Physician associate Alex Strivens-Joyce (pictured on the left) tells us what he loves about working in primary care in rural Wales.
I feel there is no greater privilege than caring for others and no greater reward.
I worked for the Royal Navy before realising my interest in patient care. Seeing the defence medical services at work first-hand motivated me to pursue a career in clinical practice.
I started an undergraduate medical degree before discovering the two-year physician associate postgraduate programme, which was a better fit for me as an older student. I am now in my fourth year as a PA in primary care and enjoy a career working across clinical and academic practice.
I work in a rural GP practice in Mid Wales with four GP partners, two PAs, two nurse practitioners and three practices nurses. No day is the same, but here is a taste of what it’s like to work as a physician associate (PA).
0800: I start my day processing clinical results and responding to high-level admin and medical queries from the team on reception. For example, we request imaging from our local x-ray department, and run our own phlebotomy service in the practice and results often come in overnight. Any abnormal results need to be looked at and interpreted. We need to think about how that’s going to affect the patient’s management plan, whether they’re seeing a nurse or a GP. If the patient is unwell do they need admitting to hospital? Do they need antibiotics? I action those results which might involve calling the patient or arranging an admission.
0900: On an average “on call” day supporting the duty GP I will have in the region of 30 direct patient contacts between face-to-face, telephone appointments and home or care home visits. During my morning surgery I’ll carry out an ‘unfiltered’ mix of appointments. It could be absolutely anything but my interests are mental health and orthopaedics. I can diagnose and manage patients, directly refer them for specialty care or admit them to hospital if they’re acutely unwell. Four years ago, when I started out as a PA I couldn’t have managed an ‘unfiltered’ workload – it’s something I’ve worked up to as I’ve gained experience. I can draw on the support of the duty GP when required. A common misconception is that PAs come off the production line as the finished article. Just like junior doctors and other healthcare professionals, we need time to mature and gain experience.
1130: I’m behind the wheel, on my way to the first of the day’s home visits. Home visits are designed for patients who are elderly, infirm, palliative or have complex comorbidity. For example, we look after quite a large care home. It can be particularly challenging to get out during the bad winters we’ve had but we do our best. Right now, I’m driving through the autumnal Welsh hills and it’s beautiful.
Taking care of home visits is one way we take pressure off GPs, as it can save them several hours out of the practice. Instead they’re able to see more complex patients and provide supervision to the rest of the team on the ground.
1400: Time now for our virtual ward meeting. This is a meeting between our community nurses, the on-call GP, the on-call PA, social workers, community physiotherapist, palliative care nurses and other local services. The idea is to keep comorbid and palliative patients at home, rather than admitting them to hospital. This is our daily multidisciplinary meeting to coordinate their care.
1415: My evening surgery tends to be when I’ll carry out minor surgery, such as skin biopsies and the excision of cysts, and urgent mental health appointments which nurses can book on a daily basis. Right now, physician associates are not independent prescribers so we need to propose medications to the GP. We also can’t request imaging involving ionising radiation (such as X-rays). We hope this will change when the profession receives statutory regulation.
1600: I make my way through the day’s telephone list, which can include speaking to patients who wanted a telephone appointment, as well as following up test results or a letter from the hospital. This all takes a load off the on-call GP.
1800: My day ends the same way it started – processing and actioning clinical results accrued throughout the day and with any late home visits.
When I’m not on a clinical shift I also work for Heath Education England (HEE) as Physician Associate Ambassador to the North West Midlands, supporting local stakeholders including senior doctors, health organisations and universities.