Primary care physician associates

PRIMARY CARE PHYSICIAN

ASSOCIATESS A R A H V I G O R P H Y S I C I A N A S S O C I AT E T U N B R I D G E

W E L L S P C N , H E E K S S P A A M B A S S A D O R

PAS IN GP

• Graduated 2010, worked two years in T&O, seven years in Acute Medicine and Lead PA, now in

primary care

• PAA 18 months in KSS supporting PAs and employers across NHS

• PAs flexible role and can move through different areas. Most stay in one place for long periods.

• Continuity for patients and teams

WHAT DO I DO WITH THEM?

• PAs have a broad range of backgrounds and experiences fitting well into primary care

• PAs can work across the breadth of primary care with appropriate supervision and development

• Develop a PA/Supervisor relationship, they are dependent practitioners, not GP trainees

• Build workload slowly (30 mins initially with blocks to review, drop the blocks then reduce apt

times)

• Don’t spread them too thin – ARRS funding for PCNs, be creative so they’re not working across

more than two practices.

• Think about development. How are you fulfilling the GP contract? Where can they slot in to

provide/enhance services?

• PA partners, PA CDs, CCG Leads – scope for non clinical development as well in longer term

WHAT CAN THEY DO?

• Scope is limited by only experience, development opportunities and good supervision

– Excluding limits relating to regulation around prescribing and ionising radiation and MED 3 notes

• If you know your PA well and nurture their development they can be trained to develop

services you need to provide in many areas of GP

• “On the day”, chronic disease clinics, women’s health clinic, diabetes, learning disabilities,

COVID work, care homes, home visits…

• Some PAs may have limitations eg children under 2, or pregnant patients depending on

experience

• PCN PAs utilise in Improved Access, Care Home work, Home visit teams,

THINKING ABOUT PA ROLES

• Surgery employed PA

• PCN working

– GP Federation/PCN – I am in one practice 4 sessions seeing pts from GP lists with some on the day appts with no restrictions. 15mins

– PCN elements; Care Home work, post discharge reviews, new admission reviews, acute assessment, care plans, CGAs. Now doing Improved Access across PCN

• 2 new PAs working with one surgery for session work, covering PCNl IA alongside FCP, CPs

• New roles PAs in UTC with GPs, home visit teams, virtual ward round teams for PCN

• Split posts with local NHS trusts, Frailty, Mental Health, Acute Medicine

• Job Descriptions can be split with PCN work and surgery work.

• Any PCN work requires consideration of supervision by another GP who is not their “named clinical supervisor” while they are in that workspace

TAKE HOME

• Plan supervision and induction allowing for longer appts at the start

• Remember they aren’t training to be a GP they have a broad shallow training you can develop

for your service

• Good supervision is key

• Be creative with the role for retention and development

• Think long term

• Further support contact Tahir

• [email protected]

Mentoring Physician Associates in Primary Care –Lessons LearntDr Sarah Greenwood

PA Fellow, Lecturer, PA Programme , University of Reading

[email protected]

PA Education• Patient-centred, competent &

safe clinicians

• Able to make autonomous medical decisions, and aware of the limits of their competence

• Knowledgeable about common and important clinical conditions

• Aware of ethical and professional issues relevant to healthcare

• Good communicators, team players, lifelong learners

PA Programme Content

• The content of PA education programmes is guided by the Competence and Curriculum Framework for the Physician Associate [Department of Health]

• The detail is guided by the Matrix of Core and Common Conditions

• These can be found on the FPARCP website: https://www.fparcp.co.uk

Faculty of Physician Associates, Royal College of Physicians

Supporting PAs in General Practice

Preceptorship

Mentoring

CPD

Supervision

Induction

Team working

IT training

Non patient-facing roles

Respect &Professionalism

Dedicated &Ambitious

Key Steps to Get Things Right in Year 1

• Consider offering a PA student placement

• Identify specifically what you want to gain from employing a PA

• Designate a named main GP supervisor

• Provide a sincere welcome, a full induction programme & AVOID dividing the workload across the PCN too early

• Structure the first year meticulously with active review checkpoints every 3 months

• Staged consultation times, duty supervision & debriefing

• Involve the PA in service planning, performance reviews and setting goals

• Provide weekly education, regular mini CEX, case based discussions & opportunities for CPD/portfolio

• Acknowledge achievements - involve the PA in structural plans, seek their opinions

‘Physician Associates and GPs in Primary Care: a Comparison’.

