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June 2019

The advanced practitioner will see you now



Workload in general practice continues to rise, against the background of a shortage of GPs and practice nurses, and an ageing and ever more diverse population. Changing skill mix in general practice is recommended as one way of addressing workforce strategies

In a study in the British Journal of General Practice, Pauline Nelson and colleagues from the University of Manchester have looked at the contributions that advanced practitioners, who may have nursing, physiotherapy or paramedic backgrounds, physician associates, and practice pharmacists can make to solving the workload and demand problems of general practice.

Their conclusions are mixed – there is scope for them to relieve workload pressures on GPs, and to improve patient management, but also barriers to their integration into the primary care team, including uncertainties about role definitions, professional tensions, and training and education issues. Physician associates faced the greatest degree of scepticism from general practice staff, while the contribution made by advanced practitioners and pharmacists was more clearly understood.

There is still uncertainty about the true financial cost of employing these ‘new role professionals’, because the very initiatives aimed at alleviating pressure may, paradoxically, increase strain on staff, at least initially, including extra workload in supervision and mentoring.


Nelson PA. Br J Gen Pract 3 June 2019. https://bjgp.org/content/early/2019/06/03/bjgp19X704117