NIHR study: Physician associates appear to make a positive contribution to inpatient care

NIHR | August 2019 | Physician associates appear to make a positive contribution to inpatient care

One of the latest Signals from the National Institute of Health Research (NIHR),  looks at the role of physician associate, albeit a  relatively new profession in the UK, but n with over 3,000 students expected to qualify by 2020. Physician associates have to undergo two years’ intensive postgraduate training based upon a medical, rather than nursing, model.  Consequently, upon qualification, they can undertake a range of diagnostic and clinical duties that would otherwise be done by doctors.

Now an NIHR funded study considers the way that physician associates are deployed and the appropriateness as well as the effectiveness of their work in relation to other team members.

A national survey shows that a small but growing number of hospitals are now using physician associates. It concludes that the profession is being restrained by a lack of autonomy, preventing the role from fulfilling its potential. Statutory regulation and prescribing or X-ray ordering rights may help ease the pressure on doctors and strengthen physician associate roles within the team. Evaluation of the impact of these positions as they become more common will be useful (Source: NIHR).

The full study is available from the NIHR


Background Increasing demand for hospital services and staff shortages has led NHS organisations to review workforce configurations. One solution has been to employ physician associates (PAs). PAs are trained over 2 years at postgraduate level to work to a supervising doctor. Little is currently known about the roles and impact of PAs working in hospitals in England.

Objectives (1) To investigate the factors influencing the adoption and deployment of PAs within medical and surgical teams in secondary care and (2) to explore the contribution of PAs, including their impact on patient experiences, organisation of services, working practices, professional relationships and service costs, in acute hospital care.

Methods This was a mixed-methods, multiphase study. It comprised a systematic review, a policy review, national surveys of medical directors and PAs, case studies within six hospitals utilising PAs in England and a pragmatic retrospective record review of patients in emergency departments (EDs) attended by PAs and Foundation Year 2 (FY2) doctors.

Results The surveys found that a small but growing number of hospitals employed PAs. From the case study element, it was found that medical and surgical teams mainly used PAs to provide continuity to the inpatient wards. Their continuous presence contributed to smoothing patient flow, accessibility for patients and nurses in communicating with doctors and releasing doctors’ (of all grades) time for more complex patients and for attending to patients in clinic and theatre settings. PAs undertook significant amounts of ward-based clinical administration related to patients’ care. The lack of authority to prescribe or order ionising radiation restricted the extent to which PAs assisted with the doctors’ workloads, although the extent of limitation varied between teams. A few consultants in high-dependency specialties considered that junior doctors fitted their team better. PAs were reported to be safe, as was also identified from the review of ED patient records. A comparison of a random sample of patient records in the ED found no difference in the rate of unplanned return for the same problem between those seen by PAs and those seen by FY2 doctors. In the ED, PAs were also valued for the continuity they brought and, as elsewhere, their input in inducting doctors in training into local clinical and hospital processes. Patients were positive about the care PAs provided, although they were not able to identify what or who a PA was; they simply saw them as part of the medical or surgical team looking after them. Although the inclusion of PAs was thought to reduce the need for more expensive locum junior doctors, the use of PAs was primarily discussed in terms of their contribution to patient safety and patient experience in contrast to utilising temporary staff.

Limitations PAs work within medical and surgical teams, such that their specific impact cannot be distinguished from that of the whole team. Conclusions PAs can provide a flexible advanced clinical practitioner addition to the secondary care workforce without drawing from existing professions. However, their utility in the hospital setting is unlikely to be fully realised without the appropriate level of regulation and attendant authority to prescribe medicines and order ionising radiation within their scope of practice. Future research Comparative investigation is required of patient experience, outcomes and service costs in single, secondary care specialties with and without PAs and in comparison with other types of advanced clinical practitioners. Funding The National Institute for Health Research Health Services and Delivery Research programme (Source: NIHR).

The full journal article is available from the Health Services and Delivery Research

Where best next? New NHS plan to help patients avoid long hospital stays

NHS England & NHS Improvement | August 2019 | Where best next?

