive to them,” they added.

The researchers warned that the “complexity of presentations in general practice, and the need to manage uncertainty” were among the strongest barriers to successful integration of new graduates into the workforce. They said that evidence on the ability of physician associates to manage such situations was mixed.

They also warned of a lack of understanding about the role and how it might support and complement other roles in general practice teams.

“Professional bodies, such as the UK Faculty of Physician Associates, should look to address this,” they said. “Additionally, GPs may also look to their own professional bodies for more information and guidance on how such new clinical roles can safely and effectively support their teams.”

Jeannie Watkins, president of the Faculty of Physician Associates, said she believed that, with the right experience, physician associates would be able to deal with the complexity of primary care.

“I worked in general practice for seven years as a PA, and you can deal with complexity and uncertainty. However, as a new graduate, this would be an unrealistic expectation. Clinicians grow and develop and, as with anything, it takes a while before you can get to that point,” said Watkins. “It just takes time, and as you progress and become more experienced then the complexity of patients you see increases.”

On the issue of prescribing, Watkins said that physician associates were awaiting a change in legislation that would allow them to prescribe. She added that the faculty was working hard to raise the profile of the role in general practice.

“We will have a stand at the Royal College of General Practitioners conference, and we have been looking at how we can raise our profile there,” she said. “We have also produced an employer guide about PAs, and we are engaging with all of the medical royal colleges. We are doing our best to make sure that we are raising our profile.”


  1. Jackson B, Marshall M, Schofield S. Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach. Br J Gen Pract  2017;9:bjgp17X693113. [Link] . [Link]   [Link] .
  2. Rimmer A. Physician associates—what do they do? BMJ Careers 30 Aug 2016. [Link] .
  3. Kaffash J. “New deal”: 1000 new physicians associates by 2020. Pulse  2015;19. [Link] .

Abi Rimmer BMJ Careers

Cite this as BMJ Careers ; doi: