Developing the role of the Physician Associate

Transcription

1 Developing the role of the Physician Associate Mr. Alex Reynolds PA-R University of Reading Senior Lecturer in Physician Associate studies Physician Associate, St George s Hospital NHS foundation trust 6 th November 2017

2 Agenda 1. The Physician Associate role and duties 2. How can the Physician Associate improve patient care and benefit your workforce 3. Supporting the Physician Associate in their roles 4. Physician Associate accountability and regulation

3 1. The Physician Associate role and duties

4 What is a Physician Associate? 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

5 1. The Physician Associate role and duties Not all Pas have the same role, but there are a few consistencies across the country with all PAs: Performing diagnostic and therapeutic procedures Carrying out physical examinations Seeing patients with undifferentiated diagnosis Providing health promotion and disease prevention advice for patients Seeing patients with longterm chronic conditions Taking medical histories

6 1. The Physician Associate role and duties Not all Pas have the same role, but there are a few consistencies across the country with all PAs: All PAs have to pass their National examination to be allowed to practice as a PA and be on the MVR All PAs have to re-certify every 5-6 years - the equivalent of a DR doing their medical finals every 5-6 years

7 1. The Physician Associate role and duties Where do Physician Associates currently work? Hospitals Emergency departments Acute medicine Cardiology C.O.E Neurology Trauma and Orthopaedics General surgery Neurosurgery General practice Walk-in Centres Physician Associate educators And everything else in-between!

8 1.1 Secondary care Physician Associates Ward rounds Ward care/jobs Discharges Outpatient clinics Clinical governance Pre-operative clinics, optimisations Theatres Research

9 1.1 Secondary care Physician Associates Tasks performed by the majority of Physician Associates in secondary care: Scribing and documentation Assessment and clerking of new admissions Taking bloods/ placing IV cannulas Interpreting ECGs Urinary catheterisation Suturing NG placement And speciality specific jobs

10 1.2 Emergency Department PAs Take histories & examine patients in minors and majors Performing common procedures in the ED Developing management plans & facilitating discharges or referral to specialities. Can be used in UCCs Participating in clinical audits

11 1.3 Primary care and walk in centres Asses walk-in or same day appointment patients Able to manage chronic disease patients Follow ups Home visits Telephone consultations Specialist clinics - Minor ops, smoking cessation, heart failure clinics, travel clinics

12 2. How can the Physician Associate improve patient care and benefit your workforce?

13 2.1 Physician Associates in your workforce Your Physician Associates are permanent members of the junior medical team. The more you invest in them, the more they will provide.

14 2.2 Physician Associates complement your workforce PAs complement the workforce The Physician Associate is trained in the medical model and complements the whole healthcare team to bring skills into the NHS rather than taking away from existing services. The support which the Physician Associate provides, helps your doctors to focus on complex patients. They are able to support the doctor in their decision making and help the doctor make a decision in the patients best interest.

15 2.3 Continuity of care PAs provide continuity of care for patients & departments- they are permeant members of the medical team! PAs are often able to provide more time to the patients, helping build rapport and provide explanations

16 2.4 Institutional memory Physician Associates usually don t rotate trough specialties. Seniors doctors often rely on the knowledge of the PA to ensure the smooth running of the ward Patient familiarity

17 3. Supporting Physician Associates in their roles

18 2.5 Your workforce and the Physician Associate relationship Employing a PA is the easy part! Utilising the PA to the maximum potential is much, much harder! This is a new role Often is faced with scepticism Unsure of competencies and how much responsibility- a knee jerk reaction is to fence them in.

19 3.1 Supporting the PA in the workforce As the Physician Associate develops give them steady increases in responsibility Show the Physician Associate that the consultants are supportive of the role Allow for feedback and teaching Roles and responsibilities should co-inside with the confidence that medical team (and other staff members) has in the individual

20 3.2 Supporting the PA in the workforce All Physician Associates have on-going CPD requirements CPD- 25 hours of Type 1 and 25 hours of Type 2 CPD- Faculty of Physician Associate and Managed Voluntary Register membership requirements Training is important for departments to gain the most out of their Physician Associate Other courses & competencies can be offered depending on the needs of the department

21 3.3 But, won t they start taking away opportunities for my Junior Doctors? Yes/No Any one who is required to learn in the job will compete with others. However by training up your Physician Associate, you can allow your Physician Associate to teach the junior doctors!

22 3.3 But, won t they start taking away opportunities for my Junior Doctors? Lumbar punctures Prior to me being trained to perform LPs, the registrars had to help and train the rotating doctors, sometimes preventing theatre/clinic time etc. After agreed consent with the department I was able to develop a training programme for the rotating Drs Subsequently- the medical deanery received much better teaching feedback and allocated more resources to the department- a Physician Associate was teaching junior doctors.

23 3.4 How much can I rely on them? The PA role and the level at which they practice in the UK varies depending upon the setting in which they are deployed. Physician Associates have functioned up to the level of Specialty Training Year 3 (ST3). - GMC 2015 (Scope of medical regulation Physician Associates 2015) ***Subject to experience, competency and appropriate evaluation by seniors***

24 4. Physician Associate accountability and regulation

25 4. Responsibility and accountability Physician Associates work under defined levels of supervision When delegating care you must be satisfied that the person to whom you delegate has the knowledge, skills and experience to provide the relevant care or treatment; or that the person will be adequately supervised. If you are delegating to a person who is not registered with a statutory regulatory body, voluntary registration can provide some assurance that practitioners have met defined standards of competence and adhere to agreed standards for their professional skills and behaviour - GMC Website The named supervising clinician has final accountability for the patient

26 4. Responsibility and accountability All Physician Associates are responsible for their actions PAs will often have direct contact with patients and are responsible for the care of a range of needs Are responsible for providing the best medical care, formulating appropriate diagnosis, and producing concise documentation

27 4. Responsibility and accountability All Physician Associates take responsibility for maintaining their own CPD diary Learning and addressing gaps in their knowledge All Physician Associates are responsible for ensuring adequate indemnity coverage All Physician Associates take responsibility to ensure their portfolio remains up-todate and they pass their re-certification examination However it is the employers responsibility to ensure appropriate employment checks are performed: Managed Voluntary Regsiter status Evidence of passing the National examination. Team 4 3 rd May 2017 Page 27

28 4. Regulation

29 4. Regulation XXXXX XXXX XXXXX

30 Thank you! Website: Tel: Mr Alexander Jay Reynolds PA-R