Educational and Clinical Supervision: the Physician s (and Physician Associate) Perspective Dr V.Sankara Raman FHEA, FRCP Consultant Gastroenterologist Director of Medical Education Teresa Dowsing Acute Elderly Care Practitioner Physician Associate A Journey of Continuous Improvement
Background- George Eliot Hospital Integrated (acute, community and primary care) provider Main facility at George Eliot Hospital site District General Hospital (352 beds) Serving a catchment population of 300,000 (across Nuneaton, Bedworth, North Warwickshire and Hinckley and Bosworth, South Leicestershire)
Keogh Review July 2013 put into special measures Challenges in respect of clinical workforce numbers and delivery of 7 day services Impact on recruitment and retention Locum spend Development of potential solutions including the PA Associate role Linking with University of Birmingham PA programme for student placement Employing PAs and growing our own
Benefits of Physician Associates Generalists with national standards and recertification Improved patient care as focused on service provision Improved continuity of care: Doctors come and go, PA can help nursing and other staff emphasise the culture of the organisation Stabilisation of the Workforce Reduction in locum spend and provide a flexible workforce Providing teaching to junior members and opportunities for them to undertake their training Improvements in care through quality improvement projects
CQC Review 12 months on from being put into special measures April 2014 the Care Quality Commission noted exceptional progress at the George Eliot Hospital and we were taken out of special measures. Only 2 of the 16 hospital trusts came out of special measures George Eliot was one In their report the CQC highlighted Physician Associates as an area of outstanding practice. The CQC noted as best practice the benefit of the PA during their 2014 visit There were physician associates who were trained to support medical staff with assessment, investigation and diagnosis.
The PA role in the Hospital Work in a variety of medical specialties medicine, paediatrics, general surgery, T&O Function as integral part of multidisciplinary team on medical wards Undertaking history taking, examination, developing differential diagnosis and management plans Dependent clinician working under supervision of consultant Run clinics e.g. chronic diseases and liaison services e.g. geriatrics
Employment at the Trust One of the largest employers of Physician Associates in England outside London First appointment in 2010 Now 14 Physician Associates Working across Medicine, Paediatrics, Surgery, T&O and A&E Initial rotations through medical specialties similar to doctors in training as well as static posts Medical Specialties include Respiratory, Cardiology, Gastroenterology, Acute Medicine and Geriatrics Good retention rate
Clinical Supervision Clinical Supervisor Clinical Director Physician Associate Medical Director Director of Education Educational Supervisor Clinical Lead Line Manager The Physician Associate is supervised and supported in the clinical environment Work alongside junior doctors to support On ward environment experienced Physician Associate supervised by registrar and/or supervising consultant
The Physician s Role- Working in partnership with Physician Associates Set up as rotational posts for 2 years through various specialities Each PA assigned to a clinical supervisor (consultant) Initial and end of placement meetings with supervisor Assessment of skills and competencies to be carried out Escalation of responsibilities depending on competence
Tasks and procedures performed History and examination Venepuncture and cannulation Obtaining and Interpreting ECGs General new-born examination Psychiatric assessment Pelvic examination Antenatal ultrasound Cardiac stress testing
Tasks cont d (From PA member census by RCP) NG tube placement Incision and drainage of abscesses Lumbar puncture Joint aspiration Nerve block Intubation Abdominal Paracentesis/tap Catheterisation Suturing Cervical smear Chest tube Casting/splinting Skin biopsy The list goes on.!
Mandatory Requirements CBD/DOPS/Mini CEX/MSF (Recommended) 40 hours CPD a year National PA Conference Need to recertify with exam every 6 years
Challenges and Successes in Supervision Need robust arrangements for supervision of rotational PAs to ensure they don t get lost Have advanced planning for end of rotational posts for process of applying and identifying static posts Static post PAs feel well supported and feel enabled to contribute to the department and ward as a whole due to continuity of supervision
The PA role in supporting the wider GEH services Morbidity and mortality Patient flow projects Falls Patient Experience Group Audit and NICE guidance Teaching including Grand round presentations Improving medical handover Supporting PA and medical student placements
Maximising educational opportunities Integrate PAs in current educational opportunities offered with the Trust Encourage PAs to present at hospital events such as grand round and acute medicine teaching Supporting PAs to attend RCP FPA national conference Annual appraisals including personal development planning Allocate PAs a Trust wide project to develop skills and raise profile (e.g. patient experience group, morbidity and mortality, care bundles, frailty)
Working with the Multidisciplinary Team Integral part of multiprofessional and multidisciplinary team Accepted by all layers of staff Work very well with Nurse specialists Liaise regularly with social services, nursing staff, junior doctors, physio, OT, ambulance staff No issues with engagement with higher managerial hierarchy
Education of PA students Students from Univ of Birmingham PA programme -between 14-20 students at any one time PA programme students from USA on special observerships Students rotate through various specialities as needed Students mentored by service PAs Under tutelage of clinical supervisors(consultants) Overseen by Education Several more Universities now in the fray
Role of the Executive Team Director of Education (DME)oversees educational and training needs including CPD Medical Director is the RO (responsible officer)and oversees service needs and revalidation Regular meetings of the PA Forum within the trust attended by MD and DME Physician Associates recognised by CEO and Executive team as an integral part of workforce Invited to Strategy Board meetings and operational meetings of departments
Moving Forward Expanding role across the hospital Reinvigorate regular Physician Associate meetings with education and clinical service leads Potential development for a PA school First development role for PA as Acute Care of the Elderly Practitioner
Whither next? Service development opportunities Audit leads PA Education Endoscopy Multidisciplinary Clinical skills training Resuscitation and Simulation training Management GP Partnership
National Recognition 3 Awards at National Conference 2017 Chris Meally- PA of the Year
Further Information Sankara.Raman@geh.nhs.uk Teresa.Dowsing@geh.nhs.uk A day in the life of a Physician Associate documentary https://hee.nhs.uk/hee-your-area/west-midlands/ourwork/attracting-developing-our-workforce/physicianassociate
Thank you Questions? We know what we are but we know not what we may be William Shakespeare