Bolton Community Practice Physicians Associate A CASE FOR CHANGE ? Bolton Community Practice Dr Tony Dysart Karen Robinson ANP Dr Anne Talbot

A role for the ‘new’ NHS? European Working Time Directive (EWTD) Modernising Medical Careers Resources- reduction in funding; ageing population increasing expectation and medical complexity

Physician Associate what is it? ‘ 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’ Department of Health 2006

Physician Associate what is it? Developed in USA in 1960’s to support the work of Dr’s in Health Care within the control of the medical team (more than 4,500 PAs graduate from US schools each year) Work to the medical model and to a named medical supervisor Work in a dependent mode as opposed to an independent mode

Post Graduates- with requirement of having a science degree before starting the course Undergo a two year post graduate diploma programme split between clinical practice and theory Pass both institutional assessment and national examination of knowledge and skills About 81,000 PA’s work in the USA in every clinical field in medicine

Physician Associate What are the Benefits? Work under the supervision of doctors and will seek consultation appropriately Focus on the needs of the employer Continuity to team and patients in a continual changing challenging workforce Provide the ‘glue’ for the MDT acts as the link between nursing / medicine / allied health professionals Standardised training, so reliable quality, improved governance

Physician Associate / Advanced Practitioner Autonomous Authority to order investigations/ interpret Specialist Non Medical Prescriber Registered professional Dependent- requires supervision Generalist Requires doctor time to sign prescriptions and request investigations on behalf of PA

Bolton Community Practice Our Experience Opportunity arose for new role Working in General Practice is based around single individual consultation- there is supervision in General Practice but not the scope for the continued supervision that a PA requires Insufficient experience and exposure across the different specialty groups

Bolton Community Practice Theoretical Knowledge was sufficient however, marked lack of clinical exposure Our expectations of role were unrealistic Address the role and put into place supervision, and design clinical frameworks. Physician Associate expectations were also unrealistic

Recommendations Recognise training programme to be undertaken in rotation hospital specialties/ general practice after qualification Recognised career structure Further qualifications and a national register of PA’s Non Medical Prescribing

Thoughts… Changing NHS, changing primary care Shift of care from Secondary to Primary Care Increasing population expectations Managing medical complexity/ long term conditions / ageing population The Three R’s - Recruitment- Retention- Retirement

Thoughts….. Embracing change, being creative in the way we work and use our workforce. Change in how we work has to happen- it is already Proactive rather than reactive Primary Care has an opportunity to shape how care is delivered and how this role develops

Develop a diverse Primary Care workforce that reflects Any Questions ? Develop a diverse Primary Care workforce that reflects the diversity of the populations we care for.