Spotlight series – physician associates in primary care

Physician associate (PA) Vima Gomes qualified in 2014 from the University of Aberdeen and began working in primary care in 2017. Having recently joined New Dyce Medical Practice, Vima is a PA general practice representative on the PA Board for NHS Grampian.

What made you decide to become a PA?

I have always been interested in pursuing a career in healthcare and studied biomedical science with human anatomy for my undergraduate degree. During my third year, the University of Aberdeen launched Scotland’s first PA course. While I wasn’t 100% sure what route I would take in healthcare, I knew I wanted to work in a patient-facing role, and I began researching PAs online. I came across the history of the role from its initiation in the American healthcare system and realised how integral PAs were in providing stability to the American medical model.

I saw a potential for the role in the UK NHS medical model and particularly liked the idea of working as a generalist healthcare professional. It so happened that the timing was just right for me being in my third year. I applied for the subsequent cohort and was thankfully successful.

Can you tell us more about your experience working as a PA in primary care? 

When I first qualified, I worked as an intern in haematology, psychiatry, and geriatric medicine, and was then offered a permanent post in haematology. This was a very specialised role which I thoroughly enjoyed as I learned a lot of skills, including performing bone marrow biopsies. However, I knew I wanted to work in a more generalist area of medicine, and at this point, after working in secondary care for nearly 3 years, I moved into primary care. There wasn’t an internship opportunity for me, but during my student placements, I had worked in a primary care setting for a month and had enjoyed the generalised approach.

Since moving to primary care in 2017 and transferring from a secondary care setting, it was a steep learning curve, certainly in the first few years. I started treating patients with minor illnesses initially and then moved on to more complex cases. That’s what I enjoy about primary care – no two days are the same and there are varying levels of complexity.

Vima Gomes

What diagnostic/investigation/procedural skills have you gained?

Since I moved from secondary care into a primary care setting, I’ve had to adapt my knowledge and use my transferable skills to cater to a more generalised working environment. Telephone triage isn’t performed regularly in secondary care, and this is an area I have developed. Having the skill to filter what needs to be seen physically versus what cases can be diagnosed virtually is something I am proud to have significantly developed. In addition, the skill of focused history taking with time constraints is also something I have developed over time. Of course, this is something you learn while training, but it is vital in a fast-paced, high-pressure general practice environment.

Chronic disease management is another area I continue to develop. Providing an integrated care plan and being a constant support to my patients in this area is rewarding. I’m present from the initial investigation stage, through to continued check-ups and treatment coordination. In the future, I hope to become more involved in minor procedures. I also have an interest and desire to develop my expertise in women’s health.

How would you describe the impact your role as a PA has had in primary care?

Currently, two PAs are working in my practice, and my priority is to work alongside the urgent care team managing unscheduled cases. This element of primary care is unpredictable, and as a PA I am there to manage this process alongside the duty GP and advanced nurse practitioners. Alongside telephone triage, I have also performed face-to-face consultations for complex unscheduled care presentations since COVID-19. Previously, I would see a varied mix of complex minor cases alongside chronic disease reviews.

There is also a large portion of paperwork generated from hospital discharge, which is vitally important but time-consuming. The PA team is responsible for dealing with all discharge paperwork from secondary care and the out-of-hours GP service. I’m also involved in quality improvement and undertake several audits. We’re then able to use those to implement important changes and provide our patients with an improved standard of service.

What do you find the most enjoyable and rewarding being a PA?

I had always wanted to work in a patient-facing role and getting to see the positive difference we have in patients’ lives is so rewarding. I thrive working in a generalist environment and as part of a highly skilled team as I am continually learning and growing my knowledge base.

When I reflect on the growth of the PA profession since my early days, it is encouraging and motivating to see that there are many more opportunities for us now. There is certainly scope for exploring other avenues alongside clinical work. For instance, research and teaching, which I would like to explore in the future.

As a PA working in primary care what challenges do you face?

Our main challenge is the lack of prescribing rights. In general practice, it limits how efficiently you can work in the already limited consulting time offered per patient. Alongside this, not being able to request ionising radiation can also be considered a challenge.

I feel that the PA profession is more established in England. In Scotland, the role is growing but at a slower pace. It can feel isolated as there is a smaller community of us, but more representation for us is on the horizon and we’re welcoming the new Devolved Nations Group from the FPA. I’m also a GP-PA representative at the Grampian PA Board, campaigning for improvements in the profession and supporting our local PAs. 

What does the future look like for you as a PA?

Due to COVID-19, I haven’t been able to get as involved in minor procedures as I would have liked. This is an area I would like to develop and I will then be able to offer my practice an additional skillset.

We’re lucky that as a profession there are endless opportunities for us to learn and grow. I would like to get involved in helping to create further awareness of PAs in primary care to help encourage more of us to join the specialty.

What advice would you give to a PA looking to practise in primary care?

I would highly recommend researching the primary care setting. Understanding how it works and where PAs fit is important. The pressure of a general practice environment is different from a secondary care setting, and it helps to be as aware as possible.

Gaining work experience in a general practice setting would also prove beneficial. Secondary care experience in an acute or a general medical setting, for example, would also be useful.

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