What we did
In 2012, like many practices, we were (and are) underfunded and overstretched. We had heard that a local practice was employing a physician associate (PA) on a locum basis, seeing patients in a similar way to a GP, so we decided to offer him a temporary position with us for one day a week. We audited his notes and were impressed with his knowledge, efficiency and patient feedback. So when we placed an advert for a replacement partner, we agreed that he could apply.
We were looking for someone with strong business acumen and the PA gave the best answers to the business questions. To our mutual surprise, we agreed to take him on as a partner.
When another partner left (we currently have four GP partners) we decided to recruit a second PA. We found an experienced PA who was looking to make the move from hospital to general practice and we were delighted when she decided to join us. Because she had less general practice experience than our first PA we screen the patients she sees, which is easy because we use a telephone triage system and are able to book patients directly with our PAs, GPs, registrars or nurses. After seeing the patient she comes to us with a short history, examination and treatment plan and only rarely needs any additional advice.
PAs are trained using the medical model in diverse areas of medicine, which means they are mouldable to any position, but particularly suited to general practice. They have their own indemnity, but the supervising GPs take ultimate responsibility (as they do with nurses).
Although PAs have a professional body (Faculty of Physician Associates, Royal College of Physicians) they are not yet regulated so cannot sign prescriptions, Med3s, X-ray requests, and cannot confirm or certify death so you always need a GP available for this. They can independently take a history, perform an examination and make a treatment plan.
It was also a challenge for receptionists to explain the role to patients. We have used a crib sheet explaining PAs are not doctors but can see patients in a normal appointment and can deal with most things. If patients are not happy they can be offered appointments with a GP or nurse.
Taking on PAs resulted in more positive patient feedback, probably because it was easier to get appointments with them, we had a younger and more dynamic team and because of the personality and efficiency of the PAs themselves (patient feedback often names them particularly). We moved from two stars on NHS Choices in 2012 to five stars in 2015. We have found that our PAs are happy seeing patients every 10 minutes (although many take 15) so we have been able to increase the number of appointments by around 60 per week within the same budget (as the PAs work more sessions than the GPs who left) and increase our flexibility to deal with staff shortages.
PA salary varies with experience from band 7 (starting at £31,383) to band 8a (upper limit of £48,034), meaning it is possible to employ a full-time PA for a similar cost to a half-time GP.
We wouldn’t take on another PA at the moment, because you need to make sure there is at least one GP as the responsible clinician and to be available to sign off any paperwork. However, if you are interested, you could try networking at the annual PA conference, advertising on NHS Jobs or contacting the Faculty of Physician Associates at the RCP. Arguably though, one of the best methods may be to ‘try before you buy’. Because of the massive increase in numbers of PAs being trained, many universities are searching for practices that are willing to teach a trainee PA.
Dr Trisha Wildbore is a GP in Coleshill, Warwickshire