Physician Assistants Associates: the new clinical profession

PA education & trainingJim Parle, Course Director, PA PgDip

Chair of UKIUBPAEUniversity of Birmingham

December 2013

A Physician Assistant is

“…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.”

(The Competence and Curriculum Framework for the Physician Assistant, Dept. of Health, 2006; recently revised)

• to the medical model and ‘credentialed’ to practice medicine with physician supervision

• within the scope of practice of their supervisor• as dependent practitioners• in a relationship between doctor and PA which is

based on mutual trust and respect.

How does a Physician Assistant (PA) work?

What do PAs do?

• Work like doctors– Listen/gather information– Differential diagnosis– Investigations if needed– Treat/counsel/medicate/refer

patient care

Increasing acuity and complexity

Those moving from other disciplines into

training

Consultants provide supervision

Cons

ulta

nts

seni

or tr

aine

es

Senior Trainees contribute to supervision / training of the

Permanent Medical Team

permanent (non-consultant) medical team

ED patients

Those in training to be part of the permanent medical team

Those in specialist training with the intention of gaining an consultant post

Those gaining experience in as part of other training

programmeFY1/2; GP trainees

Improving the experience of patients and trainees through the development of a broad-based permanent non-consultant medical team. Authors: Parle J and Ross N, University of Birmingham, September 2012 .

Care delivered directly or appropriately supervised by a permanent medical team familiar with the unit

PAs globally

USA – now a 40+ year history

~100,000 qualified

Canada (e.g. Military and now others: McMaster)

The Netherlands (n~700 from 5 programmes)

Australia (e.g. James Cook)

South Africa

Similar professions worldwide e.g. Ghana

Background to West Midlands programme development

• Initial interest from the NHS locally• Department of Health involvement: steering

group– Jointly chaired by Royal College of

Physicians & Royal College of GPs– NHS/patient/UoB membership

• West Midlands NHS backing (“SIFT”)

DH specification for PA education

Competence and Curriculum Framework 2012

CompetenciesProcedural SkillsMatrix of Conditions

Programme Specification

~ 3200 hours over 2 yrs~ 50% clinical (incl. 200 simulation hours)~ 50% theory

http://www.ukapa.co.uk/files/CCF-27-03-12-for-PAMVR.pdf

Who are they?

• All are graduates• Backgrounds in health or life sciences• Average age ~30• ~2/3rd are female

Theory focus

Clinical focus

Holiday

General Practice

Hospital

Clinical Skills/simulation

Calendar Year UoB course: 46 weeks per year, F/T

General Med55%

GP12%

Surgery7%

Paeds7%

O&G7%

Mental health7%

A&E5%

Clinical time

National assessment

Institutional Core

Scope for student selection

High level of Sickle Cell Anaemia in Population

Expertise in Communication Skills

National Centre for Immunology

National Core

UoB student placements (current in italics; outside WM in red)

– Heartlands & Solihull & Good Hope; – City & Sandwell; – Dudley group– University Hospital Birmingham– Walsall– Shrewsbury and Telford– Leicester Royal Infirmary– George Eliot– Stafford– Women’s, Children’s, mental health trusts– Northampton– GPs++

•

UK intakes

• (very small numbers pre-2008)• 2008: 15 UoB + 13 UoW + 15 St. George’s: 43• 2009: 59• 2010: 66• 2011: 21 St George’s + 11 Aberdeen medical school: 32• 2012: 39• 2013: 44• 2014: 44 + 30 UoB +?20 Worcester + ?20 Wolverhampton (~110) • 2015: ?36 St George’s +?26 Aberdeen +?80 UoB +?20 Worcester

+?20 Wolverhampton +?20 Barts +?20 Exeter +?20 Plymouth: (~240)

• others preparing business cases and others considering

NHS / Trust / HE relationship

• Who pays in West Midlands:– Currently students (small HE contribution)– Trusts pro bono/pro Trust!– GPs paid opportunity cost

• Sustainability?– New grads coming with bigger debts– HE/Gov’t HAS to fix:

• ‘loans’• Bursaries• As per graduate entry medicine

Commissioned?

• Old style model?• Flexible enough?• What about sponsoring/educational

contracts?

Student placement = long (mutual) interview!

2008 2009 2010 2011 2012 2013 2014 20150

50

100

150

200

250

PA graduatesm

um

ber

s p

er y

ear

Employment

• ~200 or so PAs• ~35 Trusts ~30 GPs• Wide range of specialties• Most started at 30k (ie ‘Band 7’ 30-40k)• A few at Band 6 (25-30k) internship• 3 at Band 8 (40-47k)

ScotlandLothian University Hospital

MidlandsUniversity Hospitals of Leicester George Eliot Hospital Solihull & B’ham Mental Health University Hospitals B’ham Sandwell & W. B’ham Hospitals Walsall Healthcare Dudley Group of Hospitals Mid StaffordshireShrewsbury & Telford Hosps

South & London

St George’s Healthcare Royal National Orthopaedic HospNorth West London Hosps (Northwick Park) Weston Area Health (Somerset) Great Western Hospitals (Swindon)

Kingston Hospitals Epsom & St Helier University Hosp

UoB grad Physician Assistant posts in UK Hospitals (excl. GPs)

Current Issues

Regulation & prescribing

Managed Voluntary Register → statutory register

Prescribing as integral to role rather than extension

Registering Body HCPC? / GMC?

Reaccreditation

First iteration of national licensing examination

Reaccreditation

• US model• Maintains PAs’ flexibility

– ‘stem cell’• 6 yearly cycle

– CPD– Re-examination in basic knowledge 200 mcq

questions

As NHS needs change, so can PAs’ skill set

Royal Colleges

• Royal College Physicians Faculty agreed• Royal College GPs• College Emergency Medicine• Royal College Obstetrics & Gynaecology• Royal College Paeds & Child Health• Royal College Surgeons

Recent reports/publicity

• CEM• RCP Future Hospital Commission• RCP, Dr Andrew Goddard, to NHS

employers, 2011:• Jeremy Hunt

– Times– Grauniad– TorygraphBBC/ITV/radio ++

Conclusion

• PA courses going well (with some hiccups)• Newly qualified PAs will still be beginners • BUT • Can make a substantial contribution to

continuity for - patients - health care teams

• Profession thriving

• Numbers rising

• Not ‘the’ answer; but part of the answer

USA 40 years100, 000 PAs certified1PA:9 MDs qualifying

Australia

Taiwan

Canada

South Africa Netherlands

Scotland

England

NZ &&&

Thank you

j.v.parle@bham.ac.uk

More info:

www.UKAPA.co.uk

www.ukiubpae.sgul.ac.uk/