Physician Associate: A Modern Healthcare Solution

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

2. European Working Time Directive (EWTD) Modernising Medical Careers Resources- reduction in funding; ageing population increasing expectation and medical complexity Arole for the ‘new’ NHS?

3. ‘ 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 PhysicianAssociate what is it?

4. 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 Physician Associate what is it?

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. 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 Physician Associate What are the Benefits?

7. Advanced Practitioner Physician Associate • 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 Physician Associate / Advanced Practitioner

8. 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 thecontinued supervision that a PA requires Insufficient experience and exposure across the different specialty groups Bolton Community Practice

9. 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 Bolton Community Practice

10. 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 Recommendations

11. 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 Thoughts…

12. 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 Thoughts…..

13. Develop a diverse Primary Care workforce that reflects the diversity of the populations we care for. Any Questions ?