Spotlight series – PA in general practice sexual health
The Faculty of Physician Associates (FPA) census report 2020 revealed that 30% of physician associates (PAs) work in general practice (GP). Brad Sewell is part of this cohort. Having qualified as a PA in 2020, Brad has since become the first PA in the UK to obtain the Faculty of Sexual Health and Reproductive Healthcare’s sexual health diploma, in May 2021.
Currently working for NHS Wales, Brad shares his story in celebration of his achievements.
What made you decide to become a PA?
I initially trained as a paediatric nurse and qualified in 2017. I thoroughly enjoyed it, but felt that I wanted to focus on more investigative healthcare. I considered joining medical school, but then I found the PA profession. It was the flexibility that drew me in, and after talking to PAs in the role, I felt confident that it was the right choice for me.
The PA role is still in its infancy, which is exciting, because it means there are additional opportunities in research and leadership.
Can you tell us more about your experience of working as a PA in general practice sexual health?
During my nurse training, I spent time with other services, as well as sexual health commissioners and public health managers. Seeing their work, and understanding that sexual health is much more than STI screening, really spoke to me. I joined sexual health clinics for further experience during my PA placements, and that’s when I became even more interested in the specialty.
There is a perception that sexual health only deals with STIs, but there is so much more to the specialty, and I enjoy exploring that. There are links between sexual health and vulnerable people, mental health, and safeguarding. I also love that working in general practice is very person-centred. We treat a diverse range of patients and cases, which range from potential emergencies to preventative medicine, meaning no two days are ever the same.
What diagnostic/investigation/procedural skills have you gained?
As a newly qualified PA, working in practice involves consolidating what you’ve learned during your course and becoming confident using this learning when working with patients. There’s a case I remember particularly well, of a patient suffering from vertigo. I was taught a technique on the PA course called the Epley manoeuvre, and I performed it on the patient in the hope it would help relieve symptoms. A couple of weeks passed, and the patient came back a completely different person, and was so thankful that their vertigo had vastly improved. Successes like that offer a great sense of accomplishment, and helps confidence to grow.
Working in sexual health has helped my confidence grow further, too. I’ve improved my ability in carrying out pelvic and speculum examinations in women and a range of other genitalia examinations. I have also recently obtained my letter of competence in the fitting and removal of contraceptive implants. This has given me a real sense of achievement, alongside gaining my diploma.
How would you describe the impact your role as a PA has had?
It’s an accomplishment to be the first PA in the UK to obtain a diploma in sexual health and to be pioneering the PA role in this area. When working in sexual health, I ran a PA clinic alongside the doctors, which meant that more patients could be treated, as we had two avenues of care.
In my PA clinic, I treat patients with both sexual health and general practice concerns. My practice benefits from an additional resource, thanks to my knowledge in contraceptive implantation. It’s exciting to see how the PA role is becoming a part of the wider sexual health service and proving to be beneficial in maintaining the throughput of patients.
What do you find most enjoyable and rewarding about being a PA?
It is a challenging and somewhat intimidating process for patients to be vulnerable about their sexual health. Knowing they feel comfortable, and can be honest with me about their feelings and concerns is humbling. I enjoy the flexibility of the PA role, too. I have grown my knowledge and skill base, and I understand elements from other specialties – something I wouldn’t necessarily be able to do in another healthcare role.
As the healthcare system continues to be under unprecedented pressure, more patients present with mental health concerns, and they appreciate having time with PAs. As I’m newly qualified, my appointment slots are longer, which allows me to spend more time with a patient to discuss their concerns. Building positive and trusting relationships with patients is one of the most rewarding elements of my role.
What challenges do you face as a PA working in sexual health?
The biggest challenge is role identity. During my PA student placements, I had to explain my role and what I was able to support with – and what I wasn’t. Since qualifying, I find educating patients helps to break the ice – especially with regards to mental health. I don’t receive negative responses; people are curious, and I find the older generations are more prone to asking more questions, as they are more accustomed to the standard doctor/nurse healthcare model.
Prescribing is the other challenge that impacts our profession, and this can be a barrier to completing a patient’s case independently. I’m hopeful that in the future, once regulation begins, that prescribing rights won’t be far behind.
What does the future look like for you as a PA?
A large portion is unknown, but that is the beauty of our profession. We don’t have a regimented structure – we can create our possibilities, which is exciting. I’ve recently begun teaching and lecturing. I thoroughly enjoy it and would like to build on this in the coming months and years.
I’ve recently joined the British Association of Sexual Health and HIV and will be part of an STI course committee to represent PAs. Clinically, I envision creating a GP clinic for young people to attend as a service development project. It would be so rewarding to offer them a safe place to discuss their sexual and mental health concerns.
What advice would you give to a PA looking to work in general practice sexual health?
My biggest tip would be to carry out research and use credible sources, including the FPA. Reading content that isn’t true or relatable can seem intimidating. Therefore, I made sure to discuss issues with qualified PAs during my research stage, which I found beneficial. Networking with employers and healthcare bodies and building positive relationships is also helpful, especially when the time comes to look for a role after qualifying.
We’re always looking for qualified PA FPA members to share their story. If you’re interested in sharing yours, get in touch using the contact details below. If you’re thinking of a career as a PA, you can learn more about how to begin your journey here.
Get in touch to share your PA story:
Jenna Donaldson – FPA Communications Officer