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Rise of the ‘assistants’?

A nursing associate essentially sits at the mid-way point between unregistered healthcare assistants and registered nurses. It is not intended that they will independently make decisions on care.

Needless to say, the creation of the role has proven controversial. From all kinds of perspectives.

Last week, our own Department of Health told the Medical Independent (MI) it has no plans to consider the introduction of this role into the Irish healthcare system.

Yet there is plenty to suggest that the funding gods will increasingly look to healthcare workers filling an ‘adjunct’ role to both doctors and nurses, particularly as recruitment and retention are proving so difficult. The question is less about whether these roles may prove advantageous within clinically-watertight multidisciplinary teams, and more to what extent they will be inappropriately presented as ‘alternatives’.

In comparison to nurses, doctors in Ireland have been somewhat less challenged by the rise of alternative ‘providers’. But that will change.

Despite problems with the task transfer initiative in hospitals, health service funders (and nurses themselves) are increasingly looking to take on roles traditionally occupied by doctors. Community pharmacists, too, are keen to assume duties previously exclusively occupied by GPs.

It has also been well documented in these pages that the RCSI and Ulster University have initiated Physician Associate postgraduate courses. In this respect, the RCSI has recently established a scholarship programme with Bon Secours Healthcare System, a clear indication of private sector interest in this role. A pilot trialling Physician Associates at Beaumont Hospital, Dublin, is due to be completed later this year.

In their respective addresses/submissions to the Joint Oireachtas Committee on Health last week, the IMO and NAGP suggested differing standpoints around this area.

The NAGP’s opening statement said it would “welcome” the addition of healthcare assistants, physician assistants and clinical pharmacists to work in general practice “as part of the new clinical team”.

The IMO’s submission said proposals to address the shortage of GPs by transferring GP tasks to other healthcare professionals was “not in the interest of patients or the State”.

The issue is sure to arise quite prominently at GP contract talks — although whether the NAGP and IMO will be at that table together is another matter entirely.

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