Physician Associate - a new role in NHS? - Page 2

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True, I guess I am coming at it from the point of view of someone who wants to do medicine. I just find it difficult to imagine that anyone doing PA hasn't at one point considered medicine because after all, PA is literally medicine x 0.4. All of the automated thought processes of a junior doctor but none of the in depth knowledge to allow them to go back to first principles and really understand the bigger picture. I also have the following specific concerns about PA's in the UK health system.

1. Who the **** are these people accountable to? The most senior doctor working? The hospital? What happens if they make a mistake? Am I going to get into trouble or does the NHS cover them? Do they even have a defence union?

2. Do doctors have a choice in working with PA's?

3. Are we in charge of them? (i.e. during an on call can we send them somewhere to do something for us or do they operate with complete autonomy, which actually completely defeats their purpose come to think about it)

4. Are they going to supplement the workforce or replace it?

5. Do the public want this?

Reply 21

Revenged

i have worked with physician assistants. in my hospital they were employed and saw patients on the medical acute take. it was not the place for them at all as this is where you see all the emergency cases and they had no experience. also they couldnt prescribe and so they cant initiate any management. the consultant was accountable for the physician assistants since they were not indepedent practioners. nurse specialists are far more common as they have experience, can prescribe and can work as independent practitioners so these are the reasons why in most hospital the nurse practitioner / nurse specialist role is booming.

(edited 10 years ago)

Reply 22

dnsr

Hi.. i strongly agree with u as i am one of those who tried hardest to get to medicine but could not due to strict selection rules. I am interested in becoming a PA as this will only give me and many other like me to get in to work in this field but also an opportunity to be part of this revolutionary new programme for PA s in UK. I am hopeful, it will go beyond expectations.

Reply 23

rootoot

Hello,
Im a qualified british PA coming up to my 4th year working in an emergency dept.

For me, I ended up being a PA because ultimately I wanted to do medicine and it was a plan B.

I disagree with the previous post stating that acute medicine is not for PAs. After 4 years obviously I have gained experience and increased my knowledge and I provide a stable 'junior' workforce during the 4 monthly SHO rotations.

Im happy to answer any questions if you have any.

Reply 24

hslakaal

Correct me if I'm wrong, but I was under the assumption that UK PA is not as autonomous nor as legally authorized as their American counterparts, and hence the roles played are quite different?

Original post by rootoot

How much autonomy do PA actually have? What would be the difference between an ANP, as I'd have thought nurses provide a slightly more stable and broader pathway than a PA. Theoretically, 2 year nursing courses (PG) exist, and I'm assuming the additional training time would be worth something.

Reply 25

rootoot

Typed out a long reply and then lost it trying to log in :frown:

In a nutshell:

I would agree with you hslakaal that American PA's probably have more autonomy since the role is more established there and they can prescribe in most states.

When comparing PAs and ANPs I can only draw on experience from my working environment and am not generalising.

I am part of the medical team, whereas the ANP and ENP's are part of the nursing rota and they only work in minors, whereas I work both minors and majors.

In minors I can discharge patients without review if I feel this is appropriate.
In majors I can refer to specialities without review but I don't discharge home without review - however neither do SHOs.

Today for example I led a cardiac arrest (I have ALS) but my team members were a consultant and a middle grade doctor, so I have opportunities to develop but in a supported, safe environment.

I must emphasise that this is based on my environment and other PAs will have different limitations according to their speciality and consultants in charge.

Reply 26

FeliciaO

Hi Rootoot, I'm in the process of applying for a PA role. I 'm keen to understand what your day looks like usually. And would there be a chance for me to shadow you, if you are based in London that is.

Reply 27

p90rsk

Original post by rootoot

Typed out a long reply and then lost it trying to log in :frown:

Thanks for the info- would you mind just clarifying what you mean by ALS?

Reply 28

Fission_Mailed

Original post by p90rsk

Thanks for the info- would you mind just clarifying what you mean by ALS?

ALS is Advanced Life Support, it's essentially a course that teaches healthcare professionals to manage cardiac arrest and related problems with more complex techniques than basic CPR (stuff like heart monitoring, defibrillation, gaining IV/IO access, intubation).

(edited 10 years ago)

Reply 29

rootoot

Original post by p90rsk

Thanks for the info- would you mind just clarifying what you mean by ALS?

ALS = Advanced life support - its a course health professionals can do to train them in managing cardiac arrests.

Felicia - Unfortunately i'm not based in London but there are many PAs at St Georges hospital and some in a+e at Kingston that you could contact regarding shadowing.

