The new rapid systematic review, published in the British Medical Journal and led by Professor Trisha Greenhalgh and Professor Martin McKee, is the most comprehensive UK-based analysis of peer-reviewed research into PA and AA roles to date. It was written to inform the ongoing government-commissioned Leng Review which is examining the effectiveness and safety of these roles in UK healthcare.
PAs and AAs are being rapidly introduced across the NHS as a solution to workforce shortages and funding cuts. However, many question if these roles will improve the challenges facing the NHS and whether the training students receive is sufficient – two years following an undergraduate degree, in contrast to the five years it takes doctors to qualify and the additional ten years it takes to specialise.
The study found little evidence supporting the effectiveness and safety of the PA and AA roles, with almost no research on patient safety and many studies involving fewer than ten PAs.
Key findings
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Research on PAs and AAs in the UK is very limited. Only one small study assessed the competence of PAs through direct observation and no studies directly assessed the safety of AAs. Few of the studies screened for this research were of sufficient quality and relevance to current NHS policy and many studies were small, outdated, or lacked rigorous methods, making it difficult to assess the safety, effectiveness, or impact of PA and AA roles.
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Safety concerns remain unaddressed. No research examined safety incidents or prescribing safety and there is no robust evidence assessing PA and AA roled in managing high-risk or complex patients (for which their relatively limited training may not equip them).
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What evidence exists is limited to a few settings. There was some preliminary evidence that PAs could support hospital ward teams and emergency departments when undertaking carefully circumscribed roles and closely supervised. However, evidence suggests PAs struggled in primary care, where the role is more autonomous and clinically complex. There is no direct evidence supporting the value of AAs in anaesthetics.
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There is no evidence that deploying PAs or AAs improves efficiency or saves money. As a senior doctor is needed to oversee and check the work of PAs and AAs, this model may be more expensive than employing doctors.
Read the full story on the Nuffield Department of Primary Care Health Sciences website.