Dr Sarah Greenwood. Physician Associate Fellow, Health Education England Thames Valley

Supporting newly qualified Physician Associates (PA) in practice – Insights from a mentor

As mentor to newly-qualified Physician Associates (NQPAs), I’ve gained some important insights into GP supervision and support mechanisms that have helped PAs transition into general practice. I’d like to share my experience and provide some recommendations for any GPs who might finds themselves supporting a PA during their first year in post.

Its worth knowing that Health Education England run a national Preceptorship Programme. In my area (Thames Valley) this initiative has seen a substantial rise in the retention of NQPA preceptees in the region. Documentation of individuals’ perspectives throughout their first year has provided valuable anecdotal evidence to help other GP supervisors and general practice employers.

This is how it works. GP supervisors and PAs meet with the mentor and workforce transformation lead at the start of the preceptorship and throughout the year as necessary. This initiative has been particularly successful in managing GP expectations and addressing any PA concerns. GPs appreciate the provision of external support and value the opportunity for focussed discussion. Supporting PAs with mentorship has notably increased confidence in the workplace and enabled these individuals to achieve realistic professional development goals.

The importance of a thorough induction cannot be overstated. An NQPA must feel welcomed and be formally introduced to all members of the practice. It’s so important to provide opportunities to observe other clinical staff performing their roles and to then have a say in the construction of their own work schedule. IT need to be explained and demonstrated so that the NQPA understands core processes from the start, even if a PA has been a student at the practice already. Building relationships with other members of the team is particularly valued by PAs as it helps to increase opportunities for communication and support and reduces feelings of isolation.

It’s essential to set realistic consultation times, timetable debriefing and provide weekly one-to-one supervision throughout the first year. At the start, thirty-minute consultations reducing to twenty minutes within 3-5 weeks has generally proven most effective. PAs require a named duty supervisor for each session and must know how to contact them. Debrief should be provided after every patient, reducing to every 2-3 patients once the duty supervisor and PA have developed a trusting, working relationship. This usually takes several weeks. Mentoring has revealed that NQPAs have good insight regarding their limitations and seek duty support appropriately.

Weekly meetings with a designated supervisor and regular education sessions are highly valued by PAs and are a requirement of the preceptorship programme throughout the year.

This initial slow steady start helps PAs to adjust, stay in control of their consultations and learn key processes at the practice which helps to reduce the risk of feeling overwhelmed. NQPAs with effective support early on should adapt to twenty-minute consultations, typically within 4-6 weeks and you’ll notice as they begin to gain in confidence.

From this point, a new six-month process can begin, whereby NQPAs conduct consultations with increasing independence and the debrief frequency reduces. PAs should be supported to consult with more complex patients, take on specific tasks and undertake additional training to meet the needs of the practice. Examples include dedicated appointment slots for same-day mental health patients, annual reviews, dermatology clinics and women’s health services. During this six- to nine-month period, GPs and practice staff will recognise the contributions and capabilities of their PA, appreciating the skills, interests and value of the individual and their role. Patient feedback indicates satisfaction with PA consultations.

Towards the end of the year, PAs are able to acknowledge their progression and generally feel valued and settled at work. As a mentor this has been notable and rewarding.

The success of the PA preceptorship programme in the Thames Valley area, can be evidenced by the recent surge in job offers, ‘serial employment’ of PAs by several practices as well as through the Primary Care Networks (PCNs) opting to employ several NQPAs together. If you’re thinking about employing a PA, my advice is to seek advice early on, set realistic objectives and plan detailed support structures appropriately. This stepwise, considered approach really will help you to develop a successful and lasting investment.

For more information, downloadable templates and resources for general practice employers, try the Faculty of Physician Associates (Royal College of Physicians)

British Medical Association Employing Physician Associates in Primary Care

If you want to find out who your PA local lead is email primarycare@hee.nhs.uk or visit the Health Education England website 

Physician Associates Transforming Healthcare (PATH) are running a free nationwide time limited PA supervision support programme for GP practices and supervisors of newly qualified and new to GP physician Associates in conjunction with Health Education England. For details visit PATH website  or email PATH at info@our-path.co.uk or primarycare@hee.nhs.uk for more detail.

November 2020