Employing a Qualified PAInformation and advice for employers who are considering adding PAs to their workforce.
This document addresses key issues in relation to employing physician associates in both primary and secondary care. This includes the background to the PA role, the duties a PA can perform, governance issues and ongoing management in the workplace.
- When considering employing a PA, consider the skills gap that you have and whether PAs have those skills. PAs are not a good fit for every department.
- The PA’s role needs clear definition to ensure both PA, supervisor and team appreciate each other’s roles and responsibilities as well as the current restrictions on PA practice.
- The benefits of employing PAs are usually realised over time as the relationship between PA and supervisor develops.
- PAs need to re-certify every 6 years and need support to achieve this. Consider how you can help them meet this need. This may involve granting study leave to attend CPD events, or supporting in house training and the need to keep up generic skills at work.
- When writing job descriptions, formulate a job plan that offers variation in terms of activities and opportunities to develop. This will encourage staff retention over time.
- When employing a PA, only consider a PA who has qualified from a recognised UK or US Physician Associate programme and who is registered on the managed voluntary register held at the Faculty of Physician Associates at the Royal College of Physicians in London (PA-MVR).
Understand your rationale for employment
Useful tips for this:
• Perform a skills gap analysis and compare this to a number of health professional roles
• Do not replace one health professional with another. If a doctor is needed for the role then a doctor is what should be sought
• Consider the reason for employment of PAs; this might include continuity in high volume areas where junior medical staff work across varying shift patterns
• In secondary care, PAs can allow doctors to see more patients. In primary care, PAs have their own appointment list but there must always be a GP on hand in the practice for supervision
• The business case for PAs will be informed by the drivers to employment. This may include time release for doctors by adding an additional team member, better GMC feedback as ability to attend training increases, reduced clinic waits (RRT), better patient feedback in areas where complaints are high.
Speak to current employers of PAs
Designing a job plan
Consider the working hours of the PA in relation to where you see the role working best and based on your rationale for employing them. In secondary care budgets will have to allow for an uplift if PAs are working outside of normal working hours as is the case for all Agenda for Change clinical staff. The pay scale in used in Primary care is usually locally negotiated and will not be subject to the restrictions of Agenda for Change.
Physician Associates are usually advertised at Agenda for Change band 7 although some Internship years for those who are newly qualified may be advertised at band 6.
Internship years are popular with newly qualified Physician Associates as they can offer a variety of experience to help shape the career direction of undecided PAs. It does mean, however, that the recruitment process is continual and arrangements with local universities training PAs may be one way of providing a continued resource of graduating PAs. Other employers may seek to employ PAs who will stay for a longer period of time, who will ultimately gain organisation knowledge which can generate significant work and team efficiencies.
Only consider employing PAs who have completed a recognised UK or US training course and have passed the UK national examination that allows them to practice in the UK. Ensure that applicants are listed as current members of the Managed Voluntary Register held at the FPARCP (PA-MVR).
Job adverts are usually posted on NHS jobs and the FPARCP website. www.jobs.nhs.uk
If your organisation is based in Kent, Surrey or Sussex and you are considering employing a PA, please contact the KSS School of PAs for further help and advice: [email protected] Please also advise us of all PA appointments so we are able to keep a record of where PAs are working within the region.
In primary care the salary for a PA can be negotiated dependent on experience. Job descriptions should describe the work environment as well as provide an indicative job plan. It should also highlight supervisory arrangements and job plans should allow opportunity for regular contact with the supervising doctor.
PAs are employed by the GP practice or trust where they work and their salary is paid by their employer.
Qualifications and Professional Registration
The First Year
Fitness to Practice
Employers should consider how a PA has access to development in the workplace. Opportunities for internal development in areas such as research, audit, leadership and management are some examples and allowing time for such activities in job plans is recommended. Employers may also wish to allow time release for PAs wanting to support the national development of the profession by working with FPA committees, specialty societies/colleges or Higher Educational Institutions as educators of future PAs.
