Increasingly, physician associates (PAs) and anaesthesia associates (AAs) play key roles as part of teams in a range of healthcare settings. The four UK governments have asked the GMC to regulate these professionals. We’re currently awaiting the change in the law which will allow this to happen so that we can then draft and consult on new rules and guidance.

Dr Natalie King heads the Kent, Surrey and Sussex School of Physician Associates and is also Clinical Director for Emergency Access and Consultant in Acute Medicine at Surrey and Sussex Healthcare NHS Trust. At her trust she helps train and tutor PAs employed there. She tells us how PAs are an asset, and how time on the wards helps develop their skills.

Introducing PAs to medical teams

Investing in PAs in 2011 is probably one of the best things our trust has ever done and it’s hard now to imagine our teams without them. None of us could have predicted how PA numbers would grow.  Back then, there were only a handful of courses and a few hundred practising if that. Now, in Kent, Surrey and Sussex we have more than 150 PAs across primary and secondary care and in mental health.

Initially, we introduced eight PAs as an additional level of staffing for our medical ward team. Many of these original PAs have stayed with us, developing in their specialties, taking on more senior positions and becoming key members of the multidisciplinary team. They offer us much needed continuity and their generalist training allows them to provide holistic care even in highly specialised areas. 

Developing their roles

Many PAs become technical experts in their specialties and others develop non-clinical skills, such as teaching, management and leadership. Allowing PAs to carve out portfolio careers brings a new wealth of skills to the workplace. I would strongly encourage employers to promote non-clinical activities as part of their development.

Responding to Covid

As part of our response to covid pandemic staffing challenges, we introduced new graduate PAs across medical specialties. They supported our medical staffing during peak sickness levels, and in return it offered these new graduates a range of fantastic clinical experience.

We were also able to explore cross-organisational working across patient pathways. This meant senior PAs had opportunities to work in both primary and secondary care, seeing patients from admission to discharge and beyond.

Preparing the ground

Introducing any new role can be challenging so preparing the ground in advance is vital. To ensure our PAs were welcome, existing team members needed to understand the PA role, why they had been employed, and what would be needed to support them. For PAs, a period of shadowing proved useful to introduce them to existing teams and to help them understand where they’d fit in.

It’s also important to remember that a key driver for taking on PAs is that they can help free up doctors to attend and access teaching and training opportunities. This factor has been essential in ensuring cohesion and fairness within the team.

Good supervision is key

A good job plan for a PA needs to allow for regular contact with supervisors and a fair balance between service provision and development opportunity. Adapting the job plan over time will support longer term retention but, above this, the relationship between supervisor and PA is what ultimately drives success. Our PAs each have a named consultant supervisor, and we have a lead PA for the trust and a PA tutor (that’s me) to oversee governance and professional development.

Over time, this supervision becomes more of a collaboration and a PA’s development can often mirror their supervisor’s roles.

What regulation could mean

The lack of regulation has never inhibited the role of PAs at my trust, but I have no doubt that GMC regulation will support the development of the profession. Regulation will allow for a widened scope of practice and will offer much needed validation for PAs, many of whom have campaigned for it for so long.  PAs want to demonstrate to everyone and, most importantly, their patients, that they are skilled, safe and proficient healthcare providers.  

Workforce shortages will not be solved by PAs alone, but for me they have allowed team expansion and have provided value added care. They have become my ‘go-to team’ for most queries.

As a consultant colleague of mine said: ’The PAs are just brilliant, and the hospital wouldn’t run nearly as efficiently without them.’