Physician Associates in Primary Care Dr Tariq Khan

Aims & Objectives To set out the case for Physician Associates in Primary Care To briefly outline the PA Education and Training Programme To discuss how PA’s work To discuss the benefits of PA’s working in Primary Care To discuss some of the perceived barriers to PA’s working in Primary Care

Context of Primary Care Predicted shortfall of 275 GPs in East London in the next 5 years “Demographic cliff” – early retirement and inability to retain our trainees

What is a Physician Associate? ‘…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’ (Department of Health, 2012 )

What is a Physician Associate? 288 physician associates in the UK working throughout the NHS currently 1,210 current physician associate students in the UK

How Do PA’s Work? To the same medical model and ‘credentials’ to practice medicine with clinical supervision (GP/Consultant) Within the scope of practice of their supervisor As dependent practitioners In a relationship between doctor and PA which is based on mutual trust and respect

PA Education Postgraduate course Healthcare experience Motivated, mature students

What do PA’s do in Primary Care? Is there a role for PA’s in your practice? What are the potential benefits?

What do PA’s do in Primary Care? Same day bookable appointments Pre-bookable appointments Telephone consultations Requests for investigations/correspondence Referrals for non-elective and elective cases Home visits Support nursing and residential home residents Chronic disease management Collaborative care co-ordination role

What do PA’s do in Primary Care? Support the achievement of QOF Contribution to clinical education meetings Teach – medical, nursing and healthcare students. Help with the achievement of Enhanced Services e.g. INRs, coil clinics, minor surgery Take responsibility for audits Notes summarisation

Benefits of PA Local workforce modelling for local needs Recruitment & retention from the local population Motivated, mature students Working to a medical model – generalists capable of being moulded according to the needs of Primary care

Perceived Barriers What are some of the barriers or concerns that you can envisage about the role of PA’s in Primary Care?

Perceived Barriers Unregulated profession – there is however a managed Voluntary Register Cannot prescribe – once the profession is regulated this may be rectified Unable to request ionising radiation Indemnity Concerns about the training – new course and new professional role for the UK

Supervision What is the role of the GP tutor in PA Education and Supervision?

Supervision Creating a bespoke service with a fellow generalist Supporting career development and continuing education Enhancing the role of the GP as a Co-ordinator of Care rather than purely a deliverer of care

How can you get involved? Sign up your Practice to place QMUL PA students Sign up to supervise a 4 week SSC – next opportunity in November 2017 Attend the Tutor Training Day September 2017

Conclusion GP practices in London are effectively using them to support access and their numbers are growing and will continue to grow given the expansion of training programmes Physician Associates not the only answer but it could be part of the solution

References Alberti, H., Randles, H,, Harding, A., McKinley, R. (2017). Exposure of undergraduates to authentic GP teaching and subsequent entry to GP training: a quantitative study of UK medical schools. British Journal of General Practice, e248-e252 British Medical Association. (2016). Physician associates in the UK. London: British Medical Association.