Employers should provide regular appraisal (at a minimum of annually) that reviews progress made against a personal development plan as well as performance within the role. Appraisal documentation is available from the FPARCP which can be used in combination with organisational appraisal documentation.
Recommendations for reviews, appraisals and the number of workplace-based assessments are set out below. The frequency of review meetings may depend on individual PAs and whether areas have been identified for additional support.
|Timing||Number of CBD/MiniCEX|
|Year one ‘Internship’ or upon entering new specialty:|
|3 months||3 x CBD, 3 x MiniCEX|
|6 months||A further 3 x CBD, 3 x MiniCEX|
|1 Year:||An overall total of 8 x CBD, 8 x MiniCEX|
|6 monthly review||3 x CBD, 3 x MiniCEX|
|Yearly appraisal||6 x CBD, 6 x MiniCEX|
|6 monthly review||1 x CBD, 1 x MiniCEX|
|Yearly appraisal||2 x CBD, 2 x MiniCEX|
|Year 4 onwards:|
|Yearly appraisal||2 x CBD, 2 x MiniCEX|
Clinical Supervision Meetings
Some employers may wish to offer newly qualified PAs a one year ‘internship’ to allow the them to consolidate core knowledge and skills and demonstrate competence in practice. During this period the PA should be supervised more closely, undergo experiential learning in the clinical area in which they are working, and maintain a portfolio of cases and case discussions with clinicians which may also be reviewed with the clinical supervisor.
Writing a Governance Policy for your Trust
The PA’s qualifications and registration on the PA-Managed Voluntary Register (PA-MVR) should be checked.
The Faculty of Physician Associates (FPA) recommends that employers only employ PAs who have graduated from a recognised UK or US training programme. The FPA will accredit UK training programmes in due course.
The governance policy should specify that PAs have a contractual obligation to be registered on the MVR held at the RCP in London and that registration status will be checked at appointment and annually thereafter. All essential job specifications and adverts should also state this. Employers should also stipulate the outcome of failure to comply with this obligation.
It is up to employers to determine whether PAs require professional indemnity coverage and this should be mentioned in the governance policy. For NHS Trusts, indemnity is not required but it is advisable to provide the PA with access to ‘non-claims’ benefits such as assistance with disciplinary proceedings, advice on ethical or professional issues and access to support at coroners’ inquests.
In most primary care organisations, PAs must have personal indemnity cover which may be funded by the employing practice.
Specific job plans are not required in a governance policy but it is useful to include any recommended sessions that PAs should undertake. This helps to guide departments when formulating or changing job plans. For example, each PA might be expected to have a session in front door medicine seeing new patients, or to take part in audit or quality improvement projects. If PAs are required to take part in out of hours activities, this information should be included as well as the associated supervision arrangements.
Secondary care salaries are in line with Agenda for Change standards and the matching process for Agenda for Change demonstrates that at qualification, Physician Associates are Band 7.
In primary care, PA salaries vary and are set by individual practices.
First year of employment
This includes preceptorship arrangements and probationary periods. This section should cover arrangements for probationary periods, supervision and reviews for newly qualified PAs or those transferring from other clinical environments. The FPA website gives some recommendations on the frequency and type of review.
Core skills that PAs can carry out in a Trust
This section should provide a list of duties, core skills and procedural competencies to ensure that all staff understand PAs’ core practical skills as well as restrictions to practice.
Controls & restrictions
This section will apply to controls regarding consent, ordering investigations, referrals, prescribing, transcribing medications, discharge medication and letters, certificate of death, end of life care and DNAR.
Given the current restrictions on practice (prescribing and ordering x-rays) the policy should refer to how PAs work in practice, for example in completing discharge paperwork. Supervision arrangements should also be considered, as well as who is responsible for reviewing when the PA’s named supervisor is not present.
