Controversy over a physician assistant pilot at Middlemore Hospital appears to have delayed rather than stopped the proposed pilot.
Kai Tiaki last month reported Ian Powell of the Association of Salaried Medical Specialists as saying that seven general surgeons at Counties Manukau District Health Board had pulled the plug on the pilot over a variety of issues including supervision concerns and lack of consultation.
The New Zealand Nursing Organisation submission on the pilot also called for it not to go ahead. It said a comprehensive assessment of the country’s future health workforce needs – including expanded nursing roles – should be done before introducing a “new cadre of health professionals”.
But Helen Pocknall of Health Workforce New Zealand said HWNZ board chair Des Gorman has since confirmed that the pilot would still progress. Recruiting several US-trained physician assistants is one of the “innovative” health role trials being backed by HWNZ as it investigates how to recruit 800 extra staff to boost elective surgery.
Counties Manukau director of nursing Denise Kivell, who is on the pilot committee, said there was definitely a commitment to do the pilot but it was still a work in progress with consultation taking place across the sector.
Pocknall said HWNZ was aware that the physician assistant trial was “quite hotly debated” in some areas and that stakeholder meetings had been held to discuss issues. It was also understood that junior doctor representatives had raised concerns over whether introducing PAs could undermine their role.
Kivell said all feedback had been looked at – negative and positive – and the focus was on ensuring patient and staff safety.
She believed it was important for nursing to be involved in the pilot’s development and to ensure there was robust criteria for evaluating how the PAs fitted into the New Zealand health system. She said from a nursing point of view there was some overlap between the PA and nursing roles but there was potentially plenty of work for all, as well as opportunities to explore innovative nursing roles.
Kivell said a rigorous evaluation process would look at the PA role’s scope, accountability, boundaries and supervision which were all matters of interest to the nursing workforce. “I’d rather be around the table then not at the table,” Kivell added.
The pilot was being carried out at Counties Manukau but was a combined project by the northern regional DHBs. It was due to start in June but recruitment has been delayed.
The physician assistant role can involve diagnosis, treatment and prescribing but unlike a nurse practitioner they have to work under delegated responsibility from a physician.
The Medical Council consulted on whether a physician assistant workforce needed to be regulated and Pocknall said it had now advised the HWNZ board that PAs are not required to be registered in New Zealand.
The NZNO submission recommended that written consent for examination and treatment by PAs should be required and for patients to be informed that PAs were not a regulated workforce in New Zealand.
