UKAPA Ltd
Division of Population Health Sciences and Education,
6th floor Hunter
Wing
St George's, Univ of London
Cranmer Terrace
London
SW17 0RE
Company No: 5502792
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Division of Population Health Sciences and Education,
6th floor Hunter
Wing
St George's, Univ of London
Cranmer Terrace
London
SW17 0RE
Company No: 5502792
See us on Facebook
A physician assistant is a dependent health care professional who has been trained in the medical model and works with supervision of a doctor or surgeon. PAs obtain medical histories, conduct comprehensive physical exams, request and interpret tests, diagnose and treat illnesses and injuries, and counsel on preventive health care.
As in the early days in the United States, PAs in the UK are not able to prescribe medication at this time. PAs are involved in acute medicine as well as chronic disease management.
The PA concept started in the United States 40 years ago, and the model has since spread to Canada, Australia, the Netherlands and the United Kingdom. A number of other countries around the world have similar but not identical non-physician providers.
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The Physician Assistant profession was founded in the mid-1960s during a time of primary care physician shortage in rural areas in the USA. Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of physician assistants in 1965. For more information, see the Physician Assistant History Centre website.
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Physician assistants currently can be found working in GP surgeries, Accident and Emergency departments, and inpatient hospital wards. PAs are also working in trauma and orthopaedics in Scotland.
In a GP surgery, PAs see patients of all ages for acute and chronic medical care. PAs can refer patients to consultants, the EAU or to A & E when clinically appropriate. Other duties include home visits, prescription reauthorisation, review of incoming post and laboratory results. Physician assistants are an additional health care team member to help the practice reach Quality Outcome Framework targets.
In Accident & Emergency departments, PAs are able see whatever comes in the door. They see patients in minors and majors as well as resuscitation and post resuscitation. They are also able to see medical, trauma, mental health, children, obstetrics and gynaecology cases. PAs obtain the history, conduct the physical exam, request blood tests and / or imaging. They are able to make referrals both to in-house specialities as well as arrange for outpatient appointments or GP reviews. PAs are able to discharge or admit patients and can arrange for intermediate care or community services as well. Some experienced PAs help with teaching for the PA and medical students as well as FYI and FYIIs.
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There are currently American and UK physician assistants working in the United Kingdom. They practice in the East and West Midlands, parts of London and the surrounding areas, Weston-super-Mare, Bristol, Glasgow and Edinburgh. To network with PAs practicing in the UK, pleasee contact the webmaster.
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As of October 2010, there are three universities currently training physician assistants. These are the Universities of Birmingham, St. George’s of London and Wolverhampton. Upon successful completion of a Physician Assistant programme, each student is awarded a Post Graduate Diploma. For further information, please check each university’s website.
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As a new role in the UK, PAs are not yet formally registered therefore the title ‘Physician Assistant’ is not a protected title. The UK Association of Physician Assistants along with the universities involved in training physician assistants continue to work toward registration of the profession in order to protect the title ‘Physician Assistant’.
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In certain areas of the UK, there are organisations which employ people to do technical tasks in the hospital such as phlebotomy, ECGs, arterial blood gases, and administrative duties. While they are also called ‘physician assistants’, they do not have the training of NCCPA certified American PAs or the UK PAs being trained at the four universities listed above. There is a clear distinction in the level of medical training, and for this reason, the UK Association of Physician Assistants along with the universities involved in training physician assistants continue to work toward registration of the profession in order to protect the title ‘Physician Assistant’.
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American PAs are able to practice in the UK as a result of a clause within the British General Medical Council’s guidance on Good Medical Practice.
Delegation is discussed within paragraph 54 as follows:
Delegation involves asking a colleague to provide treatment or care on your behalf. Although you will not be accountable for the decisions and actions of those to whom you delegate, you will still be responsible for the overall management of the patient, and accountable for your decision to delegate. When you delegate care or treatment you must be satisfied that the person to whom you delegate has the qualifications, experience, knowledge and skills to provide the care or treatment involved. You must always pass on enough information about the patient and the treatment they need.
