Guidance for employers and supervisors

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Guidance for Employers and Supervisors

Physician associates are healthcare professionals with a generalist medical education, who work alongside doctors as an integral part of the multidisciplinary team. Physician associates work under the supervision of a fully trained and experienced doctor. 

At the FPA, we're here to help guide and support employers who employ PAs or are looking to employ them in the future. We are currently reviewing and updating our employer guidance document and our previous guidance is no longer available to download. If you're an employer with a specific question or query, please get in touch with us via [email protected] for support during this time.*

*Updated June 2023. 

If you’d like to talk to a PA directly about the scope and potential of the role within your organisation, Health Education England run a PA ambassador programme. These are experienced individuals working in primary and secondary care. Make contact in your area to see what ideas, advice and support they can offer.  

SW England: [email protected] 

London: [email protected]

South Yorkshire: [email protected]

Yorkshire, Humber, Coast & Vale: Billie Lowson (primary care), [email protected] & Declan McHugh (secondary care), [email protected] 

West Yorkshire: Asad Khan (primary care) [email protected]

NE England & Cumbria: [email protected]

NW England: [email protected]

SE England: [email protected]

East of England: [email protected]

Midlands: [email protected]

 

Employing a physician associate 

We strongly recommend that employers only consider recruiting physician associates who are registered on the  Physician Associate Managed Voluntary Register (PAMVR) . This is a register, managed by the FPA, of fully qualified physician associates who have been declared fit to practise in the UK. It enables supervisors and employers to check whether a physician associate is qualified and safe to work in the UK. American trained physician associates are required to have and maintain their National Commissions on Certification of Physician Associates (NCCPA) to work in the UK, and should also be a member of the FPA and listed on the PAMVR.

Because physician associates await statutory regulation, employers are strongly advised to be diligent in their recruitment process. Any job description advertising for the role must state that it is essential for applicants to hold a PG Diploma or MSc in Physician Associate Studies from a recognised UK or US programme, and that they have passed the UK Physician Associate National Exam. American trained Physician Associates would be required to have and maintain their National Commissions on Certification of Physician Associates (NCCPA) to work in the UK and should also be listed on the PA-MVR.

Please note that national exam results can take up to six weeks to be released. PA students who have passed the PA national exam will then need to apply for FPA membership to be added to the PA MVR. Employers should consider this when setting PA employment start dates.

We would recommend that employers keep abreast of the  FPA national exam dates   and ensure that graduates are aware of recruitment opportunities in good time to submit applications in advance of completing the FPA national exam.

Physician Associates Professional Dress

The FPA has received numerous queries about Physician Associates in the UK wearing uniforms and what our position on this is.

It is clear that PAs have a distinct role and remit within a wide and varied healthcare team. It is important that PAs can identify themselves and be identified by patients and other staff groups. It is also important that PAs can identify with the medical teams with whom they work. In the UK the majority of PAs do not wear a uniform (unless working in ED or surgical specialities where their medical colleagues also wear uniforms) and there is no national or professional body requirement for PAs to wear a uniform.

A standard uniform policy is therefore not obligatory and we understand, having listened to our patient representatives that this does not generally affect the patient- medical professional experience.  The most significant concern for patients tends to be about  receiving correct and appropriate medical care and less about knowing which member of the extensive care team delivers it.

We do however recognise that individual trusts have their own policy on how they manage visibility of different healthcare professions including PAs and that some will provide uniforms as a key identifiable feature. We would recommend that members of the healthcare team should be clearly identified with a name badge which includes their role and should introduce themselves to the patient. Please refer to the FPA titles and introduciton guidance document. 

Professional Indemnity Coverage

Physician associates require professional indemnity coverage in order to practice in the UK. The cost of this coverage is typically paid for by the employer. Physician associates and other hospital staff employed by a secondary care trust may typically have some form of indemnity provided through their employing trust, as will those working in primary care through their practice; however, this should be discussed with the employer.  Additional coverage through providers such as  Medical Defence Union (MDU)  , Medical Protection Society (MPS)  and  Medical and Dental Defence Union of Scotland (MDDUS)  may be advisable depending on the physician associates' roles and duties.

How are PAs indemnified in Primary Care

Physician associates working in general practice benefit from the same state-backed clinical negligence indemnity as their general practice colleagues.

There are two general practice indemnity (GPI) schemes, which you can read more about  on the GPI webpages on the NHS Resolution website:

  • Clinical Negligence Scheme for General Practice (CNSGP); and
  • Existing Liabilities Scheme for General Practice (ELSGP).

Whilst cover under both schemes is automatic, with no need to register and no need to pay, there are some things that the schemes do not cover and physician associates will need private indemnity cover for these.  This is especially true of the ELSGP where, as PAs will be covered under the ELSGP only if at the time of the incident giving rise to a claim, they were employed by a general practice where the partners were beneficiaries under the ELSGP.

How are PAs indemnified in Secondary Care

Physician associates working in secondary care are indemnified against clinical negligence through their employer’s membership of the Clinical Negligence Scheme for Trusts (CNST), administered by NHS Resolution. All NHS trusts are currently members of the scheme, as are a number of independent sector providers of NHS care. Make sure to check that your employer is a member.

If an employer is not a member, or the PA is involved in the private care of patients, they should check with the NHS or HSC body employer what indemnity is in place.

There are some things that the CNST scheme does not cover and you will need private indemnity cover for these. This includes access to personal regulatory and medico-legal support and advice. CNST only applies to NHS bodies in England, the devolved administrations have separate arrangements.

 

The supervisor and physician associate relationship

Physician associates' ability to practice is enabled by collaboration and supportive working relationships with their clinical supervisor, meaning that there is always someone who can discuss cases, give advice, and attend to patients if necessary.

Supervision of a qualified Physician Associate is comparable to that of a doctor in training or a trust grade doctor, in that the physician associate is responsible for their actions and decisions; however the consultant is the clinician who is ultimately responsible for the patient. 

As a clinical supervisor there is also a responsibility for ongoing development of the PA including appraisal and development of a professional development plan (PDP).

The first year 

Employers of newly qualified physician associates, or of those who have just moved to a new specialty, may wish to offer a one year “internship” so that the physician associate is able to consolidate their core knowledge and skills, and demonstrate their competence in practice. During this period, they should be supervised more closely, have experiential leaning in the clinical area in which they are working, and should maintain a portfolio of cases and case discussions with clinicians which may also be reviewed with their clinical supervisor.

The  FPA Code of Conduct  may also be of use. As it sets out the key areas that the FPA deems of particular interest including, professionalism, knowledge, skills, risk analysis and communication.

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