Where can PAs work and what can they do?
PAs work in both primary care (general practice) and secondary care (largely hospitals and mental health trusts).
PAs are employed directly by the trust or surgery in which they work. In hospitals PAs work across a wide variety of specialities including medicine, surgery, paediatrics and emergency medicine. PAs work across the UK but often begin their careers close to where they received training.
In general practice, PAs work under GP supervision. They can undertake telephone triage, have a mixture of pre-booked and same-day appointments, manage acute and chronic conditions and follow up with patients they have seen. PAs are also able to deliver specialist clinics following appropriate training and experience.
In hospital medicine, PAs have a consultant Clinical Supervisor. Job roles differ based on specialty but most will include clerking patients, clinical examination, clinical procedures, diagnosing and implementing management plans.
Qualified PAs have these core skills:
- Taking medical histories
- Conducting comprehensive physical exams
- Requesting and interpreting certain investigations
- Diagnosing and treating illnesses and injuries
- Counseling on preventive health care
PAs have also trained and been assessed as competent in a number of procedures:
- Venepuncture
- Blood culture sampling
- Cannulation
- Arterial gas sampling
- Catheterisation (male and female)
- Peak flow examination
- Urine dip stick
Most common extended skills:
The extended skills and procedures that a PA develops over time following qualification will depend on the clinical specialties in which they have been employed. Employers should encourage PAs to acquire extended skills and procedures with adequate training from a qualified and competent practitioner. The training and ongoing supervision of these skills should be rigorously governed.
Most common extended skills practiced by PAs in the UK include:
- Ascitic drain
- Ascitic tap
- Joint aspiration
- Lumbar puncture
- Pleural aspiration using ultrasound marking
- Suturing
Other extended skills:
Other extended skills practiced by PAs working in the UK include:
- Antenatal ultrasound
- Arterial line insertion
- Backslab application
- Casting / Splinting
- Central line insertion
- Chest drain
- Contraceptive implant placement and removal
- Diaphragm insertion
- Dislocation reduction
- FAST ultrasound for trauma
- Fracture reduction
- Haematoma blocks
- Iliofemoral block (#NOF)
- Incision and drainage of abscess
- Intubation
- IUD insertion and removal
- Nerve blocks
- NG tube placement
- OGD
- Pleural tap
- Psychiatric assessment
- Pulmonary lung function tests
- Relocation of shoulder
- Ring blocks
- Skin lesion removal
- Surgical first assisting
Although US trained PAs are allowed to work in the UK and are able to register on the PA Managed Voluntary Register (PA-MVR), UK trained PAs are currently unable to practice in the US or elsewhere overseas.
For further information please refer to the Faculty of PAs website: www.fparcp.co.uk
Suggested Career Paths
Newly qualified Physician Associate
The first year upon qualifying is all about learning how the job works in practice and becoming submerged in the environment you are working in. PAs need to learn the basics and fundamentals of the role and how it fits within the team. This may include being on the ward, contributing to ward rounds, taking bloods and completing referrals. In General Practice, this may involve seeing patients over a longer timeframe and feeding back to the GP supervisor.
A newly qualified PA or one that is new to a specialty (for example when moving from primary to secondary care or vice versa) will need closer supervision and will initially be more dependent in their practice. With time their clinical experience will develop and with that their confidence. Understanding the limitations of the role and the logistics of this will need some time to establish.
With time the experience and local in-house knowledge will start to become more apparent and useful to the wider medical team, particularly with the junior doctor rotations.
Experienced Physician Associate - Specialty PA
Over time, and with a good supervisor relationship, a PA can become very experienced within the area in which they work. Once the PA has developed skills specific to the specialty, he/she might, with the consent of the supervisor, take part in out-patient clinics (alongside a Consultant), or carry out extended procedures (for example assisting in surgery for a surgical PA or performing pleural procedures for a respiratory PA). A PA with a wealth of experience in one area becomes like a ‘mini-expert’ in that field.
Experienced Physician Associate – Educator
With a growing number of Physician Associate courses across the country there are many opportunities to teach PAs. Many programmes will ask for a minimum of two years’ clinical experience before being eligible to help on PA courses. PAs can add real value by role modelling and mentoring students through their clinical placements. PAs who wish to help deliver content on courses or train to be examiners should also contact their local PA course provider.
Many teaching fellow positions are part-time and this allows PAs to continue in clinical practice, as well as bringing their clinical expertise back into the classroom. Some employers allow PAs to contribute to courses on a secondment basis.
PA educators can teach on a variety of topics such as clinical skills, leading problem-based learning groups and teaching a range of course content.
Experienced Physician Associate – Leadership and Management
Some PAs within secondary care may wish to develop their skills in leadership and progress to become a Lead PA within the trust. This may involve management responsibilities for the PAs working across the trust. Other responsibilities may include organising in-house teaching, coordinating student placements, participating in interview panels, and managing a range situations involving PAs within the trust. Contributing to governance meetings on PA practice would also be a part of the role.
