View from the Ground, by Pauline Weir
I had been working as a diabetes dietitian for over 15 years and was thinking about a career change when I first heard about the physician associate (PA) role, and was immediately interested. Working in a diabetes specialist clinic, I only saw those with complex or longstanding diabetes, but I had always wanted to meet people at the start of their diabetes journey.
I met the entrance criteria for the Master’s in Physician Associate Studies (MPAS) course at St George’s, University of London, and was offered a place in the 2014 cohort. I left my career (and my 2-year-old with the childminder!) to start a course with no guaranteed employment at the end, but I was determined to do well. The MPAS course is an intense, 2-year, full-time course that comprises over 3000 hours of taught lectures plus many hours of self-directed learning and placement hours across primary and secondary care.1 It was the hardest academic course I have ever taken.
From day one, we knew that there would be a national exam at the end of the course—a 14-station objective structured clinical exam combined with a 200-question, single-best-answer paper.2 Candidates have four chances to take this exam, and must pass both parts to qualify as a PA and join the Physician Associate Managed Voluntary Register (PAMVR).3 This register, managed by the Faculty of Physician Associates (FPA), is public and allows employers to check whether an applicant or employee is a fully qualified PA.4 Currently, there are almost 4000 PAs on the PAMVR.5
Since I started training in 2014, the profession has seen exponential growth; whereas few universities offered PA courses, 36 courses are now available around the UK, and around 1000 PAs graduate each year.6 In late 2024, the General Medical Council will become the regulator for PAs, which will pave the way for PAs to be able to order X-rays and, in the long term, prescribe.7 This will allow PAs to reach their full potential and relieve some of the burden on clinicians: currently, PAs cannot prescribe, instead proposing medication that must then be prescribed by a clinician.
I have worked in primary care since I qualified in October 2016. My first year in practice was a steep learning curve, but I was lucky enough to work with a supportive GP team who were able to answer my questions and mould me into a competent clinician. When a PA first starts working, the need for supervision can be high, but this eventually decreases as PAs start to gain experience with common conditions and recognise the management plans and investigations needed.
Now, I work for a primary care network in Southend with five other PAs, a large multidisciplinary team, and a dedicated supervising GP. On a clinical day, I handle a mix of telephone calls, online requests, face-to-face appointments, and pathology filing. I see an undifferentiated list of patients of any age with any complaint. The PAs are responsible for taking a detailed clinical history, identifying any red flags, determining a diagnosis, and performing any required examinations.
Recently, I have been reviewing patients with asthma to optimise their care as part of the Investment and Impact Fund incentive scheme at my primary care network (PCN).8 Extra funding is available if we are able to improve asthma care, especially for those who are over-reliant on their reliever inhaler and/or not taking a regular inhaled cortical steroid inhaler. This project has also helped to improve sustainability in the NHS by, when appropriate, increasing the prescribing of dry powder inhalers, which have a lower carbon footprint and are usually cheaper, in place of metered dose inhalers. This has been a positive project to be part of, and it has been great to help patients achieve control of all of their symptoms of asthma.
Being of a certain age now, I also have a real interest in talking to women who feel that they may be perimenopausal. Over the last few years, there has been a lot of media coverage about the effects of the menopause, and I find I am having this conversation regularly with patients. Many are nervous about asking about the menopause but have health concerns, so I like to give them the space to say how they feel and explore the options available.
In Mid and South Essex, we have been lucky enough to have access to a pilot low-calorie diet programme run by a digital change management company. The company employs dietitians and health coaches, and aims to help people with type 2 diabetes to lose weight (on average 14 kg) through a 12-week meal-replacement diet that provides around 800 calories a day, followed by dietetic support to re-introduce foods and promote more weight loss if needed. I have been referring people from across our PCN to the scheme, and we have had some really good interim results.
Reflecting on the last 7 years, becoming a PA was absolutely the best decision for me. Primary care is about so much more than just optimising the management of conditions and diseases. PAs can educate patients and staff on therapeutic and lifestyle interventions, and we get to look after people ‘from cradle to grave’. Although not without its challenges, it is an amazing opportunity to make a difference to people’s lives.
To find out more about PAs and how you can train to become one, visit the FPA website at www.fparcp.co.uk