Background
Methods
Study aim and design
Setting & cohort
Data collection
Data analysis
Results
Study population
General practitioner solo practice | 13 | (33.3%) |
General practitioner duo practice | 8 | (20.5%) |
General practitioner group practice | 11 | (28.2%) |
Manager general practitioner cooperative | 7 | (17.9%) |
Male | 18 | (46.2%) |
Female | 21 | (53.8%) |
Mean age GPs (years) | 48 | (SD 8.6) |
Theme I. Reasons to employ a PA/NP | |
Substitution of care | |
Quality improvement | |
New/ additional services | |
Theme II. Influencing factors | |
Organisational factors | |
Factors regarding professional relations | |
Factors regarding GPs’ workload and job satisfaction | |
Experience with the PA/NP profession | |
Vision about the PA/NP profession | |
Insecurities regarding the PA/NP profession | |
Theme III. PAs’/NPs’ tasks and responsibilities | |
Direct patient care | |
Indirect patient care |
Theme I. Reasons to employ a PA/NP
Substitution of care
“The intention is to get more time for the increase in complex problems we have to deal with in the near future. This is the start of an evolution: ageing, substitution, tasks shifts from hospital care to primary care. I expect that GPs will get larger practices and cannot comply with the demand for care without support.”(GP group practice, employing a PA)
“With the opening of a new ECAP we expect an increase in workload that cannot be answered by the GPs in the region. Therefore, we initiated to work with NPs to meet the increase in patients so that GPs can focus on the complex patients.”(Manager GPC, employing an NP)
Quality improvement
“I am experienced with GPs employed by another GP. Yet the downside is that they will leave as soon as they can start their own practice, which causes disturbance among the patients.”(GP solo practice, employing a PA)“Looking at the NPs at the GPC, I notice they comply even more to guidelines and bring a nursing view into their considerations that is of added value for patient care.”(GP group practice, employing an NP)
New/ additional services
“There are machines to measure the COPD condition, which is something that can easily be delegated to a PA. That would be an improvement in patient care and a lower burden for patients who otherwise have to go to the city.”(GP solo practice, employing a PA)
Theme II. Influencing factors decision-making process
Organisational factors
“When you compare practices with GPs only with practices with GPs and NPs, you need a shift in the organisation, for example triage nurses need to decide which patient has to be treated by which care provider.”(GP group practice, employing an NP)
“It is very hard to find GPs who are willing to offer work during office hours. Often the preconditions cannot be met; not enough surgery rooms, colleagues are not supportive, finances don’t fully cover, ‘we already have so many employees in our practice’. We have heard all of these arguments before.”(Manager GPC, employing an NP)
Factors regarding professional relations
“The PA training was the choice of the PA herself, whereas for me an important factor to approve the training was losing her as an employee if I wouldn’t have provided her the opportunity.”(GP solo practice, employing a PA)
“You can say, there is no support from GPs’ professional associations for the position of PAs in general practices. That makes GPs hesitant to include this profession within their own ranks.”(Manager GPC, employing a PA)
Factors regarding GPs’ workload and job satisfaction
“Look, you delegate a great part of the care. That means you partly lose sight. But the same would happen were you to employ another GP.”(GP solo practice, employing an NP)“Maybe a disadvantage is a transformation in GPs’ surgery hours in case the number of low complexity problems decreases and the majority of problems become highly complex.”(GP group practice, employing an NP)
GPs’ experience with the PA/NP profession
“We experienced working together with NPs at the GPC and my colleague and I were very satisfied with their functioning. That made us curious how it would work out in our practice.”(GP group practice, employing an NP)“I am always eager to innovate, so I thought “why not?”. This was also because I had heard from a colleague that they are really happy with their physician assistant.”(GP solo practice, employing an NP)
Vision of the PA/NP profession
“I should really revisit the differences between a PA and an NP, because for me those definitions somewhat overlap. So, no, we didn’t really discuss or look at which professional we would employ.”(GP group practice, employing an NP)“We started without good preparation or a detailed plan about what we exactly wanted to achieve in the long term. How do we want to shape our practice? We weren’t sufficiently aware about how the profession in general practices works.”(GP group practice, employing an NP)“The single-handed GP like it used to be is something that is slowly changing and completely disappearing. Now you are building a team within general practices. Maybe it should be called primary care team, in which many professionals collaborate in one centre, with the common goal of improving healthcare in the broadest sense. The GP has a role, just as NPs do. It’s the team that puts it together.”(GP group practice, employing an NP)
Insecurities regarding the PA/NP profession
“Rules keep on changing during the play. Planning ahead and ensuring a financial base is difficult as there are no certainties in general practice.”(GP duo practice, employing an NP)
Theme III. PAs’/NPs’ tasks and responsibilities
Direct patient care
“We wanted a professional who could take over parts of our job. For example, we were thinking about ear complaints, children with fever, abdominal pain, urological infections, et cetera. So, well defined areas that are straightforward for triage.”(GP duo practice, employing a PA)“In palliative care, a lot of tasks are not medical based, but rather nurse based. We intend the NP to be responsible for organising everything at home when a patient is discharged from the hospital; keeping everyone informed about agreements and having insight in expected complications.”(GP group practice, employing an NP)
Indirect or non-patient related tasks
“Of course the PA can participate in projects like quality improvement, practice accreditation, but we don’t really know exactly yet, we’ll just see.”(GP group practice, employing a PA)