Nuffield Department of Medicine, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK.
KEMRI-Wellcome Trust Research Programme, KEMRI-Wellcome Trust, Nairobi, Kenya.
Hum Resour Health. 2022 Sep 15;20(1):69. doi: 10.1186/s12960-022-00766-5.
Mid-level practitioners (MLPs), including physician associates (PAs) and advanced nurse practitioners (ANPs), have emerged to address workforce shortages in the UK and perform specific roles in relation to population needs. This has resulted in new ways of working and changes to established professional hierarchies. We conducted a study to investigate the career development, competencies, effectiveness, perceptions, and regulation of PAs and ANPs, with the aim of understanding ways to effectively integrate MLPs into the NHS workforce.
We conducted a systematic scoping review following PRISMA guidelines. Embase, Medline, the Cochrane database, Pubmed, and CINAHL databases were searched, using terms relating to PAs and ANPs in the UK. A total of 128 studies (60 on PAs and 68 on ANPs) were included in the final analysis. A narrative synthesis, guided by the pre-defined themes and emerging themes, was conducted to bring together the findings.
PAs are educated on a medical model with basic medical skills but lack formal professional regulation and do not have prescribing rights. ANPs are educated on a nurse model with enhanced skills that depend on roles within specific specialities, and their governance is mostly employer-led. PAs are primarily employed in secondary care. ANPs are employed widely in both primary and secondary care. No defined career progression exists for PAs. In contrast, becoming an ANP is a form of career progression within nursing. Both roles were regarded as cost-effective in comparison to doctors performing simple tasks. PAs were less understood compared to ANPs and received a mixed reception from colleagues, which sometimes undermined their professional identity, whereas ANPs were mostly welcomed by colleagues.
Potential ways to better integrate PAs and ANPs into the NHS workforce include further initiatives by regulatory bodies and the NHS to create more awareness and clearer role definitions for MLPs, outline potential for career progression, offer transparency with regard to remuneration, and introduction of prescribing rights. Future research might include more cadres of MLPs and explore the international literature.
中级执业医师（MLPs），包括医师助理（PAs）和高级执业护师（ANPs），已经出现以解决英国劳动力短缺问题，并根据人口需求承担特定角色。这导致了新的工作方式和对既定专业等级制度的改变。我们进行了一项研究，旨在了解有效整合 MLPs 到 NHS 劳动力中的方法，以调查 PAs 和 ANPs 的职业发展、能力、有效性、看法和监管。
我们按照 PRISMA 指南进行了系统的范围界定审查。我们使用与英国的 PAs 和 ANPs 相关的术语，在 Embase、Medline、Cochrane 数据库、Pubmed 和 CINAHL 数据库中进行了搜索。最终分析共纳入 128 项研究（60 项关于 PAs，68 项关于 ANPs）。我们采用叙述性综合方法，根据预先确定的主题和新兴主题进行综合，以汇集研究结果。
PAs 接受的是基于医疗模式的教育，具有基本的医疗技能，但缺乏正式的专业监管，没有处方权。ANPs 接受的是基于护士模式的教育，具有增强的技能，这些技能取决于特定专业领域的角色，其治理主要由雇主主导。PAs 主要在二级保健机构中就业。ANPs 广泛就业于初级和二级保健机构。PAs 没有明确的职业发展道路。相比之下，成为 ANP 是护理职业发展的一种形式。与执行简单任务的医生相比，这两种角色都被认为是具有成本效益的。与 ANPs 相比，PAs 被误解的程度更高，同事的接受程度也参差不齐，这有时会损害他们的职业身份，而 ANPs 则受到同事的普遍欢迎。
更好地将 PAs 和 ANPs 整合到 NHS 劳动力中的潜在方法包括监管机构和 NHS 进一步采取举措，为 MLPs 创造更多的意识和更明确的角色定义，概述职业发展的潜力，提供薪酬透明度，并引入处方权。未来的研究可能包括更多的 MLP 人员队伍，并探索国际文献。
