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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.