Sub-themes | Similarities | Differences |
---|---|---|
Career | ||
 Employment | • Both see employment demand rising • Job content depends on specific posts and role definition is unclear | • PAs are primarily employed in secondary care, compared to the majority of ANPs in primary care • PAs have less variation in titles compared to ANPs |
 Career progression | • No clear career progression for both roles | • ANPs emerged from nurses so they are already at an advanced level in career development, whereas it is not the case for PAs |
 Job satisfaction | • Both are generally satisfied with their roles | • PAs encounter more issues with lack of recognition and lack of prescribing rights |
Competency | ||
 Education | • Both are recommended to be educated to a master’s level or equivalent | • PAs are educated on a medical model, whereas ANPs are on a nursing model •PAs generally have a master’s degree, whereas for ANPs master’s degree is recommended but not essential |
 Key skills | • Both have a mixture of nursing and medical skills | • ANPs’ skill sets are nursing-oriented, whereas PAs are medicine-oriented •Skills for ANPs depend more on the specific specialities, whereas PAs are educated to a similar level |
Effectiveness | ||
 Patient outcomes | • In simple tasks (minor illnesses), patient outcomes are comparable to GPs in primary care for both roles | • In secondary care, PAs have similar patient outcomes as FY2 doctors, whereas no evidence is identified for ANPs in secondary care |
 Cost-effectiveness | • In simple tasks, there are studies suggesting that both are regarded as cost-effective compared to GPs | • Cost-effectiveness is less clear for ANPs due to variability in roles compared to PAs |
Perceptions | ||
 By colleagues | • Colleagues appreciate the added values and task-sharing from both roles • Both have unclear professional boundaries | • PAs could be subject to more negative perceptions due to a lack of prescribing rights and the fact that the role is not based on existing professions in the UK |
 By employers | • Employers view both roles as cost-effective and contributing to the work required within the NHS | • ANPs were mostly employed by doctors to undertake specific work, whereas PAs were employed by hospitals in more generalist roles |
 Self-identity | • Both face lack of clarity with regard to role definition | • PAs seem to encounter more identity crises due to the relative novelty of their roles in the UK |
Regulations | ||
 Policy | • Both have lack of formal regulation | • ANPs are credentialed and have prescribing rights, although their prescribing rights are based on nurse prescribers, whereas PAs do not have prescribing rights • ANP regulation is rooted in nurse regulation through the Royal College of Nursing (RCN) • PA regulation is relatively new and is expected to be regulated by the General Medical Council |
 Governance agencies | • Health Education England has control over the competency framework and education for both roles | • ANPs are governed by RCN, whereas PAs have a Faculty of Physician Associates and are regulated by the General Medical Council |