In full: Proposed scope of practice for PAs

The Leng Review gives a detailed proposed job description for physician associates, which it also says should be renamed as physician assistants. This severely limits the scope of practice for what a PA can do upon joining general practice.

Example job description for a new physician assistant in primary care

Overview of the role

As a new physician assistant in primary care, you will be given an initial induction programme to provide basic experience of working in this setting. In general practice this will be in line with an induction guide provided by the RCGP. You will be supported to work within the wider practice team to promote and maintain patient care. Your role will include the provision of care under the supervision of a doctor, using a wide range of technical and communication skills to support the smooth running of the practice. In general practice, your supervision will be provided in line with the supervision guide provided by the RCGP.

You will play a central role in all aspects of preventative care, including undertaking NHS health checks and provide lifestyle support, and support the administration of basic therapeutic procedures. You will provide annual health checks (excluding patients with learning disabilities, severe mental health issues, or other complications) and act as an initial point of assessment for minor or common conditions. You will help facilitate the pathway of care for patients, providing a key point of contact to ensure management plans, hospital visits, admissions and discharge are carried out effectively and efficiently. You will undertake audits and routine clinical administrative tasks. You will not be able to see undifferentiated patients. You should not be seeing patients for a second time if their first consultation with you did not result in a diagnosis and management success – all patients re-attending will need to see a GP.

Principal duties and responsibilities

The physician assistant will be expected to carry out the following roles, with the scope of role within general practice being as set out in the RCGP guidance:

act as first point of contact for suspected minor or common conditions in adults, within clear clinical pathways and escalation processes
carry out in-person assessments of patient health by interviewing patients and performing physical examination including obtaining and updating medical histories
administer referrals to secondary care on behalf of a GP and provide relevant information
order agreed diagnostic tests including laboratory studies as instructed by a GP and interpret agreed test results
administer the referral of an adult safeguarding concern on behalf of a GP, when confirmed by a GP clinical supervisor or GP with delegated responsibility for supervision
implement agreed management plans, and review and suggest any changes in agreement with the GP
document ongoing patient care by contemporaneous recording in the medical record
make referrals to community and social services in agreement with the supervising GP
take an active role in practice clinical audits, learning events, research and service development, and support practice outreach initiatives
perform basic therapeutic procedures by administering injections and immunisations if trained to do so (with exclusion of steroid injections or any intra-articular injections) and managing wounds and infections
review test results as part of the NHS Health Check, discuss the results with patients and offer advice on ways to make lifestyle improvements such as diet and smoking cessation
take part in prevention initiatives, working with the supervising GP and the multidisciplinary team
maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies
undertake clinical audit, research and quality improvement to deliver effective patient care and learn from best practice
undertake mandatory and priority training within the required timescales
undergo an annual appraisal
maintain professional registration as required through the relevant professional body through maintenances of a professional portfolio and or revalidation processes

Person specification

Qualifications – a postgraduate Masters or Diploma (PGDip) in Physician Associate Studies, or an integrated undergraduate Masters in Physician Associate Studies (MPAS). A pass in the Physician Associate Registration Assessment (PARA).

Regulated – on the GMC list of registered PAs.

Working experience – at least 2 years’ experience in a secondary care setting

Communication skills – excellent communication and interpersonal skills

Technical skills – competent undertaking primary care-based minor therapeutic procedures and diagnosing suspected minor or common conditions in adults within clear clinical pathways and under consultant supervision

Infection control – maintain safe and clean working environment by complying with procedures, rules, and regulations and adhere to infection-control policies and protocols.

Source: Leng Review