Physician associates in general practice

There's a short 3 step guide to recruiting a PA along with a job description and person specification template that you can download at the end of these FAQs. These resources are for guidance and may be adapted as required.

We strongly recommend that any employer looking to recruit a physician associate checks the applicant is registered on the Physician Associate Managed Voluntary Register (PAMVR).

We know there are not enough practice nurses or advanced nurse practitioners working in general practice. As an additional role, physician associates can supplement and complement GPs and nursing staff. It means that more clinicians are being trained, rather than ‘poaching’ from other professions – such a nursing that also have a shortage.

Over recent years there has been a steady increase in the number of large partnerships resulting in the consolidation and growth of a number of GP patient lists. In turn, the traditional staff roles have expanded and developed to meet the needs of the practice.

In addition to being supervised by and working with GPs, PAs may work with:

• General practice nurses including advanced nurse practitioners
• Healthcare assistants
• Clinical pharmacists
• Paramedics
• Mental health therapists
• Physiotherapists
• Practice managers
• Reception and clerical staff

In some parts of the country, it’s more difficult to recruit GP trainees. As an alternative clinical role, PAs can help a practice deliver a good service for patients and their work can be moulded to both fit the needs of the surgery and the interests of the individual PA. As an employee, rather than a trainee, they do tend to have a longer term commitment to the practice and can deal with many common conditions from day 1. It’s what they’re trained to do. As their experience increases, PAs are able to deal with a majority of patients who present at the surgery and the level of supervision naturally decreases. 

There are currently 30 active programmes with more planned to open in 2018. There are approximately 1500 total students with an expected 2000 annually from 2019 (1000 in each year of the 2-year course). Demand for places at some universities is very high, with 5-10 applicants per place. 

No – PAs can work across a range of healthcare settings. In fact, if they commit to starting work in primary care, there’s a £5000 preceptorship allowance to support the supervision and educational needs for any qualified PA working in primary care for their first year from Health Education England (HEE). The money can be used towards additional study, supervision, coaching or mentoring. 

We have a list of active PA programmes with links to their websites and contact details. Most course directors are happy to speak with clinicians or practice managers about their students/graduates and the profession.

It’s easy. Advertise and interview. You can find more information and useful resources such as job description and person specification templates under the resources section. There are details of area contacts who can help advise you too. You might also team up with neighbouring practices, or approach your local training hub (community education provider network or advanced training practice) for support and advice.

It’s worth noting that qualified PAs are listed on the Physician Associate Managed Voluntary Register (PAMVR). Anyone on this register has successfully completed the university programme and passed the PA National exam. It is advisable to only hire PAs who appear on this list, until such time that PAs gain statutory regulation.

PA graduates can be useful from the beginning of employment. But as in any other new appointment, they will need regular supervision and further training to mould around practice needs and develop individual strengths. As with all clinicians, the team’s working relationship is the key to quality and efficiency. PAs are not likely to see large numbers of complicated patients at the start of their careers but this will develop over time and the level of supervision will naturally decrease. There’s a £5000 preceptorship allowance to support the supervision and educational needs for any qualified physician associate working in primary care for their first year from Health Education England (HEE). The money can be used towards additional study, supervision, coaching or mentoring.

 Many GP surgeries are expanding their teams of non-doctor clinicians to include other groups such as pharmacists, paramedics, advanced nurse practitioners as well as physician associates. These clinicians can all contribute to the overall running of the surgery to help provide safe and competent clinical care for patients.

In some parts of the country we know it can be near impossible to recruit enough general medically trained staff to cover practice needs. The introduction of the physician associate role means there is a chance to increase workforce numbers rather than ‘poaching’ from an under resourced pool.

Qualified PAs may develop specialist expertise that reflects the specialty of their supervising doctor. This will be gained through experiential learning and CPD. A PA is expected to maintain their broad clinical knowledge base through regular testing and maintenance of general clinical skills.

Anecdotally there have been some reports about reluctance to adopt any sort of workforce change. This is an understandable concern and we know that views do alter over time with experience.

There are a number of simple guidance posters (GP Team explained under the FAQs) that can help explain where the PA role fits into a practice team. 

The PA role in primary care varies and tends to develop according to the needs of each practice. Trained in the medical model, PAs are qualified to see the range of patients from infants to elderly people. PAs may effectively free up a GPs’ time

In short they can take medical histories, perform examinations, develop differential diagnoses, analyse test results, develop management plans and refer patients as required.

Some examples of their activities could include:

• Patient consultations - same day acute illness and booked routine appointments
• Telephone triage
• Residential, nursing and home visits
• Managing chronic conditions lists (such as COPD or diabetes patients)
• Running clinics (sexual health, family planning or minor surgery for example)
• Reviewing, analysing and actioning diagnostic test results
• Support to meet clinical targets
• Providing health/disease promotion and prevention advice for patients
• Co-ordinating research activity

 There’s more information including a short video under Who are physician associates?

Many new graduate PAs begin work at a salary of £31,696 (equivalent to an NHS Band 6/7 salary). Depending on the level of experience, a PA will be able to manage a proportion of a GPs workload acting in a supportive and complementary role, freeing up a GPs time rather than as a substitute.

