A PA (physician associate) is 'a new healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision'.
This is a list of considerations for practices thinking of employing PAs, taken from the FPA Faculty of Physician Associates employers guide.
The BMA GPs committee view
Physician associates can perform a valuable role as part of the extended primary care team. There is scope for them to take some pressure off GPs by performing some defined clinical tasks.
They are not, however, a substitute for a doctor who undergoes years of medical training that enables them to provide complex, highly skilled care to their patients. GPs play a particularly important role in diagnosing serous conditions, a task that that can only be done with an appropriate level of medical expertise and experience.
Job plan and scope of practice
Prior to deciding whether to employ a PA, it is important to ensure the role and remit of a PA are what is needed by the practice team/network. Practices should not employ a PA where an alternative healthcare professional would be better suited (eg an advanced nurse practitioner, GP, practice nurse or other healthcare professional).
We strongly recommend that GP practices only consider recruiting PAs who are registered on the Physician Associate Managed Voluntary Register.
Job adverts for a PA must state that it is essential for applicants to hold a PG diploma or MSc in Physician Associate Studies from a recognised UK or US programme and to have passed the UK physician associate national exam.
Write a clear job plan so that both PAs and supervisors understand what is expected of them. The job plan should include:
- hours of work
- opportunities for development
- required duties.
Practices need to be aware PAs require professional indemnity coverage to practise in the UK. Currently, the Medical Protection Society, Medical Defence Union and Medical and Dental Defence Union of Scotland provide professional indemnity for PAs working in general practice.
- It is useful to have one dedicated GP supervisor for a physician associate.
- The PA is responsible for their actions and decisions. However, it is the GP who is ultimately responsible for the patient.
- There must always be a GP supervisor available to discuss cases, give advice, and attend to patients if necessary.
- Before employing a PA, practices must seriously consider whether they have sufficient capacity to provide this level of supervision.
- Practices thinking of employing a newly qualified PA might wish to consider a one-year ‘internship’. This is so the PA can consolidate their core knowledge and skills and demonstrate their competence in practice.
During the internship, PAs should:
- be supervised closely
- have experience in the clinical area where they work
- maintain a portfolio of cases and case discussions with clinicians, which may also be reviewed with their clinical supervisor (usually a GP)
- have their ongoing development, appraisals and PDP managed by clinical supervisors.
To enable PAs to transition into employment in primary care effectively, HEE (Health Education England) has developed a preceptorship scheme.
The scheme gives the practice a £5,000 allowance to support the supervision and educational needs of newly qualified PAs. To find out more and apply, get in touch with your HEE area lead.
Told by Audley Health Centre.
‘We were keen to explore employing a PA as we had experience of PA students in the practice from Wolverhampton University, and recognised that they could bring an element of diversity as well as supporting the clinical team. Our GP federation was supportive of the PA model and ran an internship; they handled all the recruitment and pre-occupational checks and paperwork.
‘The practice has found having a PA to be a very positive experience. It has enabled us to fully utilise care navigation by having different personnel to direct patients to. A lot of routine conditions can be directed to the PA, which means GPs can deal with the more complex and multi-morbidity patients.
‘A thorough induction and introduction to the team as well as clear guidelines is essential. Receptionists need to fully understand who and what can be booked in to see the PA in order to respond to patients’ questions or needs appropriately.
‘Our nursing staff also fully understand the role of the PA and can therefore effectively triage patients. Since employing a PA, we can now see a reduction in GP appointments and workload. Patient access is also much improved.’
Told by Sandwell and West Birmingham CCG.
‘PAs are an excellent resource. They are keen and enthusiastic to be involved in general practice, and we couldn’t manage without them; we also take on PA students at the practice.
‘I would recommend employing a PA, but the only problem is the limitation on them and the fact they are not eligible to be prescribers, which limits what they can do, despite the fact many are very experienced indeed. The PAs have helped us maintain our service, as it has been very difficult to recruit GPs – without PAs we would be at breaking point.
‘We will continue to maintain our workforce numbers. I think we employ more PAs than any other practice in the UK and we are now looking to see what other roles they can take, for example, in chronic clinics as there are shortages of experienced nurses too. Ideally, we need the DHSC to allow PAs to become prescribers.’