The impact of Medical Associate Professions (MAPs) on the productivity, quality of care, patient and healthcare workforce satisfaction, and budget implications in various healthcare settings: a systematic review

Background: Healthcare staff planning in the NHS in the UK has undergone significant changes in recent years, driven by declining productivity, staff shortages, and rising patient demand. Innovative staff planning decisions include implementing new non-medical roles, collectively referred to as “Medical Associate Professions” (MAPs). The MAP roles were established in 2014 and encompass Physician Associates (PAs), Anaesthetic Associates (AAs), and Surgical Care Practitioners (SCPs). This systematic review has been conducted to evaluate and synthesise international evidence on the impact of MAPs on health system productivity, quality of care, patient satisfaction, perceptions of the healthcare workforce regarding roles, and the budget implications of their implementation in various healthcare settings. Method: Electronic database searches were conducted using the Medline, Embase, CINAHL, Web of Science, and PubMed databases for studies published between 2004 and 2024. Blinded parallel processes were used to screen abstracts and full text of the studies that met the inclusion criteria. Data extraction, narrative synthesis and quality assessments were undertaken for the included studies. The impact on productivity, quality of care, patient and colleague perceptions, and cost-effectiveness of the roles were chosen as the key outcomes of interest. Results: A total of 8725 papers were identified following the systematic searching of the databases, and 69 papers were included in the review. These included cost-effectiveness analysis (n = 1), cross-sectional studies (n = 18), cohort studies (n = 29), qualitative studies (n = 9), case series studies (n = 1), case-control study (n = 1), and mixed-method studies (n = 10). Conclusions: MAPs have the potential to complement traditional workforce configuration to support productivity and quality of care. There is evidence that they are acceptable to patients, and there is mixed evidence about their contribution in the eyes of clinical colleagues. A modest amount of data is available on PAs and much less on SCPs and AAs. Despite most of the papers being of moderate to poor quality, our rigorous and innovative systematic review reflects the evidence that incorporating PAs and SCPs into healthcare can have a positive impact on productivity and the quality of care provided, reduce overall personnel and care costs, and elicit positive feedback from both patients and colleagues when appropriately implemented. PROSPERO registration number: CRD42023457692.