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

3. 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)

4. 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.

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

6. 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

7. 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

8. 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”)

9. 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

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

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

13. 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

14. 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++

15. 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: 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

16. 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

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

19. 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)

20. 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)

21. 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

22. 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

23. 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

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

25. 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

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

27. Thank you
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