The impact of physician associates in primary care in the UK: a systematic review

Background The UK healthcare system has a growing workforce crisis which is felt especially acutely in primary care. A prospective solution is the use of physician associates (PAs). In recent times, this has generated some controversy.

Aim There is a sparsity of synthesised evidence around the use of PAs in the UK, particularly their implementation in primary care. This review aims to look at the impact PAs have on workload, safety, efficacy and cost-effectiveness in delivering UK primary care.

Design & setting Systematic review of peer-reviewed literature including qualitative and quantitative studies of PAs in UK primary care PA.

Method Cochrane and PRISMA guidelines were followed. PubMed, EMBASE, The Cochrane Library, Web of Science and CINAHL were searched from 2011-2024. Covidence was used for data management. Narrative synthesis was performed based on the four primary aims.

Results 16 studies were deemed to meet the inclusion criteria for data extraction and synthesis. 13 commented on workload, 8 commented on safety, 13 on efficacy and 8 studies discussed cost-effectiveness. Results showed that PAs were considered clinically safe but impacts on workload and efficacy were less clear. Cost-effectiveness assessment was limited by inability to calculate full costs or benefits.

Conclusion This review found that there is limited evidence available in the published literature to demonstrate the impact on PAs in primary care. While there were some positive studies, a clear need for further research was demonstrated. An additional pathway to explore, comparing PAs with the non-GP primary care workforce, was also noted.