Vari M Drennan et al (2015)

Br J Gen Pract;

65 (634): e344-e350

Evidence

• Direct Feedback -

“I consider my PA to be at the level of a GP registrar, she’s fantastic! ” (GP, 2020)

• Serial Employment -Three PAs employed over three successive years

• ‘Team PA’ -Four PAs taken on within 12 months (two separate PCNs)

Physician Associate

2020

Dr Anthony Leung

BADGERSWOOD & FOREST SURGERIES

14,800 patients

0.5% per month growth

9 Doctors, 5 Nurses, 2 HCA’s, 1 PA

2 Practice Managers, 18 Support Staff

2 Pharmacies

Culture

Reputation

PEOPLE, VALUES

History of the role

• 1957 - Chair of Medicine at Duke University, Dr Eugene stead and Thelma Ingles, RN, begin programme to train nurses to provide direct assistance to Physicians

• 1965 - Physician Assistants were developed in the USA after a shortage in primary care health manpower. Ex-Navy corpsmen trained as PA’s

• 1970 Consortium of PA Programs establish registry to regulate role

• PA role has been established in the UK since 2005 with over 200 practicing in the NHS

Physician Associate Roles

Clinical Non-Clinical• New Patients• Specialty Reviews• Minor Illnesses• Complex Patients• Procedures• Audit• Results• Paperwork• Home visits

• Vanguard• Representing the practice• Commercial matters• Pharmacies?• Prescribing?• Research• Teaching

A VISION FOR HEALTH IN BORDON NEW TOWN

Dr Anthony Leung

GP PARTNERSHIP REVIEW

NIGEL’S FINDINGS

PARTNERSHIPS

Workload

• Intelligent delegation

• Digital enablement• Culture

Workforce

• Can do

• Think beyond the pond• Make them proud

Risk

• Diversification as mitigation

• More intelligent than size

• Opportunity requires different thinking

Ria Agarwal

PA-R (Working in General Practice since 2013)

Senior Lecturer Sheffield Hallam University

Allied health representative RCGP SYNT

What can a PA bring to your team?

(and what could you offer in return?)

My background:

• BSc Hons Biomedical Science (special interest Neuroscience) 2.1 University of Sheffield 2009

• 2009-2011 Bank HCA for 1 year at Bakewell and Chesterfield Royal hospital, and then at SCH for 1 year full- time. Also assisted in running a group for young people with learning disabilities

• Qualified from St Georges University of London Sept 2013

• November 2013-July 2015: first PA job- GP surgery in Skipton (thank you)

• August 2015- GP surgery in Sheffield 3.5 days a week, eventual lead up to co-supervising junior PAs

• January 2016- Started working at SHU part time teaching on PA program

• August 2018- Passed my Recertification exam (phew!)

• September 2018- Started PGCert to become Associate Trainer- now completed (phew!)

• Ad hoc mentoring Sheffield newly qualified Preceptorship GP PAs on Band 6 Internship & linking in with other regions where required

• Other bits and bobs: National Examiner Board role, talks at Universities/other Preceptees about PA life

A day in the life of…

• morning and afternoon clinics (on- call GP on hand if needed) : new complaints and follow-ups e.g. mental health, vague symptoms patients, medication reviews, QOF work

• Take history, examine, diagnose, manage• Order and interpret investigations• Sick notes, x-rays and prescriptions to be signed by a doctor • Lunch break- do referrals for patients into secondary care (hospital), go

through the bloods inbox, discuss patients with colleagues at “coffee” with the GPs

• On hand to support other team members and seeing extra’s/ helping on duty doctor triage list

1 “A clinical friend”

Disclaimer for picture: Do not try in COVID!

• Extra “pair of hands” to medical team

• Life experience prior to PA

• Less time-pressured (slightly!)

• “The three (PAs) we have are excellent Team members, well liked and valued by the rest of the Team, have integrated well with the ANPs and Nurses as well as GPs and have earned their respect. They are an essential part of the PHCT and well accepted and liked by patients too- some of whom prefer them to the GPs”

2 Role development Clinical: QI projects/ audits, development of a special interest, nursing home visits

Malleability allows dual clinical role development

Education:

Debriefing and supervising more junior PAs within the surgery

Medical, nursing and PA students and junior doctor teaching, clinical meeting contributions

Educational sessions to upskill nursing staff and healthcare assistants

External to practice- opportunities to be involved with local HEIs e.g. OSCE examining at Sheffield Hallam University

National level- Physician Associate ambassador roles, FPA roles, National Examining contributions, member of medical specialty subgroup boards

Research/ Other

(With thanks to Dr Natalie King for the image)

https://bjgplife.com/2020/11/02/viewpoint-a-proposed-role-for-physician-associates-pas-in-palliative-care/

May be more approachable than GPs to other team members e.g. nurses and receptionistsPermanent member of team- ‘know how things work’ at the surgery “social secretary” roles to boost morale and team building!

