PA trial opposed, NPs not officially part of trial

1 November 2012

US-trained physician assistants will be at work in five medical centres from Huntley to Gore by the end of the year, Health Workforce New Zealand has confirmed.

The primary health trial of PAs by HWNZ is strongly opposed by the New Zealand Nurses Organisation, who did a damning critique of an earlier PA demonstration at Counties Manukau District Health Board. NZNO had called for the trial to be a wider pilot involving nurse practitioners so outcomes could be measured and compared between the two roles.

HWNZ said at least one demonstration site, Huntley, aims to have an NP as part of the team by the time the PAs start, and another site, Gore, wanted to include an NP during the demonstration.

Sue Laurence, HWNZ innovations and reform manager, said whether or not an NP was part of the healthcare team was not a criteria for sites taking part in the demonstration. “The aim is to see how the PA role fits within the whole (multidisciplinary) team, not just alongside nursing.”

Brenda Wraight, the director of HWNZ, earlier told Nursing Review that HWNZ was aware of concerns about the impact of the PA on other roles, like NPs, and “absolutely” wanted to test during the demonstration whether the PA and NP roles could be complementary in a New Zealand setting.

She also said it had taken on board the NZNO criticism of the previous PA evaluation and that was behind HWNZ setting up an advisory group to define the evaluation criteria for the upcoming primary health demonstration.

Jenny Carryer, College of Nurses executive director, said she was a member of the advisory group and did not have a problem with medicine seeking an assistant role. However, she did have a problem with HWNZ’s failure to invest in the NP role (see related story).

Susanne Trim, NZNO professional services manager, also questioned why HWNZ was funding foreign recruits and not funding nurse practitioners who had a minimum of eight years’ experience and postgraduate education. “It is time these questions were answered.”

“There is no evidence that the physician assistant role is necessary in New Zealand, nor has any analysis been made of the financial or wider workforce costs of introducing this new practitioner role.”

HWNZ said the five centres taking part in the two-year demonstration, and employing at least one PA each, are Te Awamutu Medical Centre, Medicross (Tokoroa), Kaute Pacific Clinic (Hamilton), Huntley East Medical Centre, and Gore Health Limited. HWNZ said it is funding only the project management, evaluation, and a “fraction” of the PA salary at two sites, with the other three sites bearing the full costs of employing the PAs. The unregulated PAs will not be able to prescribe and their supervising physician will define their scope of practice.