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Medical care practitioners: an emergency response?

Doctors' workloads are spiralling out of control and the proposed new role of medical care practitioner could be the answer. Matthew Limb looks into the implications for physiotherapists.

The CSP has responded cautiously to government plans that would allow physiotherapists, and others, to train for the new role of medical care practitioners (MCPs). A consultation document outlines how MCPs would function as US-style physician assistants, helping to treat patients in hospitals and primary care settings. They would perform similar tasks to junior doctors, including physical examinations and diagnoses, under the supervision of consultants.

Ministers claim this 'new breed' of healthcare worker would help to cut patient waiting times, and relieve pressure on overworked GPs and hospital specialists. MCPs could be treating patients after two to three years' training, providing they meet standards in a 'competence and curriculum' framework published as part of the consultation. The CSP will study the documents closely before giving a detailed formal response. Jill Higgins, CSP director of learning and development, said the plans raise a series of crucial questions and added that it is not yet clear how such roles would fit in with current systems of practice, such as emergency triage. She told Frontline: 'It feels as though there could be a multitude of roles that are not quite [those of] doctors, all with slightly different responsibilities and accountabilities, all with the focus of speeding up access to care.'

There could be about 100 MCPs in each strategic health authority if and when the government's plans are fully implemented. Ministers expect them to be drawn from two main pools - life-science graduates and existing health staff, such as physiotherapists and nurses, who would train at universities offering the MCP curriculum. Once registered, MCPs would have to adhere to a professional code of conduct and undertake continuing professional development.

An MCP is defined as: 'a new healthcare professional who, while not a doctor, works to the medical model, within the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision.' MCPs would be able to obtain patients' full medical histories and perform physical examinations, including breast checks. They would also diagnose, manage and treat illnesses within their competence such as depression, gout and eczema. In addition, they could request and interpret certain diagnostic tests, prescribe medications as appropriate and advise patients on managing conditions such as diabetes and angina.

Two leading medical bodies - the Royal College of Physicians (RCP) and the Royal College of General Practitioners - have drafted the proposed competence and curriculum framework. They say the new role is needed because the existing medical workforce is struggling to meet the demand for healthcare. They acknowledge that nursing and allied health professional staff have developed extended roles that have benefited patients. But they warn in a foreword to the consultation: 'The capacity issue... has led to the rapid establishment of a wide range of new posts of medical support workers across the country with variable training, roles and responsibilities and in standards of clinical practice. This is unsatisfactory.'

Mary Armitage, RCP clinical vice president, said there were concerns over the 'plethora' of unregulated healthcare workers, with no common standards or training. She said: 'We hope the new framework will standardise the role, thereby reducing any confusion for patients and any risk to patient safety.' Jill Higgins and Sue Hayward-Giles (director of CSP member networks and relations) have confirmed that the Society will be taking a close look at the proposals. Dr Higgins told Frontline: 'At first sight it seems that in some parts of the new role physiotherapists are already there, within an extended scope role and working in triage teams.' She said it was uncertain whether MCPs would have the depth of knowledge, following a three-year study programme, to work independently in so many areas - or would need to work in teams with other specialists. 'Physiotherapists are autonomous practitioners, and the implications of supervision by a consultant would need to be understood,' she said.

'It seems that MCPs would be responsible for decision-making about patients, unless each decision was to be overseen by a supervising consultant. Jill Higgins also pointed out the question that arises next: 'If the idea is that these practitioners are unencumbered by the requirement of attaining specialist skills that doctors in training need for career development, is this new role seen as the end point in their career?' Health minister Lord Warner says the government plans to work closely with the Health Professions Council to ensure appropriate regulation of the new role.

See the Modernisation Agency website for more informaton about the new role, including links to its development in the US and the consultation document.

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