Physician associates (PAs), formerly known as physician assistants, are health professionals with a generalist medical education.
PAs work within the medical model and are trained to perform a range of roles including taking medical histories, performing examinations, diagnosing illnesses and medical conditions and requesting and analysing test results.
They are able to see patients autonomously, but always work under the supervision of a fully trained and experienced doctor.
Born in the USA
In the US, where they’re called ‘physician assistants’, PAs have provided medical care for over 45 years.
Originally developed as a solution to a scarcity of doctors in rural areas, PAs in the US now work in every setting from rural primary care to major academic medical centres.
In the UK, PAs currently work in over 20 different specialties in over 30 NHS localities according to their professional association, the UK Association of PAs (UKAPA).
A UKAPA survey of PA supervisors and employers, revealed that PAs are viewed in a positive light.
However one big barrier to PA recruitment the UKAPA has identified is a lack of understanding about the role by other health professionals and NHS workforce managers
Qualifying as a PA
Six UK universities - St George’s, London, Aberdeen, Birmingham, Worcester, Wolverhampton and Plymouth - offer the two-year Post Graduate Diploma in Physician Associate Studies.
After completing the course, PAs must sit a national examination and are required to sit a recertification examination every six years. The PA Competence and Curriculum Framework sets out the core competencies of a PA.
Trained as generalists PAs can work across all specialities. However GP practices were among the first NHS employers to pioneer the PA role.
PAs at GP practices
The PA's role in primary care varies according to the needs of each practice. PAs are qualified to see the full spectrum of patients presenting at the practice from infants to the elderly.
Examples of their general practice activities include:
- Patient consultations: same day acute illness appointments and booked routine appointments
- Telephone triage
- Home visits
- Managing chronic conditions lists (such as COPD or diabetes patients)
- Running clinics (sexual health, family planning or minor surgery for instance)
- Dealing with paperwork/admin
- Reviewing and actioning diagnostic test results
- Assistance with meeting QOF targets
- Facilitating patient educational sessions
- Co-ordinating research activity
The supervising GP’s role
The GP supervisor will be aware of the PA’s current skills and competencies and know their role requires them to seek help appropriately.
The PA’s skill levels are developed and expanded through supervision and CPD activities and can be focused towards the practice's priorities. For example, a practice may wish to train its PAs in sexual and reproductive health.
As time goes on, supervision may well consist of the GP giving the PA brief clinical advice during a clinic session about one or two patients and following this up with a discussion about appropriate management after the session.
Occasionally, the PA may ask the GP to a review a patient they have seen - either immediately or in a booked appointment.
As with any health professional, a newly qualified PA will need a higher level of supervision compared to a PA with many years’ experience.
It is important GPs realise that spending more time with a new PA initially is likely to be a good investment as, if US experience is a good indicator, PAs tend to stay in post for about seven years.
PA role evaluated
The 2009 evaluation of a pilot project in Scotland was supportive of the PA role and a 2012 discussion paper from the College of Medical & Dental Sciences at the University of Birmingham, highlighted the suitability of the PA role as a way to relieve NHS workforce pressures.
Recent qualitative research at a selection of GP practices concluded: ‘General practice employers view PAs as a positive addition to a mixed skill team for meeting patient demand within a practice’s finances.’
The same research team has conducted a further study, funded by the National Institute for Health Research, into PAs’ contribution to primary care in England. This found that PAs were 'acceptable, effective and efficient in complementing the work of GPs' and that they could 'provide a flexible addition to the primary care workforce'.
Meanwhile, an article published in Clinical Medicine found that doctors who work with PAs on a regular basis are pleased with the role. However, doctors are concerned that they cannot use PAs to their full potentialdue to current legal limitations.
The PA role fits well into the primary health care team. With the current NHS changes, especially in primary care, there are increasing demands on GPs.
The presence of a PA facilitates workload redistribution, freeing up GPs' and other team members’ time for other duties.
However, investment is needed at the educational and workforce level to meet current and future demands for PAs.
- Lori Williams is a PA at East Surrey Hospital. Karen Roberts is course director at St George's, University of London and a member of the UKAPA board or directors. She also works as a PA in an NHS walk-in centre.
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