A typical day for me is an 8 hour shift, I tend to work minors one day and then majors the next day, some days i flit between the two.
Basically I start my shift and crack on seeing patients, whoever is next.
I take histories, examine, do bloods if required and order appropriate tests. I refer to specialities (ortho, surgery, gynae etc).
I ask for help and reviews from middle grade doctors and consultants where required.
Now i've been there a few years I am expected to see all cases, and not shy away from difficult cases.

I get 2 hours teaching per week which is with my a+e doctor colleagues.

Reply 30

Rstand21a

I was responsible for coordinating the development of the Physician Assistant (Associate) Competence and Curriculum Framework in 2006 (so not really a 'new role' now) when I worked for the Department of Health NHS Modernisation Agency Changing Workforce Programme so probably more qualified than most (apart the PAS who have responded so eloquently) to respond to the original question. There over 80 thousand practising PAs in the USA and the role has been introduced in Canada, Australia, Europe and other continents/countries and it appears that healthcare systems across the globe are looking at alternative solutions to strategic workforce planning needs. I had deja-vu when reading the posts from the medical school graduants and students on this board as the opinions and comments were exactly the same as when the role was being introduced. It was never intended that the introduction of PAs would substitute the role of the Medical Practitioner - it was introduced to add capacity into the medical team. This extra capacity would, in theory, provide time for GPs and Consultants and the medical teams to focus on more complex care that they have been trained for and potentially allow juniors to have more time to gain their competences within the Working Time Directive rules thus supporting their need to gain higher levels of knowledge and skills.

PAs follow a structured Masters level education curriculum based on the medical model (based on the tried and tested US model that has been around for nearly 50 years). They also have to pass the national examination to gain certification and they also have to pass the revalidation examination every few years.

In response to some of the concerns posted (please excuse the spelling and grammar of the original posts):

Who the **** are these people accountable to? The most senior doctor working? The hospital? What happens if they make a mistake? Am I going to get into trouble or does the NHS cover them? Do they even have a defence union?
Apart from the distinctly limited range of vocabulary, PAs are accountable to their supervising physician. All employees in the NHS are covered through their employing organisation. If they make a mistake, like all other healthcare staff they would be subject to the relevant employer policy. If you are a qualified professional and the task you delegate is outside of their competence they should advise you accordingly - if you ignore this then you are responsible (for doctors see http://www.gmc-uk.org/guidance/ethical_guidance/21187.asp). If the PA undertakes a task where they know they are not competent then they are accountable. At the moment there is a Managed Voluntary Register. Whilst those involved in the development recognise the need for statutory regulation the Department of Health are reluctant to consider introducing primary legislation until there is a critical mass.
In Primary Care PAs can apply for professional medical indemnity through the MDU if their practice qualifies as a GROUPCARE scheme. - See more at: http://www.themdu.com/choose-mdu/group-membership/groupcare-plus#sthash.SehkVJV1.dpuf

All PAs are encouraged to take out personal indemnity insurance.

Do doctors have a choice in working with PA's?
Do PAs have a choice in working with junior doctors with these views? No. If PAs are employed within an organisation they, like all other healthcare professionals, have been through their organisational checks - why wouldn’t you want to be part of a medical team with PAs? They have the respect and trust from their supervising physician which has been built up over a period of time.

Are we in charge of them? (i.e. during an on call can we send them somewhere to do something for us or do they operate with complete autonomy, which actually completely defeats their purpose come to think about it)
It’s all about teamwork - I guess you will learn this as you get more experience. The Consultant / GP leads the medical team and ultimately they are, and always will be, ‘in charge’ of the patients care. You could probably request (not send) they attend patients as part of the multidisciplinary team’s holistic management and delivery of care.

Are they going to supplement the workforce or replace it?
The original intention was that PAs would add capacity to medical teams. How employers (including GPs) plan their workforce within the budgets they are allocated is up to them.

Do the public want this?
During the development of the Competence and Curriculum Framework (co-Chaired by the RCP & RCGP) there was a public consultation exercise (following Cabinet Office guidelines) and the response to this was posted on the internet.
From my experience the public want to be seen quickly by safe and competent healthcare staff.

i have worked with physician assistants. in my hospital they were employed and saw patients on the medical acute take. it was not the place for them at all as this is where you see all the emergency cases and they had no experience.
You can only get the experience by doing the job - you were inexperienced once and I am sure you were mentored and learnt from more experienced staff. Where PAs are experienced they usually participate in junior doctor teaching.

also they couldnt prescribe and so they cant initiate any management. the consultant was accountable for the physician assistants since they were not indepedent practioners.
They cannot prescribe because they do not have statutory regulation. See previous comment. The supervising physician is not accountable - the PA is accountable for their actions and omissions.

