Evaluation of Physician Associates in Mental Health Services: (PAMHS)

Physician associates have been introduced as a new role within the NHS, to complement the medically qualified doctors. There is some existing evidence that physician associates can contribute to the delivery of healthcare and hospitals and general practice. However, there is no existing evidence, relevant to the NHS, about the potential benefits and challenges of using physician associates in mental health service settings.

This area is particularly important as there is a chronic shortage of medically qualified doctors working as psychiatrists in the NHS. Physician associates could help address these medical workforce shortages as well as potentially improving the physical healthcare of people affected by mental illness.

This research is especially timely as there has been some recent controversy over the physician associate role. Indeed, some organisations representing doctors have argued strongly for a pause in the further roll-out of physician associates in the NHS. Such organisations cite concerns around the level of supervision that physician associates will require from doctors, and whether others, including patients, will confuse physician associates for medically qualified doctors.

We are using a mixed methods ‘realist’ approach to the research project.

We are collaborating with three large mental health providing NHS trusts. We have recently completed a review of the research literature on the use of physician associates (or the US equivalent- physician assistants). We are conducting qualitative interviews with senior doctors involved in implementing the physician associate role in mental health services, physician associates themselves, their colleagues, patients and carers. We also plan to carry out a questionnaire survey of physician associate students.

Our review of the research literature highlighted that virtually no relevant research has been carried out in regards to physician associates and mental health services. Almost all existing research was based on ‘physician assistants’ in the United States, and much of this focus on prescribing patterns. This is not relevant to the UK at present as physician associates are currently not able to prescribe medications.

The interviews that we have carried out with physician associate implementation leads in physician associates themselves have only begun to highlight some of the factors that help attract and retain physician associates working in this context. Information in the interviews as also highlighted similar challenges and barriers of physician associates working sustainably and effectively within NHS mental health services.

We hope our findings will feed into a review that was recently commissioned by the Royal College of Psychiatrists, and we will help to evidence the recommendations for those employing and supporting physician associates and mental health services.