A study by Drennan et al (2015) compared aspects of physician associate consultations with those of GPs. It found that processes and outcomes of PA and GP consultations for same day minor illness patients were similar, while the cost was cheaper. Anecdotal evidence from GPs suggests PAs can contribute to reducing GP workload and freeing up time.

As you might expect, GPs report different benefits according to the need of each practice. There are a number of short case studies that can help to give you a better idea of how PAs are most useful in a primary care setting. Or use the local contacts on this page to be put in touch with a practice who employ a PA in your area and can offer a first-hand practical point of view.

If you’re thinking about taking a student physician associate on clinical placement it may be useful to know that across the UK most self -fund their tuition costs. Health Education England provides a support payment for each physician associate programme and clinical placement to help students gain experience in a good learning practice environment. Remuneration is available to support these learners based on an agreed national scale.

Course providers have been asked to increase clinical placement time for student PAs in primary care from 180 up to 510 hours in England.

There is a £5,000 preceptorship allowance to support the supervision and educational needs for newly qualified physician associates working in primary care in England. Get in touch with your HEE area lead (details on this page) for more information including the process for application and payment.

As an initial guide the preceptorship programme eligibility criteria is listed below:

• The preceptorship programme will be undertaken for a minimum of a 1 year (WTE).
• Open to all PAs commencing a programme in the year after gaining registration on the national register.
• Normally the preceptorship programme will be wholly in primary care, but a minimum of 50% or 6 months’ full time equivalent in any rotation of placements should be in primary care.
• The weekly timetable should include at least 1 dedicated session for education.
• Placements should have an educationally approved primary care clinical supervisor.
• The programme should have a mentor available from an appropriate education organiser (e.g. HEI, HEE, Training Hub) and describe a process for preceptees to feed back on their programme.
• The preceptor should have an induction period – a meeting with their supervisor, with mid-point and an end of programme review.
• The preceptor should take part in the employer’s annual appraisal system.
• Access to a professional development programme from a local HEI or equivalent should be available which will include alumni activity.
• The preceptorship programme should enable the post–holder to engage in multi-professional learning activities.
• Where the post-holder’s objectives include a further course of study, this should usually be funded from the support payment. This could be up to the cost of a postgraduate certificate qualification if appropriate for the preceptor and the service context. This funding should be used flexibly to meet the needs of the preceptor.
• Individual post–holders will be expected to complete and maintain all the requirements of the UK PA managed voluntary register (PAMVR).
• Ideally the preceptorship programme will set out expected outcomes for the preceptor in the form of competence acquisition or a brief curriculum which may be locally derived but based on established national guidance, eg the FPA guidance.

When new roles are introduced there is bound to be an amount of speculation and misunderstanding until the benefits of the role are better understood and established. It’s worth remembering that the PA role does not replace a GP. There is significant evidence (see under research) that PAs are safe clinicians. They are trained in the medical model to consult, examine, understand the patient’s problems and plan care. They have to complete a rigorous, academically demanding programme to qualify.

Physician associate courses in the UK all follow a national curriculum and competence framework.

All physician associates must have a:

• relevant degree (for example bioscience or healthcare-related) and
• postgraduate diploma which takes two years of full time study to complete.

The current curriculum framework specifies that a PA will have successfully completed a Masters level 1 academic programme of no less than 90 weeks leading to a Postgraduate Diploma in Physician Associate Studies. It also recommends that newly qualified PAs undergo a period of preceptorship to consolidate and practise learning.

All PAs must pass a national exit exam covering knowledge and skills developed and administered by the Faculty of Physician Associates. This includes a written assessment (multiple choice) and a practical component known as an OSCE (examination of consulting and procedural skills). Revalidation is required every six years by passing the written test along with an annual appraisal (recommended with a GP) and a requirement to complete 50 hours of CPD -  to remain on the voluntary register. 

At the moment, physician associates are not regulated under statute, so they work under the ’delegation clause’. This means they are the responsibility of the supervising doctor. According to GMC guidance, doctors can delegate tasks to non-clinicians but must be sure that person is capable. PAs are indemnified in the same way as doctors.

Health Education England and NHS England will work with the government to take forward work to introduce prescribing rights for PAs. This process follows a timeline which began in 2017 with the government consulting on proposals to consider regulation of medical associate professionals.

On 12 October 2018, secretary of state for health and social care Matt Hancock announced the introduction of statutory regulation for physician associates and physician assistants in anaesthesia, following direct engagement with the NHS workforce. You can track the progress of the bill via the UK parliament website.

NHS England is developing a state-backed indemnity scheme for general practice in England. It is likely to cover tasks being delivered under a GMS/PMS/APMS contract including all medical roles working in a general practice setting.

Clinical support can be provided by any clinician who is trained and qualified to complete a required task - for example, a practice nurse can support a student PA in learning peak flow and spirometry procedures or help a qualified PA to complete a smear taking course. It’s usually a GP because PAs assess and treat patients in the same way. 

Many patients already have appointments with non-doctor clinicians. A small study focussing on acute GP visits published in the UK concluded that patients were happy with the service provided by PAs and would make future appointments.

There are some additional FAQ's on page 7 and 8 of An employers guide to physician associates.