Can you describe the supervisory arrangements and how they have helped you?
At the moment, because we're not registered with the GMC, we're always supposed to be working underneath the supervising clinician. The amount of supervision I think depends on the experience of the of the PA. I like to have Doctor here to be honest, it's always a another opinion, just double check to make sure that it's okay. It means a lot to have the supervision for sure.
In Lakeside, because it's a small practice, I have hands on access to Doctor all the time if he's in the in the practice. In HPI, they have the supervising GPS on every shift, so that's a supervising GP for all clinicians. We don't always need a supervising doctor around, just in those situations where we still have to get all x-rays and all scripts and things signed off by the GP. We can't put our names to any of the any of the prescriptions or anything like sick notes, patients request them then if they need to be seen before this, I'll see them and then I can I can print it ready to go to Doctor.
As a relatively new profession, how well is your PA role understood by patients?
I've had a lot of younger patients, they understand what PAs do and I think middle aged people tend to have an idea about what we are. I do get called a doctor or a nurse! I think most of the patients now understand exactly what I do and what my role is. They do muddle the words up a little bit, but they understand my role, and still have my regular patients at Lakeside. At HPI I know they've not had much exposure to PAs there, so I probably have to explain again.
What does a typical week look like for you?
I just finished my internship and now I'm employed by two practices, Lakeside for three days and Healthy Prestatyn Iach for two days. They are contrasting practices, Lakeside has 2400 patients and HPI 25,000 patients. I’ve only recently joined HPI and the only PA there at the moment.
On the internship in Lakeside, Monday and Tuesday were book on the day appointments in the morning. At the start I was maybe seeing two to three patients which I took off the doctors list, it's just slowly got more and more, and I now see ten to fourteen depending on how busy we are. The morning was quite varied, in the afternoon it was routine appointments. Wednesdays, Thursday and Fridays used to be chronic diseases like asthma, COPD, and diabetes.
At the start of the internship, I picked what I wanted to see. In Lakeside at the moment, if they phone and it's deemed on the day appointment, they'll get put onto my list. And obviously if I'm not comfortable treating it then I've got Doctor next door and he'll give me advice. And the same with the stuff that I normally see, we can go to his office and ask questions and present a patient so he knows what's going on and make sure he's happy with them and he'll sign it off. On the busier days, he has a full list, so after my morning clinic, I'll sit down for half an hour after my clinic with Doctor and we'll go through what I wasn't sure about or if I need to get anything signed. We do the afternoon clinic and then we do the same thing.
What is special about your profession in primary care?
I think we bring a relatively broad depth of knowledge in terms of specific clinical conditions because we have our Physician Associate competency matrix, defining all the conditions that we're trained to know how to diagnose, treat, or manage.
We've only had clinical training for the two years. For myself, the internship on top of that, it's three years. We don't hold a lot of first-hand experience in a clinical setting, but we do have a lot of knowledge behind us to help treat the regular stuff that you see on a day-to-day basis, the minor injuries and we have the option to specialise if you want to focus on one specific and disease area like diabetes or respiratory. I think we're fresh and quite mouldable!
What has been your greatest area of learning from primary care?
I think the variety of presentations. If I went to secondary care straight out of university and post-qualification straight away for a job in respiratory or cardiology, then even though it's technically general medicine and patients have other issues, I wouldn't feel comfortable just focusing on one thing. I'm trained in a lot of things, but if I go straight down to just one speciality and learn, I feel like my other skills might wane a little bit. That's the main reason I went into GP because I see a lot of different things from different areas and I still learn quite a lot. Then there are downfalls GP, I don't do a lot clinical skills like bloods, ECG's, catheters, the routine stuff you'd be doing in the hospital. But my general knowledge is much better than it was.
The other good thing about GP, you don't have to deal with everything on that day. As long as you make sure that there's nothing glaringly obvious, no major red flags or anything like that, and sometimes you get to know them a bit more.
What are the 3 key skills essential to your role?
Understanding a patient in a holistic approach. If somebody comes in and they are complaining of feeling short of breath, I think we have the knowledge to understand the multiple reasons and we wouldn't just necessarily funnel down, go respiratory straight away and antibiotics and send them home. We think about other causes. So it gives us that thorough picture when we see a patient rather than just treating the one symptom on the day, and looking for a cause.
The ability to develop the role. We're a very new role, so I know we're looking to be in the regulation of the GMC. Once we are registered by the GMC, we can do the independent prescribing and hopefully we will have a full structure in place. There's a big contrast between your newly-qualified PAs and experienced PAs at the minute. I think the broad spectrum that we have, we provide that extra support for the clinical team as an extra brain essentially to bounce ideas off that has the knowledge, but at the same time, we also have the supervision of a doctor.
Continuity of care. A lot of the patients that come to the practice, they know me by name now and they know what role that we [PAs] do. It's nice to know that somebody knows their story when they come in rather than, just another clinician or a locum.
What is the benefit of having a Physician Associate for primary care/practice/patients?
Definitely in a smaller practice, a lot of the patients come to see me all of the time. So they have an element of continuity in terms of, they can come, and they don't have to re-explain their issues. Everything that comes to me also goes to Doctor, so even though they're not necessarily seen by them, Doctor knows a lot of the names and therefore histories without actually they see in those patients. He knows a lot about these patients just by filtering everything through to him.
What plans do you have to develop the role?
When I was on the internship, I really liked my chronic disease list with COPD and asthma. I think my plan at the moment is to see what it's like outside of the a smaller practice. HPI is the polar opposite, I want to I see how I get on in the busier practice to begin with. I'll carry on doing the same day appointments and then try and see COPD or asthma clinics.
I don't necessarily think at the moment I want to go into secondary care. Dermatology was probably one of my weakest subjects, and now, on a daily basis there's dermatology on my list. So my general knowledge on lesions and things like that has got much better, whereas if I went straight to the hospital, not being good at dermatology and then not doing any dermatology would have been lost I think.
It's something I want to do in the future, once I feel like I've got a good knowledge base behind me. Because then I can I can focus on technical procedures. Particularly somewhere like SDEC where you get a lot of GP referrals. Having somebody that's had primary experience, knows what primary care can deal with, and knows when they should refer for testing. There's a lot of referrals that go to the hospital which might not necessarily need to, and there's a lot of things from my experience that bounce back from the hospital which and could be dealt with on discharge and just to follow up by the GP.
What advice would you give to somebody interested in becoming a PA?
I'd say if it's something that you really, really want to get into and want to do, the role is what you make it!
