The role of physician assistant has been established in the US for some time, and has proved a useful and effective adjunct to the medical profession. A similar role is being developed in England by the National Practitioner Programme, and this article reports the early progress of a pilot that is training primary care Medical Care Practitioners (as they are called) (MCPs) in Waltham Forest. Three trainees, all former nurses, are currently undergoing a two year programme of study and placement in general practice. It is anticipated that MCPs will be able to see up to half of the cases at present seen by general practitioners (GPs). The pilot has had to face many challenges. The role has needed to be defined, and its basis in a ‘medical model’ was not originally fully understood; training has had to be devised and provided ‘on the hoof’, before national competency and regulatory frameworks have been developed and agreed; the senior input required from the Primary Care Trust and its higher education provider has been substantially in excess of funding support received. Despite the commitment of pilot participants, a pilot is probably the wrong change management model for the creation of a new health care profession.