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

Abstract

<h4>Background</h4>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. There is a sparsity of synthesised evidence around the use of PAs in the UK, particularly their implementation in primary care.<h4>Aim</h4>To look at the impact PAs have on workload, safety, efficacy, and cost-effectiveness in delivering UK primary care.<h4>Design & setting</h4>Systematic review of peer-reviewed literature, including qualitative and quantitative studies of PAs, in UK primary care.<h4>Method</h4>Cochrane and Preferred Reporting Items for Systematic reviews and Meta-Analyses (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.<h4>Results</h4>Sixteen studies were deemed to meet the inclusion criteria for data extraction and synthesis. Thirteen commented on workload, eight commented on safety, 13 on efficacy, and eight 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.<h4>Conclusion</h4>This review found that there is limited evidence available in the published literature to demonstrate the impact of 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.