Physician Assistants Associates: the new clinical profession PA education & training Jim Parle, Course Director, PA PgDip Chair of UKIUBPAE University of Birmingham December 2013

A Physician Assistant is “…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.” (The Competence and Curriculum Framework for the Physician Assistant, Dept. of Health, 2006; recently revised)

How does a Physician Assistant (PA) work? to the medical model and ‘credentialed’ to practice medicine with physician supervision 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.

What do PAs do? Work like doctors Listen/gather information Differential diagnosis Investigations if needed Treat/counsel/medicate/refer

Consultants Consultants provide supervision Increasing acuity and complexity senior trainees Care delivered directly or appropriately supervised by a permanent medical team familiar with the unit Senior Trainees contribute to supervision / training of the Permanent Medical Team permanent (non-consultant) medical team Those moving from other disciplines into training ED patients Those gaining experience in as part of other training programme FY1/2; GP trainees Those in training to be part of the permanent medical team Those in specialist training with the intention of gaining an consultant post patient care Improving the experience of patients and trainees through the development of a broad-based permanent non-consultant medical team. Authors: Parle J and Ross N, University of Birmingham, September 2012 .

PAs globally USA – now a 40+ year history ~100,000 qualified Canada (e.g. Military and now others: McMaster) The Netherlands (n~700 from 5 programmes) Australia (e.g. James Cook) South Africa Similar professions worldwide e.g. Ghana

Background to West Midlands programme development Initial interest from the NHS locally Department of Health involvement: steering group Jointly chaired by Royal College of Physicians & Royal College of GPs NHS/patient/UoB membership West Midlands NHS backing (“SIFT”)

Competencies Procedural Skills Matrix of Conditions DH specification for PA education Competence and Curriculum Framework 2012 Competencies Procedural Skills Matrix of Conditions Programme Specification ~ 3200 hours over 2 yrs ~ 50% clinical (incl. 200 simulation hours) ~ 50% theory http://www.ukapa.co.uk/files/CCF-27-03-12-for-PAMVR.pdf

Who are they? All are graduates Backgrounds in health or life sciences Average age ~30 ~2/3rd are female

Calendar Year UoB course: 46 weeks per year, F/T Theory focus General Practice Clinical focus Hospital Holiday Clinical Skills/simulation

National assessment Expertise in Communication Skills National Core National Centre for Immunology High level of Sickle Cell Anaemia in Population Institutional Core Scope for student selection

UoB student placements (current in italics; outside WM in red) Heartlands & Solihull & Good Hope; City & Sandwell; Dudley group University Hospital Birmingham Walsall Shrewsbury and Telford Leicester Royal Infirmary George Eliot Stafford Women’s, Children’s, mental health trusts Northampton GPs++

UK intakes (very small numbers pre-2008) 2008: 15 UoB + 13 UoW + 15 St. George’s: 43 2009: 59 2010: 66 2011: 21 St George’s + 11 Aberdeen medical school: 32 2012: 39 2013: 44 2014: 44 + 30 UoB +?20 Worcester + ?20 Wolverhampton (~110) 2015: ?36 St George’s +?26 Aberdeen +?80 UoB +?20 Worcester +?20 Wolverhampton +?20 Barts +?20 Exeter +?20 Plymouth: (~240) others preparing business cases and others considering

NHS / Trust / HE relationship Who pays in West Midlands: Currently students (small HE contribution) Trusts pro bono/pro Trust! GPs paid opportunity cost Sustainability? New grads coming with bigger debts HE/Gov’t HAS to fix: ‘loans’ Bursaries As per graduate entry medicine

Commissioned? Old style model? Flexible enough? What about sponsoring/educational contracts? Student placement = long (mutual) interview!

Employment ~200 or so PAs ~35 Trusts ~30 GPs Wide range of specialties Most started at 30k (ie ‘Band 7’ 30-40k) A few at Band 6 (25-30k) internship 3 at Band 8 (40-47k)

UoB grad Physician Assistant posts in UK Hospitals (excl. GPs) Scotland Lothian University Hospital Midlands University Hospitals of Leicester George Eliot Hospital Solihull & B’ham Mental Health University Hospitals B’ham Sandwell & W. B’ham Hospitals Walsall Healthcare Dudley Group of Hospitals Mid Staffordshire Shrewsbury & Telford Hosps South & London St George’s Healthcare Royal National Orthopaedic Hosp North West London Hosps (Northwick Park) Weston Area Health (Somerset) Great Western Hospitals (Swindon) Kingston Hospitals Epsom & St Helier University Hosp UoB grad Physician Assistant posts in UK Hospitals (excl. GPs)

Current Issues Regulation & prescribing Managed Voluntary Register → statutory register Prescribing as integral to role rather than extension Registering Body HCPC? / GMC? Reaccreditation First iteration of national licensing examination

As NHS needs change, so can PAs’ skill set Reaccreditation US model Maintains PAs’ flexibility ‘stem cell’ 6 yearly cycle CPD Re-examination in basic knowledge 200 mcq questions As NHS needs change, so can PAs’ skill set

Royal Colleges Royal College Physicians Faculty agreed Royal College GPs College Emergency Medicine Royal College Obstetrics & Gynaecology Royal College Paeds & Child Health Royal College Surgeons

Recent reports/publicity CEM RCP Future Hospital Commission RCP, Dr Andrew Goddard, to NHS employers, 2011: Jeremy Hunt Times Grauniad TorygraphBBC/ITV/radio ++

Conclusion PA courses going well (with some hiccups) Newly qualified PAs will still be beginners BUT Can make a substantial contribution to continuity for - patients - health care teams Profession thriving Numbers rising Not ‘the’ answer; but part of the answer

Australia England USA 40 years 100, 000 PAs certified 1PA:9 MDs qualifying Canada Scotland South Africa Netherlands Taiwan NZ &&&

Thank you j.v.parle@bham.ac.uk More info: www.UKAPA.co.uk www.ukiubpae.sgul.ac.uk/