Physician Associates in Primary Care Development of the physician associate role in general practice

Context The NHS England General Practice Forward View and HEE’s Primary Care Workforce Commission both recognised the requirement for a wider clinical workforce in primary care to support service transformation HEE is investing in and implementing a range of workforce initiatives to support primary care workforce transformation This work contributes to the commitment to increase the number of multi-professional primary and community care staff by 5,000 by 2020. This includes the HEE’s mandate target of ensuring that there are 1000 physician associates working in primary care by 2020. Published July 2015 Published April 2016

What is a physician associate? The Faculty of Physician Associates (FPA) describes physician associates as ‘collaborative healthcare professionals with a generalist medical education, who work alongside doctors, GPs and surgeons providing medical care as an integral part of the multidisciplinary team. Physician associates are dependent practitioners working with a dedicated supervisor, but are able to work independently with appropriate support.’

Education and Training Physician associate courses in the UK all follow a national curriculum and competence framework. Full time, postgraduate level 7 programme (either postgraduate diploma or Masters degree level 3200 hours over two intensive years – divided approximately into 1,600 hours of theory and 1,600 hours of clinical practice (based on the Competence and curriculum framework for the PA) End point assessments consists of both MCQ style and a 14-station objective, structured clinical examination (OSCE)

What are PAs able to do? More specifically, the FPA website provides information about the various duties that PAs are able to undertake in primary care. These include: Assess, manage and treat patients of all ages with a variety of acute undifferentiated and chronic conditions Carry out physical examinations Residential, nursing and home visits Telephone triage Support to meet clinical targets Formulate differential diagnoses and management plans as well as develop and deliver appropriate treatment and management plans Reviewing, analysing and actioning diagnostic test results Further information regarding the PA role can be found on the FPA website at http://www.fparcp.co.uk/employers/pas-in-general-practice, which also provides an range of FAQs

Regulation Without regulation, PAs are not yet able to: The government and the DHSC are currently considering regulation and a decision is anticipated in the autumn. The outcome of the consultation will inform whether HEE can commence work with NHS England to progress prescribing rights for PAs. There is however, a Physician Associate Managed Voluntary Register (PAMVR) which is held exclusively by the FPA, and allows employers to check whether an applicant or employee is a fully qualified and approved PA and is fit to practice in the UK This was established in 2010 to provide public protection and safety, set standards for post graduate education and development, and to advance towards statutory regulation. Without regulation, PAs are not yet able to: Undertake Mental Health Act assessments Prescribe medications Order X-rays, MRIs or CT Studies Order investigations without medical supervision Register/sign death certificates However, they do have a range of skills and competencies that are complementary to the multi-disciplinary workforce.

HEE National Funding Model To support PA numbers, in June 2017, the HEE Executive agreed a national model for PA investment and primary care incentivisation. This model was fully implemented from January 2018 to support the cost of PA training until 2020 with a particular emphasis on those PA students entering primary care. Student Support Allowance: A training grant of £5,000 per student, per programme will be offered to all student PAs undertaking training in England. Students should be able to utilise this payment against course fees, travel or similar costs incurred during the programme. If a PA student contracts to work in primary care on qualification, they also attract an additional £5,000 payment direct to the employer for a tailored preceptorship programme. In addition to this, there is an increase in primary care placement time of 330 hours to a total of 510 hours (per course) to allow for increased exposure of the student to primary care and vice versa.

Preceptorship criteria / guidance HEE has introduced criteria for PA Preceptorship programmes in primary care which attracts £5000 programme support, which includes: It is recommended new preceptorship programmes should be developed in consultation with Training Hubs, new registrants and local PA course providers. The preceptorship programme will be undertaken for a minimum of 1 year (whole time equivalent) Open to all PAs commencing a programme in the year after first gaining registration on the national register A minimum of 50% or 6 months’ full time equivalent in any rotation of placements should be in primary care There should also be: An educationally approved primary care clinical supervisor A mentor available from an appropriate education organiser An induction meeting with their supervisor Further information can be accessed here.

Marketing and Communications HEE is now undertaking a programme of work to stimulate the primary care employer market through a number of initiatives, which includes: A national campaign (which has already seen employer interest increase). This includes an A5 booklet ‘Physician Associates, a working solution in primary care’ has been posted to every GP practice in England. These have been produced to help raise awareness and provide a better understanding of how the physician associate (PA) role can work. This can be accessed at the bottom of the Faculty of physician associate (FPA) website A PA Ambassador programme A series of regional roadshows targeted at employers and education providers in Autumn 2018 which aim to raise the profile of PAs (along with the other three Medical Associate Profession roles*) *Medical Associate Professions include Physician Associates, Surgical Care Practitioners, Advanced Critical care Practitioners and Physician Assistant (Anaesthesia)

PA numbers PA numbers are growing substantially in the UK, with 1470 student PAs confirmed as being registered on UK programmes at February 2018. 1358 of those are registered within the HEE geography. It is estimated that there will be 2855 PA graduates by the end of 2020, and an increase to 5965 by the end of 2023. Although these figures are encouraging, the majority of trained PAs are choosing to work in secondary care across 20 specialties. Emergency medicine is the most popular specialty area for PAs – 30% of all PA graduates are believed to enter the specialty across the UK (FPA). The proportion of PAs recruited into the primary care workforce is estimated at 15%, and this needs to increase to 30% to meet government targets. Achieving the primary care target would require 465 qualified PAs employed in general practice in 2018/19 and 2019/20 respectively. This is ambitious and unlikely to be achieved without significant system wide intervention.

PAs in training

PA Trainees on Programme by HEE Local Office North East Yorkshire and the Humber North West Local Office No of PA Trainees on programmes North East 48 North West 287 Yorkshire & Humber 253 East Midlands 12 West Midlands 240 East of England 143 London 166 Thames Valley 40 Wessex Kent, Surrey & Sussex 94 South West 75 Total 1358 East Midlands West Midlands East of England Thames Valley London Kent, Surrey & Sussex Wessex South West

Local HEE area leads Please get in touch if you need more national or local information, discuss ideas or help answer your questions. East of England; Professor Vijay Nayar Dean of Postgraduate GP Education / Head of Education and Quality. Vijay.Nayar@hee.nhs.uk Kent, Surrey & Sussex; Professor Hilary Diack. Head of Primary and Community Care Education. Hilary.Diack@hee.nhs.uk North London; Faizun Nahar. Programme Manager. info.northlondon@hee.nhs.uk South London; Elaine Lancaster. Associate Workforce Transformation Lead. Elaine.Lancaster@hee.nhs.uk Midlands; Lynn Turner. Portfolio Lead West Midlands. Lynn.Turner@hee.nhs.uk North; Judith McGregor. Physician Associate Programme Lead. Judith.McGregor@hee.nhs.uk North West; Judith McGregor. Physician Associate Programme Lead. physicianassociates.nw@hee.nhs.uk Wessex; Sue Hill. Workforce Transformation Lead Wessex. Sue.Hill@hee.nhs.uk South West; Marc Lyall. Workforce Transformation and Education Development Lead. Marc.Lyall@hee.nhs.uk Thames Valley; Tessa Candy. Associate Workforce Transformation Lead. Tessa.Candy@hee.nhs.uk