🧵 1/11 📚 Our new rapid systematic review, led by @trishgreenhalgh.bsky.social in @bmj.com examines the role of physician associates (PAs) and anaesthetic associates (AAs) in the UK. This is a crucially important question in light of the Leng Review
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2/11 🔍 We analysed approximately 5000 titles, identifying 52 empirical papers (48 on physician associates and 4 on anaesthetic associates). Ultimately, 29 papers met our inclusion criteria for trustworthiness, generalizability, and relevance to UK policy
3/11 📊 Our review found that the total number of physician associates studied was very small, particularly in primary care. Alarmingly, no studies directly assessed anaesthetic associates' performance
4/11 🏥 Our findings suggested that the evidence was limited and preliminary. There were important concerns about the competence of PAs in managing complex patients and prescribing (which happens, even if illegal)
5/11 ⚠️ Notably, we found no evidence that physician associates add value in primary care or that anaesthetic associates contribute positively in anaesthetics. If you add cost of supervision, which the studies don’t, it’s very unlikely they are cost-effective
6/11 🗣️ Patient feedback was crucial! Two lay commentators on our review emphasised the importance of patients knowing whether they are being seen by a doctor or an associate, highlighting the need for clear scopes of practice.
7/11 📉 Our review concluded that the UK literature on these roles is sparse and of variable quality. The absence of evidence regarding safety incidents should not be misinterpreted as proof of safety in deploying these occupations.
I was recently seen by a physician associate for unusual symptoms.
The consultation involved two telephone calls & a face-to-face exam. They had to speak to the GP 'team' twice. It was a whole day of going back and forth.
I refuse to believe this is more cost effective than just seeing a GP once!
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Thanks to you and Trish for this critically important review.
The consultation involved two telephone calls & a face-to-face exam. They had to speak to the GP 'team' twice. It was a whole day of going back and forth.
I refuse to believe this is more cost effective than just seeing a GP once!
I saw one about a cyst that I thought had become infected. She said it was fine and discharged me with no intervention.
Within 24 hours I was in A&E and needed out-patient surgery. Hugely wasteful.