1. Physician Associate : The Primary Care point of view
Andy King
Physician Associate-R

2. What is a Physician Associate?
A science graduate who undertakes a 2 year full time , intense training based on the medical model who, when qualified is able to help manage patients as part of the medical team

3. What did my training involve?
Year 1
University Monday-Friday 9-5 in the first year
Taught consultation skills i.e. history taking, breaking bad news, examinations , differential diagnosis, management including pharmacology, NICE guidelines, referral pathways , blood test interpretation. Also anatomy and physiology, research, medical ethics , procedural skills
One day a week GP placement

4. YEAR 2
Back to back placements with 1 day a month revision sessions back at the university
In placement built on clerking/ examinations/ management
Procedural skills including bloods, cannulas,catheters, ABG’s, suturing, NG tubes, ECG’s, fluorescein eye staining , injections , uninalysis, blood pressure , peak flows , spirometry
Keeping a portfolio which includes histories written up, reflective pieces, certificates (eg manual handling, ILS)
University and National examinations

5. Placements
GP A&E AMU PAEDIATRICS OBS AND GYNAE MENTAL HEALTH SURGERY GENERAL MEDICINE (RESPIRATORY) ELECTIVES (ONCOLOGY , A&E , AMU)

6. Placement requirements (hours)
The minimum core placements are as follows:
Community Medicine 180 hours
General Hospital Medicine 350 hours
Front Door Medicine180 hours
Mental Health 90 hours
General Surgery 90 hours
Obstetrics & Gynaecology 90 hours
Paediatrics (acute setting) 90 hours
All placements required end of placement sign off taking into account the common and core competencies ie History taking and consultation skills / working with families and children / examination / therapeutics and prescribing etc

7. National Exam 200 MCQ’s 14 station OSCE
Post graduation need to recertify every 6 years and sit national exam in order to carry on practicing as a Physician Associate
Undertake 50 hours of CPD including type 1 (attendance at accredited events and activities- eg conference), type 2 ( including teaching/ lobbying for profession , non accredited events , reflective writing )

8. When I first graduated Started on 30 minute appointment for 2 weeks
20 minute appointments for 2 weeks
15 minute appointments for 4 weeks
10 minute appointments FOREVER
Debriefing with the doctor after almost every patient initially as building relationship with GP
Then only getting GP involvement for problematic patients
Now only get GP in once every 2 months or more
Have a conversation with GP about a patient once every 2 weeks

9. Why a Physician Associate?
From undergrad degree experience enjoyed human anatomy and medical modules
Worked as a GP receptionist / diabetic HCA and ran clinics – enjoyed patient relationship /clinical aspect
Never had considered being a doctor but wanted to do something with similar skill mix
Can change specialty if wanting at any point in career

10. Why General Practice? Personal decision : Enjoyed placements
An opportunity to practice the medicine and skills you’re taught
Acute and chronic patient presentations including mental health
Generalist knowledge , also good as a base for recertification every 6 years
Every day is different

11. My day in a nutshell 27+ patients/day
AM clinic ; 14 patients plus extras, 10m appointment slots
“”Lunch break:”” referrals , blood test results, phone calls, care plans/ QOF, home visits?, “floating”
PM clinic: 2-5PM: 13 patients plus extras
referrals , blood test results, phone calls, care plans/ QOF, seeing extra’s that duty doctor has booked / helping see GP’s patients if they are running late

12. How do the MDT benefit?
When nurses need help they come to me , freeing GP up to deal with other more pressing issues
Receptionist queries come to me too so GP not disturbed
Trained in the medical model so can see GP’s patients for them if running late or emergencies.
Can deal with QOF etc and set up reviews with appropriate staff member
Malleable part of the team – can help fill a void with certain absences and GP needs.
I also contribute to meetings and provide teaching on up to date guidelines as well as being involved in teaching the medical students , registrars and Physician Associate students

13. THE END

14. USEFUL RESOURCES