A new campaign is encouraging NHS doctors, nurses and other staff a to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness.  ‘Where Best Next?’  aims to reduce the hospital stay of  140,000 people every year spared a hospital stay of three weeks or longer.


As well as being better for those individuals who get home with the right support quicker, the drive could also free up more than 7,000 beds for other patients – the equivalent of building an extra 15 large hospitals.

The campaign, launched on Monday, will see posters and other information placed in hospitals aimed at different staff groups, encouraging them to take practical steps every day to help get patients closer to a safe discharge – whether to their own home or a more suitable alternative in the community (Source: NHS England).

Full details from NHS England 

See also:

NHS England [blog] Valuing 350,000 patients’ time


Helping doctors and nurses to improve care for patients with a learning disability

NHS Digital | August 2019 | Helping doctors and nurses to improve care for patients with a learning disability

NHS Digital have produced Helping doctors and nurses to improve care for patients with a learning disability to help  public health, health professionals, paid social care staff and family members to prevent falls in people with learning disabilities (Source: NHS Digital).

The full document is available from NHS Digital


The Healthcare Safety Investigation Branch launch online feedback form

Healthcare Safety Investigation Branch | August 2019 | Online feedback form launched so you can ‘tell us what you think’

The Healthcare Safety Investigation Branch (HSIB) have launched an online feedback form so that anyone involved in their healthcare safety investigations can tell HSIB what they think.

  • National investigations in general
  • Specific national investigations
  • Maternity investigations
  • HSIB in general

Full details from HSIB

BMJ study: 5 % of patients exposed to preventable harm across medical settings

BMJ | 2019| Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

A systematic review with meta analysis observes that the prevalence of preventable patient harm across a range of settings, their analysis indicates that approximately 1 in 20 patients are exposed to preventable harm. The study findings suggest that preventable patient harm was more prevalent in advanced specialties such as intensive care or surgery. 


Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.

Design Systematic review and meta-analysis.

Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.

Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated.

Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).

Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

The article is available to read in full from the BMJ 

In the news: OnMedica One in 20 patients exposed to preventable harm in medical care

A data-driven approach to cancer care

This publication brings together healthcare experts to discuss the potential of a data-driven approach to cancer care. 


The following articles show how data are currently shaping the delivery of cancer care, how to gain the most from data that are currently available and how to maximise the potential of this data in the future:

  • Health inequalities data tell an unjust tale of two cities
  • Simple changes could improve cancer care now
  • The right data?
  • The evolution of cancer data to improve patient care
  • Accelerating research and improving patient care
  • Building a picture of patient benefit
  • How NICE can keep pace with science

Full report: A data-driven approach to cancer care | Reform | AbbVie UK

GP scheme frees up half a million hours for patients

NHS England | April 2019 | GP scheme frees up half a million hours for patients

The Time for Care programme- a programme to help practice teams manage their workload, adopt and spread innovations that free-up clinical time for care, and develop the skills and confidence to lead local improvement- has enabled GP practices to find more time for patients during the last year.



The programme, which will now be rolled out across the country after success in pilot sites, such as in Pickering, North Yorkshire and  Chiswick Health Practice, Hounslow;  has been extended for three years beyond its initial March 2019 end date and aims to cover three quarters of GP practices by 2022.

The saving of 205,00 clinical hours is the equivalent of 1.23 million GP appointments of 10 minutes each. At an average of £30 an appointment, that represents close to £40 million in time saved. If the same number of clinical hours saved are achieved over the next three years, it would represent around 3.7 million GP appointments – or around £110 million in terms of appointment time saved (Source: NHS England).

Further details are available from NHS England

See also:

NHS England  Releasing time for care

GP scheme frees up half a million hours for patients

Royal College of General Practitioners Time for Care ‘one part’ of much bigger solution that is needed on GP workforce and workload

BBC News More GP appointments available due to success of pilot scheme