Background - Physician associates (PAs) (also known as physician assistants) are new to the NHS and there is little evidence concerning their contribution in general practice.Aim - This study aimed to compare outcomes and costs of same day requested consultations by PAs with those of GPsDesign and setting - an observational study of 2086 patient records presenting at same-day appointments in 12 general practices in England.Method - PA consultations were compared with those of GPs. Primary outcome was re-consultation within 14 days for the same or linked problem. Secondary outcomes were processes of care.Results - There were no significant differences in the rates of re-consultation (rate ratio1.24, 95% confidence interval (CI) = 0.86 to 1.79, P=0.25) There were no differences in rates of diagnostic tests ordered (1.08, 95% CI = 0.89 to 1.30, p=0.44), referrals (0.95, 95% CI = 0.63 to 1.43, p= 0.80), prescriptions issued (1.16, 95% CI = 0.87 to 1.53, p=0.31) or patient satisfaction (1.00, 95% CI = 0.42 to 2.36, p=0.99). Records of initial consultations of 79.2% (n=145) of PAs and 48.3% (n=99) of GPs were judged appropriate by independent GPs (p<0.001). The adjusted average PA consultation was 5.8 minutes longer than GP consultations (95% CI = 2.46 to 7.1, p<0.001), cost per consultation was GBP £6.22. (US$ 10.15 lower (95% CI = -7.61 to -2.46, p=<0.001)Conclusion - The processes and outcomes of PA and GP consultations for same-day appointment patients are similar at a lower consultation cost. PAs offer a potentially acceptable and efficient addition to the general practice workforce.