“They are enthusiastic, willing and eager to learn and take on responsibility. They have brought a breath of fresh air to the Practice and we cannot now imagine working without them”

3 Bridging the gap

What could you do in return/ to retain them

Feed their ‘ikigai’:

- Study leave (CPD requirements)

- Appropriate Renumeration

- Team member integration

- Person-centred appraisals

- Encourage mutually beneficial special interests

- Appropriate level of supervision for their experience

Modified Maslow’s hierarchy

Picture taken from: https://www.servicefutures.com/can-maslows-hierarchy-needs-help-understand-employee-engagement

Comments from Sheffield PA supervisors

Research paper here: https://www.rcpjournals.org/content/clinmedicine/20/6/e255“They have shown themselves to be capable of far more than we expected, provide holistic care, are very motivated to learn, flexible, responsive and willing to see a wider range of presentations than ANPs , for example, treating young children, mental health and social problems. Their home visiting skills are far better then those of the average GP. They have also been mentoring PA students.”“Patients are generally very happy with the service provided by our PA clinicians . They often request them by name”“Our PA is a valued and well liked member of the practice team. Her clinical knowledge is very good, she works extremely well independently but demonstrates good self awareness about when to ask for help.”

Preceptorship scale in Sheffield

Further resources

• https://bjgplife.com/2020/11/27/life-as-a-physician-associate-bp-before-primary-care-preceptorships/

• https://www.fparcp.co.uk/employers/pas-in-general-practice

• https://drive.google.com/file/d/1ZXjDTvjeAq-9DufDt1ZlQezBu0hXgexC/view?usp=sharing (‘Hot off the press’ Booklet developed by one of our Sheffield Hallam University alumni and Physician Associate Ambassador)

• https://youtu.be/VV2xVYkFYwg Video from the perspective of a newly qualified PA and their employer

@riaagarwal19

Supporting PA recruitment

Candidate attraction

Employee Value Proposition(EVP) – What makes you stand out to candidates?

• Define the team/employer/values/culture • Define the role • Define the person you want • Define the offer (Salary, compensation &

benefits)

Physician Associate candidate attraction

What are the basics of an offer to attract PA’s

• Band 7 AfC, start of band for NQPA – but use salary not AfC bands• Preceptorship / supported training in 1st yr.• Annual study leave allowance• Training and education • A retention plan beyond yr1• Opportunity to develop subspeciality within GP• Future leadership opportunities • Get PA’s involved in education & student PA’s learning• Maximise use of PA’s to the fullest extent of their scope of practice to ensure benefits• Reimbursed top up indemnity

Key Points to NQPA recruitment

• National exam results dates 2021 - March, June and Nov – plan recruiting accordingly• NQPA’s are looking for preceptorship / supported training in 1st yr.• NQPA’s want to join practices with a forward plan for their career – as an employer,

have a clear EVP – What’s your offer?• Recruit PA’s committed to GP, not just looking for a 1st job• Highly competitive recruitment environment – more jobs than PA’s • Manage expectations of everyone in the practice• NQPA’s are not suited to multi-site working for at least 3-6months and until the

Supervising GP is confident in the PA’s competence. • Enable peer networking for PA’s• Planning is essential – Plan recruitment, plan preceptorship and training, plan for

longer term development (and plan to call PATH!)

Plan your recruitment

• Do you have a preceptorship in place?• Who is going to manage the recruitment process? (queries, shortlisting,

rejections, acceptance and HR / background checks)• Do you understand HR compliance requirements for PA’s?• Who is going to write the advert, JD & PS?• What is your recruitment budget per role?• When are you ‘going to market’?• How are you going to stand out from the the crowd? (advertise and

promote)• Review stages to change tactics • When are you going to interview and how?• What is the Onboarding and induction

Where to attract candidates?

• Via local University programmes / offer PA student placements

• Local PA Ambassadors• Incentivise referral and recommendations• NHS jobs – open to swamping & bureaucratic • Indeed/Monster/Reed – Are the candidates

there?• CV Library / CV databases• www.your-path.com jobs site• Use PATH recruitment services• GoogleAds/web/Social Media/influencer ads

Where are my candidates and how do I find them?

Candidate attraction

• Sell the area, sell the employer, sell the role• Make it easy & quick – Do you really need a

letter and completed application form? • Don’t expect candidates to find you• Be realistic – your ad is unlikely to go viral• To be successful, you need to spend money• To stand out you will need a clear offer• Don’t be afraid to change tactics, run multiple

different ads or go full spectrum• Respond quickly, candidates have a habit of

wandering off.

To be successful in attraction you need to plan

www.your-path.com

Free Physician Associates in GP jobs board

This is a jobs board used by PA students and employers specific to General Practice

For all enquires, contact

[email protected]

www.our-path.com