Physician Assistants
Associates: the new
clinical profession
PA education & training
Jim Parle, Course Director, PA PgDip
Chair of UKIUBPAE
University 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)
How does a Physician Assistant (PA) work?
• 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.
What do PAs do?
• Work like doctors
– Listen/gather information
– Differential diagnosis
– Investigations if needed
– Treat/counsel/medicate/refer
Senior Trainees contribute to
supervision / training of the
Permanent Medical Team
Those moving from
other disciplines into
training
Consultants
Increasing acuity and
complexity
Care delivered directly
or appropriately
supervised by a
permanent medical
team familiar with the
unit
senior trainees
Consultants provide
supervision
permanent (non-consultant)
medical team
ED patients
Those gaining experience in
as part of other training
programme
FY1/2; GP trainees
Those in training
to be part of the
permanent
medical team
Those in specialist
training with the
intention of gaining an
consultant post
patient care
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 .
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
Competencies
Procedural Skills
Matrix of Conditions
Programme Specification
~ 3200 hours over 2 yrs
~ 50% clinical
(incl. 200 simulation hours)
~ 50% theory
http://www.ukapa.co.uk/files/CCF-2703-12-for-PAMVR.pdf
Who are they?
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All are graduates
Backgrounds in health or life sciences
Average age ~30
~2/3rd are female
Calendar Year UoB course: 46 weeks per year, F/T
Theory focus
General Practice
Clinical focus
Hospital
Holiday
Clinical
Skills/simulation
Clinical time
A&E
5%
Mental health
7%
O&G
7%
Paeds
7%
General Med
55%
Surgery
7%
GP
12%
National assessment
Expertise in
Communication
Skills
National Core
Institutional
Core
National Centre for
Immunology
Scope for student
selection
High level of
Sickle Cell
Anaemia in
Population
UoB student placements (current in italics;
outside WM in red)
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–
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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
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(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!
PA graduates
250
mumbers per year
200
150
100
50
0
2008
2009
2010
2011
2012
2013
2014
2015
Employment
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~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)
UoB grad Physician
Assistant posts in UK
Hospitals (excl. GPs)
Scotland
Lothian University Hospital
Midlands
University 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 Staffordshire
Shrewsbury & Telford Hosps
South & London
St George’s Healthcare
Royal National Orthopaedic Hosp
North West London Hosps (Northwick Park)
Weston Area Health (Somerset)
Great Western Hospitals (Swindon)
Kingston Hospitals
Epsom & St Helier University Hosp
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
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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
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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 years
100, 000 PAs certified
1PA:9 MDs qualifying
Australia
Canada
South Africa
Taiwan
England
Scotland
Netherlands
NZ &&&
Thank you
j.v.parle@bham.ac.uk
More info:
www.UKAPA.co.uk
www.ukiubpae.sgul.ac.uk/