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Supplemental material, sj-pdf-1-hsr-10.1177_13558196211036727 for Are advanced clinical practice roles in England���s National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives by Vari M Drennan, Linda Collins, Helen Allan, Neil Brimblecombe, Mary Halter and Francesca Taylor in Journal of Health Services Research & Policy

This article describes the 10-year journey of a research group helping to build the research evidence base for physician assistants (PAs), known as physician associates in the United Kingdom, in the National Health Service in England. It draws out some key issues that may be of interest to those developing PA research programs in different specialties and different countries. PA research also can help healthcare policy makers address growing demand, issues of quality, and cost.

Summary Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.

To compare the contribution of physician associates to the processes and outcomes of emergency medicine consultations with that of foundation year two doctors-in-training. Mixed-methods study: retrospective chart review using 4 months' anonymised clinical record data of all patients seen by physician associates or foundation year two doctors-in-training in 2016; review of a subsample of 40 records for clinical adequacy; semi-structured interviews with staff and patients; observations of physician associates. Three emergency departments in England. The records of 8816 patients attended by 6 physician associates and 40 foundation year two doctors-in-training; of these n=3197 had the primary outcome recorded (n=1129 physician associates, n=2068 doctor); 14 clinicians and managers and 6 patients or relatives for interview; 5 physician associates for observation. The primary outcome was unplanned re-attendance at the same emergency department within 7 days. consultation processes, clinical adequacy of care, and staff and patient experience. Re-attendances within 7 days (n=194 (6.1%)) showed no difference between physician associates and foundation year two doctors-in-training (OR 0.87, 95% CI 0.61 to 1.24, p=0.437). If seen by a physician associate, patients were more likely receive an X-ray investigation (OR 2.10, 95% CI 1.72 to 4.24), p

Internationally health care systems are developing advanced clinical practitioners (ACPs), such as nurse practitioners, to address growing health care needs, shortages of doctors and financial constraints. At present in the United Kingdom there is no state regulation for such roles in nursing, midwifery, allied health professionals or health scientists, either for the level of education or clinical competency. In England, Health Education England (HEE) which is responsible for workforce planning and training is supporting the development of ACP roles in all types of professional groups (nurses, midwives, allied health professionals and health scientists). The London HEE team commissioned an evaluative study concerned with factors influencing the development of ACPs. The evaluation questions addressed were: 1. What has influenced the development of ACP roles? 2. To what extent are NHS acute, community and emergency services employing and deploying ACPs? 3. What are the factors influencing the success or otherwise in introducing and sustaining ACPs in the workforce? 4. Is there documentary or published evidence of the value, or otherwise, of ACP roles and of patient perceptions of ACP roles. This monograph reports on a qualitative exploration in 2019 of the views of senior NHS managers and clinicians in a range of health care organisations in London.

Topic guide for semi-structured interviews. Topic guide for semi-structured interviews, including questions and questionsâ prompts. (PDF 40 kb)