The Role of Physician Associates in General Practice. PA Internship Programme for Primary Care. “Preceptorship.” DR LIZ JENKINS GP TRAINER NORTHLANDS WOOD PRACTICE Dr S Brydie Teaching Fellow PA studies BSMS

What is a Physician Associate? A PA is a healthcare professional who is trained to the medical model and who works as part of a medical team to provide holistic medical care

PAs in the UK 1961 First proposed in the USA US 2014 110,000 qualified PAs DoH Competence and Curriculum Framework (2006, 2012) 3200 hours over 2 years 1600 clinical hours in variety of specialties

All with physician supervision What can PAs do? Take a focussed history Examine a patient Undertake diagnostic tests/procedures Request appropriate tests and investigations Interpret tests and investigations All with physician supervision Formulate differential diagnoses Refer to other teams as required Suggest medication Compile a treatment and management plan

What can a PA do? Mixture of pre-booked and on-the-day No triaging Follow up of patients/continuity of care Appointment length dependent on experience of PA 10 – 30 minutes Often 15 min appts to allow for patient education time Assigned overall Clinical Supervisor (GP) Day to day supervision can be duty doctor/another GP Number of cases discussed decreases with experience Specialist clinics: e.g. Diabetes, COPD, Asthma, Anti-coagulation, minor ops, cryotherapy, smoking cessation, travel advice Indemnity : MPS, MDU & MDDUS Usually paid by the employer Home visits and OOH work

Where do PAs work? Adult Medical General Surgical Paediatrics Cardiology Care of the Elderly Dermatology Endocrinology Gastroenterology General Internal Medicine Sexual Health Haematology Infectious Diseases Lymphoedema Psychiatry Rehabilitation Medicine Respiratory Medicine Educators Emergency Medicine General Practice Acute medical/clinical decision units Breast Surgery Colorectal Surgery Neurosurgery Orthopaedic Surgery Otolaryngology Spinal Surgery Trauma and Orthopaedics Urology Vascular Surgery Paediatrics Critical Care General Paediatrics Paediatric Surgery

Why employ PAs? Development in line with organisations values Quality Permanent members of staff Development in line with organisations values Flexibility and continuity Quality and Safety These programs are not always about specific health conditions, they also focus on the skills we require to be able to listen to you, take your concerns seriously and do our best to provide excellent Healthcare 7

Drennan et al, 2017 BJGP ●Aim: to compare outcomes and costs of same-day requested consultations by PAs with those of GPs ●Design and setting: An observational study of 2086 patient records presenting at same-day appointments in 12 general practices in England. ●Method: PA consultations were compared with those of GPs. Primary outcome was re-consultation within 14 days for the same or linked problem. Secondary outcomes were processes of care ●No significant differences in the rates of re-consultation ●There were no differences in rates of ●diagnostic tests ordered ●referrals ●prescriptions issued or ●patient satisfaction ●Records of initial consultations of 79.2% of PAs and 48.3% of GPs were judged appropriate by independent GPs (P<0.001).

What can a PA do for me? ●A Physician Associate is a healthcare professional trained to the medical model. ●They can take focussed histories, and perform reliable physical examination appropriate to a system. ●They can contribute to diagnosis and management plans

What can a PA do for me? ●Across the full range of clinical Systems ●They can not yet prescribe or request ionising investigations ●They will always need to work under supervision ●The level of supervision as always depends on the individual skill set I

Why a PA Internship for Primary Care? ●Support for newly qualified PAs entering Primary Care ●Assurance for employers of quality educational induction ●Positive feedback and outcomes from internships in other fields

My PA preceptor. Started in October fresh out of Brighton Started on 30 minute appointments. Now on 20 minute and 15 minute from next week I trained her in smears/ pill checks,asthma and COPD. Gives flu/ pneumo ( PSD.) Orders bloods/ USS/ makes referrals. Requests prescriptions/ X rays from supervisor Future plans for telephone consultations and baby checks/ imms/ shingles.

Costs? 1st year preceptorship is band 6 Subsequent years band 7-??8 £5000 bursary from the Deanery to support training ( if a training practice.) A monthly tutorial with a primary care tutor from Canterbury just like a GP registrar. My time to train and partners re supervision ( 3 blocked appointments per 12 patients) https://www.rcplondon.ac.uk/news/fpa-launches-employers-guide- physician-associates

What is happening re training? BSMS are in their 3rd year of a 2 year postgrad masters and next year they have 20 students. Most currently go straight into secondary care or out of area after qualifying. GP Placements needed (ES or CS practices)

BSMS GP Placements Clinical supervisors for PA students in GP need to be Educational supervisors based at a Training Practice. Additional PA specific half day training will be delivered by BSMS in September 2019 GP Placements : 1 day/week (Thursday) Year 1 Start October through to June 4 week block placement Year 2 April/May

Examples All acute on the day appointments Telephone triage All chronic disease management Baby checks and baby imms Visits to housebound patients Contraception including coil insertions Mental health Audits

Questions? Contacts : BSMS PA Programme :s.brydie@bsms.ac.uk HEKSS PA Programme Manager Jo Piper joanne.piper@nhs.net