nurse specialists are far more common as they have experience, can prescribe and can work as independent practitioners so these are the reasons why in most hospital the nurse practitioner / nurse specialist role is booming
Nurse Practitioners are far more common because they have been around longer. NPs can prescribe but only if they have the relevant Nurse Prescribing qualification. The development of the PA role was never about replacing NPs but adding capacity to medical teams. No healthcare profession is truly independent - they are all accountable.

i strongly agree with u as i am one of those who tried hardest to get to medicine but could not due to strict selection rules. I am interested in becoming a PA as this will only give me and many other like me to get in to work in this field but also an opportunity to be part of this revolutionary new programme for PA s in UK. I am hopeful, it will go beyond expectations.
Becoming a PA is not, and was never intended to be, a shortcut into medical school. Evidence from the US suggests that very few PAs, once in the PA role want to move into becoming a doctor. I am glad that you see the PA role as one where you can provide direct patient care through the medical model and be part of a dynamic and innovative workforce development programme. We hoped that the programme would be particularly interesting for men as, for a number of reasons, there is a significant gender imbalance in the non-medical healthcare professions.

Correct me if I'm wrong, but I was under the assumption that UK PA is not as autonomous nor as legally authorized as their American counterparts, and hence the roles played are quite different?
You’re right in regard to professional statutory regulation (see previous response) but the core curriculum is very similar to the US model to ensure global role consistency. There are PA roles in other parts of the world (e.g. Africa and India) where the role operates at a lower level in terms of knowledge, skills and qualifications.

How much autonomy do PA actually have? What would be the difference between an ANP, as I'd have thought nurses provide a slightly more stable and broader pathway than a PA. Theoretically, 2 year nursing courses (PG) exist, and I'm assuming the additional training time would be worth something.
PAs are not autonomous practitioners they are dependent practitioners and the concept of teamwork and their relationship with their supervising physician is core to the way the practice. PAs are trained to recognise their clinical management boundaries and their levels of competence.

Yes, 2 year postgraduate nursing courses exist but you should consider that before this most Nurse Practitioners have to gain their initial qualification, go through a period of preceptorship, gain basic and further knowledge and then specialise which does take some time. You should also consider that most of this is paid for by the NHS. The PA programme is not NHS funded (some clinical placements are, but not all) so in terms of return on investment the taxpayer gets a lot of bang for their buck.

Apologies for the long response but I felt that I had to answer some of the comments made.

Reply 31

hslakaal

Original post by Rstand21a

Thanks for the detailed insight.

The idea of varying professions and their contributions (as well as deductions) to a healthcare system interests me greatly, and I have always liked public health as a profession.

I have heard that UK PA's salaries are at about 35,000, which is quite similar to the pay of entry-level specialty trainees. Considering that PAs in US/Canada are significantly cheaper than physcians, and hence cost-effective, I'm wondering what projections the various bodies and organizations had in predicting the level of cost-effectiveness of PAs in the UK, where doctors' pay's (although fairly high) isn't very different to a PA's.

If PAs do become more popular, wouldn't that result in
1) ridiculous trade unions like the BMA (essentially), resulting in another "role" that'd be cheaper than PAs and "offload" their burden. As many have said, PAs are highly trained, educated people, and highly trained, educated people are the most likely to form smart unions and demand higher pay, once big enough
2) loss of appeal for trainees to enter a certain field where prospects of long-term job does not exist, as PAs have replaced them, and hence a general decline in a skilled workforce

I'm hoping the committee would have considered the possibility of increasing training posts of doctors, leading to a long-term increase in supply and hence decrease in salaries of doctors (tbf, the NHS seems to be on track to make cheaper, generalists), as it seems to me the cost-effectiveness of PAs would decrease over-time, as plans to lower doctor's real wages would make a doctor cheaper. Why not just create a separate degree/course that's undergraduate, maybe 4 years or so, that'd be theoretically cheaper, and teach just as many things, if some of the more unnecessary undergraduate components are stripped out? Surely that must be more cost-effective than 5 years of subsidized 9k student fees? I'm assuming there'd have been some politics involved to bring quick cuts by enticing graduates to become a PA, and no doubt the opposition of established medical bodies/unions to the creation of a completely new role.

Reply 32

GrilyBudilly

I'm thinking of applying but worried that my age stands against me (42). I have a physiology degree already 2:1 in 1994 and a physiotherapy degree 2:2 in 2001. Am I just going to be looked at as an eternal student?