Extended skills, competency levels, supervision and excluded skills
Extended skills beyond those that PAs have acquired during training should be listed, as well as how those skills are acquired, recorded and competency assessed. Consider the type of competency assessment required and review the framework for PAs taking on new skills. This will help to ensure only competent individuals are teaching PAs new practical skills and that they have adequate supervision, assessment and ongoing review. Consider how the restrictions on practice affect the procedure, ie prescription and administration of local anaesthesia. List any excluded practical skills.
Supervision arrangements for PAs
Policies should be clear on the supervision arrangements for PAs. As PAs work under the GMC clause of delegation, supervisors may delegate clinical duties to PAs when they are not present. This may, however, leave the PA unsupported. For example, if a patient requires medication or ionising radiation, this may be delayed if a PA is working alone. On a day to day basis it might be better for a PA to be paired with a fully registered doctor and not a foundation year 1 doctor, for example.
This section should also include a brief summary of responsibilities to support and review PA practice. This would be similar to the arrangement between an educational supervisor and a doctor in training. Line management could be from a senior PA.
Organisational structure chart and processes relating to governance of PAs
Clearly set out reporting lines in terms of clinical supervision, line management and any internal arrangements to monitor PA practice and whose responsibility it is to lead this.
Support available for PAs approaching the re-certification exam
This section might list sanctioned leave or financial support to aid the PA in re-certification. It should also clarify the outcome, should a PA fail to achieve re-certification (for example termination of employment).
How the Trust will help PAs ‘stay generalist’
This section may outline opportunities to attend internal teaching relevant to the core curriculum framework and time to maintain acute admissions experience. This is particularly important for PAs working in sub-specialist areas who may struggle to maintain generic competencies of knowledge.
CPD requirements and study budget/leave arrangements
This section of the policy should stipulate requirements and any employer support available such as the provision of study budget and study leave. Guidance on CPD requirements is available on the FPA website.
Description of teaching programme available
Many larger employers provide a PA teaching programme which ideally should be mapped against the Core Curriculum Framework and matrix of conditions.
This will vary from employer to employer but should utilise tools similar to those used by doctors in training. A variety of work based assessment tools are available on the FPA website along with guidance on the frequency of reviews and a suggested number of assessments.
This section should detail how the employer will deal with fitness to practice concerns regarding PAs, who is responsible for informing the FPA and, where necessary, who will remove the PA from the register.
Arrangements for PA students on placement
This section should detail general supervision arrangements for PA students hosted by the employer.
Public relations work
Role awareness is essential to acceptance of PAs into the clinical team so that all are aware of the competencies and limitation of PA practice. In areas with frequent staff rotation, inclusion of PAs in induction of new staff is a useful means to achieve this and must be continued at each point new staff are introduced.
Role awareness among doctors in training is particularly important as PAs will be working in many situations directly alongside trainees. The FPARCP are working with the training colleges as part of a wider communication strategy to publicise and define the role of a PA in working with trainees. In the workplace it is essential to do the same in order that trainees understand the role of the PA, why they were employed, scope of practice and what is expected of trainees working with them.
Similarly it is important that associated practitioner roles such as Advanced Clinical Practitioners, Nurse Practitioners, Pharmacists, etc. have an understanding of the role to promote cohesive working and the strengths of a diverse workforce.
Leaflets are available from the FPARCP about the PA role to help with this.
Employing organisations need to promote the work of PAs to their patients. This often begins when a PA is employed as PAs are the greatest ambassadors for their profession. Provision of lanyards, clear identification badges or labelled/coloured scrubs (dependent on the area the PA is working) that state ‘Physician Associate’ can help with this. Organisations may want to design their own branded leaflets explaining the role. Involvement of patient representative groups is recommended to ensure clear language is used. Short videos/stills with subtitles on screens in patient areas is also a useful way for patients to become familiar with PAs working in clinical environments.
KSS School of Physician Associates
Post Graduate Education Centre
East Surrey Hospital
01737 768511 ext 6635
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