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Physician associates in general practice - webinar

Up to 4. Develop the team
September 20. 2017
Robert Varnam

In the webinar on 20 September, we heard from Charlotte Scott-Wilson, who is a physician associate (PA) in Herefordshire.

Charlotte gave an introdction to the role of PAs, their background and the ways in which they contribute to the primary care team.She described the training as 'inherently generalist'. Currently there are an estimated 350 PAs in England, with approximately 60-70 working in general practice.

A common barrier to practices employing a PA is uncertainty about the contribution they can make. PAs are undertaking the following roles in practices:

  • Telephone triage
  • Pre-bookable appointments
  • Same day bookable appointments
  • Request for investigations/correspondence
  • Referrals for non-elective and elective  
  • Support nursing home and residential home residents
  • Chronic disease management
  • Collaborative care co-ordination role
  • Support the achievement of QOF
  • Contribution to education meetings
  • Advise of CQC registration and responsibilities
  • Help with the achievement of Enhanced Services eg INRs, family planning and sexual health clinics, minor surgery etc
  • Take responsibility for case finding for example avoidable admissions audit
  • Supportive part of the multi disciplinary team

PAs work under the supervision of a GP. In Charlotte's work, 78% of her patient contacts are managed without requiring input from the GP.

PAs are employed at AFC Band 7, and can be covered by existing medical defence organisations (current premiums approx £1500-3000 a year).

The role currently has no statutory regulation but the Royal College of Physicians hosts the Faculty of Physician Associates who operate a managed voluntary registry which places requirements on the PA regarding CPD and retaking their qualifying exam every 6 years. Work is progressing nationally towards establishing more formal regulation as well.

Charlotte reported that there are some key differences between how PAs and advanced nurse practitioners work:

  • PAs are often more comfortable seeing unfiltered patient needs than some ANPs and pharmacists in primary care
  • PAs do not work to protocols, but take more of a medical approach to decision making

The slides are attached below.

Guidance for practices about employing a PA is now available - https://www.networks.nhs.uk/nhs-networks/releasing-capacity-in-general-practice/messageboard/4-develop-the-team/231923148

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