Physician Associate : The Primary Care point of view Andy King Physician Associate-R

What is a Physician Associate? A science graduate who undertakes a 2 year full time , intense training based on the medical model who, when qualified is able to help manage patients as part of the medical team

What did my training involve? Year 1 University Monday-Friday 9-5 in the first year Taught consultation skills i.e. history taking, breaking bad news, examinations , differential diagnosis, management including pharmacology, NICE guidelines, referral pathways , blood test interpretation. Also anatomy and physiology, research, medical ethics , procedural skills One day a week GP placement

YEAR 2 Back to back placements with 1 day a month revision sessions back at the university In placement built on clerking/ examinations/ management Procedural skills including bloods, cannulas,catheters, ABG’s, suturing, NG tubes, ECG’s, fluorescein eye staining , injections , uninalysis, blood pressure , peak flows , spirometry Keeping a portfolio which includes histories written up, reflective pieces, certificates (eg manual handling, ILS) University and National examinations

Placements GP A&E AMU PAEDIATRICS OBS AND GYNAE MENTAL HEALTH SURGERY GENERAL MEDICINE (RESPIRATORY) ELECTIVES (ONCOLOGY , A&E , AMU)

Placement requirements (hours) The minimum core placements are as follows: Community Medicine 180 hours General Hospital Medicine 350 hours Front Door Medicine180 hours Mental Health 90 hours General Surgery 90 hours Obstetrics & Gynaecology 90 hours Paediatrics (acute setting) 90 hours All placements required end of placement sign off taking into account the common and core competencies ie History taking and consultation skills / working with families and children / examination / therapeutics and prescribing etc

National Exam 200 MCQ’s 14 station OSCE Post graduation need to recertify every 6 years and sit national exam in order to carry on practicing as a Physician Associate Undertake 50 hours of CPD including type 1 (attendance at accredited events and activities- eg conference), type 2 ( including teaching/ lobbying for profession , non accredited events , reflective writing )

When I first graduated Started on 30 minute appointment for 2 weeks 20 minute appointments for 2 weeks 15 minute appointments for 4 weeks 10 minute appointments FOREVER Debriefing with the doctor after almost every patient initially as building relationship with GP Then only getting GP involvement for problematic patients Now only get GP in once every 2 months or more Have a conversation with GP about a patient once every 2 weeks

Why a Physician Associate? From undergrad degree experience enjoyed human anatomy and medical modules Worked as a GP receptionist / diabetic HCA and ran clinics – enjoyed patient relationship /clinical aspect Never had considered being a doctor but wanted to do something with similar skill mix Can change specialty if wanting at any point in career

Why General Practice? Personal decision : Enjoyed placements An opportunity to practice the medicine and skills you’re taught Acute and chronic patient presentations including mental health Generalist knowledge , also good as a base for recertification every 6 years Every day is different

My day in a nutshell 27+ patients/day AM clinic 08.30-12.00; 14 patients plus extras, 10m appointment slots “”Lunch break:”” referrals , blood test results, phone calls, care plans/ QOF, home visits?, “floating” PM clinic: 2-5PM: 13 patients plus extras referrals , blood test results, phone calls, care plans/ QOF, seeing extra’s that duty doctor has booked / helping see GP’s patients if they are running late

How do the MDT benefit? When nurses need help they come to me , freeing GP up to deal with other more pressing issues Receptionist queries come to me too so GP not disturbed Trained in the medical model so can see GP’s patients for them if running late or emergencies. Can deal with QOF etc and set up reviews with appropriate staff member Malleable part of the team – can help fill a void with certain absences and GP needs. I also contribute to meetings and provide teaching on up to date guidelines as well as being involved in teaching the medical students , registrars and Physician Associate students

THE END

USEFUL RESOURCES https://static1.squarespace.com/static/544f552de4b0645de79fbe01/t/557f1c1ae4b0edab35dd92cf/1434393626361/CCF-27-03-12-for-PAMVR.pdf http://ockham.healthcare/episode-52-joanna-munden-a-gp-advocate-for-physician-associates/ http://ockham.healthcare/episode-40-ria-and-andy-physicians-associates/ http://www.fparcp.co.uk/