Last week, I visited two friends living in Louisiana – a paediatrician and a district nurse – who left the NHS more than 25 years ago to raise their family and work in the US health sector.
We spent some time comparing the similarities and differences in our two health services. I wanted to understand more about advanced nurse practitioners (ANPs) and physician’s associates (PAs) in the US – the latter being a hot topic in the UK right now, with more than 50 PAs moving from the US to work in the UK within the next few weeks.
This migration of skills has been actively sought because we are exceptionally short of GPs in primary care. Fewer medical students wish to become GPs after their foundation years and there has been a measurable reduction in the funding of the GP service. In less than 10 years, the percentage of NHS funding for the GP service has reduced from 11% to less than 8% – at a time when the focus of care delivery is the home and community.
PAs are listed on the NHS careers website, along with universities offering the two- year postgraduate PA programme. Interestingly, the PA curriculum has been delivered for the last 10 years in a small number of universities and in response to the falling numbers of GPs, this group of universities has now grown significantly. Also, while currently unregulated as a profession, qualified PAs can join a faculty at the Royal College of Physicians.
In the USA, PAs are regarded as highly skilled technicians, normally operating within a very narrow field of practice, which is often task or disease specific. Concerns have been raised about how this approach will translate into general practice, where clinicians care for a wide age range of patients with undifferentiated diagnoses and multiple morbidities – and where an holistic medico-social approach to care is required.
The contribution of ANPs – who are highly-skilled, educated, regulated, autonomous practitioners and independent prescribers – has been notably absent in the current dialogue about general practice.
A comprehensive workforce plan for ANPs is urgently required. The QNI’s General Practice Nurse survey, the results of which are due for release this autumn, will provide a robust platform of evidence for this.
Crystal Oldman, chief executive, Queen’s Nursing Institute