Reply 33

firkin

who ever is thinking of doing this course, PLEASE DO NOT. this course was missold to me and my fellow colleagues. the reality of it was , it was disorganised, hardly any good lectures took place, the placements were a waste where we were promised some teaching, and never got any. we forked out money, and got nothing back. the university even lied to the hospitals about what had been covered. in some hospitals the placements were awful, where students did nothing. even when we tried to be proactive and ask our gp if we could shadow him, he refused.

in fact i had heard some students had even complained to some organisation about the course, and its inadequate teaching.

about being a pa. you will be employed on the goodwill of the hospital. if there is enough money in the budget for that. after that should there be no funding, then you could be out of a job.so while you look for a new pa job you could be unemployed. unlike doctors there is no locum agency for pa work

also most of the pa jobs will be offered as internships, meaning that they will be open only newly graduated pa's. which is useful when you first graduate.. but should you want to stay it would be up to the hospital to find more funding to keep you on.

depending on where you work, there is alot of confusion even from consultants as to what to do with a pa.

imo there is a lot of instability in this role. you do not know when your contract will be up. pa jobs could be advertised on the other side of the country. think of this if you have a mortgage or want to settle down. Please consider this when you apply for this position.

the nursing course id a far better option which offers career progression.

Reply 34

clouis

Firkin- I am sorry for the unfortunate circumstances you have had to go through….
However I am a student in my second year on the course and I have had excellent teaching and good placements. This is a postgraduate course so there is an emphasis based on outside learning which relies on you to learn outside the classroom.

I would like to correct some of your statements
“almost most of the pa jobs will be offered as internships , meaning that they will open only newly graduated pa’s which is useful when you first graduate…but should you want to stay to stay it would be up the hospital to find more funding to keep you on”

This is not true, if you look at NHS jobs (http://www.jobs.nhs.uk/cgi-bin/advsearch) you will see that there are quite a few permanent positions (obviously at the time of going press 15.02.2014). With a permanent position this means that there is stability and you do not have to worry about when your “contract will be up”.

Another comment that you mentioned
“unlike doctors there is no locum agency for pa work”
In the beginning yes this was true but now there is scope to do locum shifts at some hospitals. Even though they are few and far between, this is now starting to spread across the UK. I believe there is now a dedicated website (http://www.parecruitmentsolutions.co.uk/pas.html)

I was previously working as a service manager but I was excited for this new profession in the NHS. I saw this as niche gap in the market were if you worked hard you can succeed. Since this is a new profession in the UK you can set the boundaries to how far you can take it. In a recent UKAPA article one PA has gone on to become a partner at a GP practice thus showing how far you can go in the role . Please read this article for further details (http://www.ukapa.co.uk/members/articles/9-years-and-counting/index.html)

So please if anybody reading this thread is seriously considering doing this course….PLEASE DO!

Hello

My name is Andy and I'm a recent graduate from the SGUL P.A course. I currently work at a GP practice seeing my own patients. If any one has any questions about the course or job prospects/how things work in practice feel free to get in touch. I don't usually visit these forums (the last time I was here was in 2007) but you can get hold of me on facebook . Just search "Andrew JD Mulder King" and send me an inbox message if you have any questions!

(edited 10 years ago)

Reply 37

shiggydiggy

Original post by ajking

Dunno if you'll get this message, but out of interest - how recent of a graduate are you to be seeing your own patients in GP?

Reply 38

Elmo79

Hi
Interesting reading of all the above posts. There does seem to be a lot of negativity and comparisons. If I wanted to be a doctor, I would be a doctor. If I wanted to be a nurse, I would be a nurse and if I wanted to become a PA, I would do this (which I did). Each of these career choices have overlapping demands and roles but are different in many ways and require the applicant and employee to be dedicated to that role. Each role has a place in the NHS and it's not as if there are a lack of patients and therefore training opportunities! Why would any one of these roles be considered a second best to the other? A lot of opinion on the page is unfounded and I implore you to do your research first.
As a PA I work as a generalist, I have to prove my knowledge by being examined every 6 years as we do not specialise but can work as a generalist in specialist areas hence giving us the opportunity for horizontal movement between specialities in our career. So if you want a direct career progression with title and authority then it may not be for you but obviously PAs gain experience year upon year and experience it key when dealing with people and for patient care!
We work alongside our medical and nursing colleagues in hospital and general practice. I have come across negativity but less so in recent years and the majority of hostility is from those who don't give time to knowing who we are and what we do and how we can all work together.
:0)

Reply 39

345rty

I've just moved to a place with a 'Doctors Assistant' which appears to be quite handy. The firm I am with have no F1s so having someone else who can be nagged to redo cannulas, the odd ABG, and rewrite charts (if not sign them) does seem to help things move along.

The one moan that seems to be common about them here though is that their hours are so limited that they miss much of the opportunities to be useful. It seems odd that we are on 8-6/7 with much of the ward stuff at the ends of that time but the assistant is available more like 9-5 and never at night when they would be really handy.