Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach

Background: Physician Associates (PAs) are described as one solution to workforce capacity in primary care in the U.K. Despite new investment in the role, how effective this will be in addressing unmet primary care needs is unclear.

Aim: To investigate the barriers and facilitators to the integration of Physician Associates into the General Practice workforce.

Design and setting: A modified grounded theory study in a region unfamiliar with the PA role.

Method: Themes generated from stakeholder interviews informed a literature review and theoretical framework, then tested in a series of focus groups with either General Practitioners(GPs), Advanced Nurse Practitioners(ANPs) and Patients(Pts). Recorded data were transcribed verbatim, organised using NVIVO (v10.2.2) with iterative analysis of emergent themes. A reflexive diary and independent verification of coding and analysis were included.

Results: 51 participants (30 GPs, 11 ANPs, 10 Pts); 8 focus groups

GPs, ANPs and Pts recognised support for General Practice was needed to improve access. GPs expressed concerns regarding PAs around managing medical complexity and supervision burden, non-prescriber status and medico-legal implications in routine practice. Pts were less concerned about specific competencies than effective supervision and accepting of a PA role. ANPs highlighted their own negative experiences entering advanced clinical practice and the need for support to counteract stereotypical and prejudicial attitudes

Conclusion: This study highlights the complex factors that may impede the introduction of PAs into U.K. primary care. A conceptual model is proposed to help regulators and educationalists support this integration that has relevance to other proposed new roles in primary care.