For further information, see the General Medical Council’s website and statement on Good Medical practice.
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PAs will require a certain amount of supervision in their medical practice. This will vary somewhat from individual to individual and is dependent on a number of factors including, but not limited to, their past health care experience and years of experience as a physician assistant. A new graduate will require much more intensive supervision compared to an experienced PA.
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PAs are currently unable to prescribe medications in the UK. Close work with supervising physicians and arrangements developed individually allow for flexible ways of working and continuation and expansion of quality patient care. For instance, many PAs working in general practice have the ability to quickly interrupt their supervising physician for a signature and then continue their work. If further advice on a case is required, the GP and physician assistant take time out to discuss it and/or see the patient together to come to a decision on further treatment.
In the hospital setting, consultants are able to delegate abilities to the PAs they supervise. For instance, PAs working in the A & E might have the ability to sign for medications administered in the hospital. These would be for those medications required in the context of the patient’s A & E visit (IV fluids, analgesia, etc.). These delegated tasks are customised to the individual PA as their supervising physician deems appropriate. For medications to be taken home or in house hospital drug charts, a co-signature might be obtained by a registrar or consultant. These delegated tasks are customised to the individual PA as their supervising physician deems appropriate.
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Yes, PAs require professional indemnity coverage. The cost of this coverage is typically paid for by the employer. Currently, the Medical Protection Society (MPS) and Medical Defense Union (MDU) will provide professional indemnity for those PAs working in general practice. PAs and other hospital staff employed by a secondary care trust may typically have some form of indemnity provided through their employing trust, however this should be discussed with the employer. Additional coverage through the Medical Defense Union or other provider may be advisable depending on the PA's roles and duties.
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UK trained PAs are required to complete a one year post-graduate paid internship. The newly qualified PA post has been evaluated under Agenda for Change [in Scotland] at Band 7. Higher level PAs (requiring a minimum of five years experience and a Masters Degree) have been banded at 8a. Physician assistants’ salaries with further training range from £45,000 to £54,000 currently. US PAs are often offered an annual flight back to the US along with funding for continuing medical education (CME) as part of their compensation as NCCPA certification maintenance is required for those working in the UK. Some American PAs have also been offered a stipend to assist them with relocation to the UK and repatriation to the USA.
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Medicine is forever changing and PAs have a responsibility to keep up to date. Continuing medical education (CME) or continuing professional development (CPD) is key to a PA’s ongoing clinical practice thus the majority of PAs are provided with some form of study leave. This is to be determined through discussions with the PA and their supervising physician as well as their employer.
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The majority of PAs and PA students are female. Most have been educated
in the United Kingdom, but 15 were trained in the United States.
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All Physician Assistants hold at least bachelor’s degree, usually
in a life science field. Most Physician Assistant Programmes require
at least a 2:1 honors degree for entry into the Postgraduate Diploma
course along with some prior health or social care experience. The prior
experience of Physician Assistants is diverse. The most commonly reported
previous occupations include nursing, health care assistant and paramedic.
Other backgrounds include:
PAs are working all over England, with concentrations of PAs near the PA training programs in London and the West Midlands. Some PAs are also working in training posts at Hairmyres Hospital in Lanarkshire.
PAs are working in a wide variety of specialties and settings. Most PAs only work in one specialty; however 14 PAs noted in the census that they work in more than one specialty at a time.
Specialties include:
PAs work in a wide variety of practice settings, including:
No, however typically American trained physician assistants are required by their employer to have and maintain their NCCPA certification to work in the UK. In the future, US trained PAs may be ‘grandfathered’ into the UK system, have to take a UK certification exam or another route may be decided. This has yet to be determined.
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Job postings can typically be found on the UKAPA job opportunities web page, in AAPA publications, the PA Job Link and at NHS Jobs. In the past, some employers have had a booth at the AAPA annual conference trying to recruit to their areas. You can also check directly with the various PA programmes.
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Employers are usually looking for PAs with a number of years of experience. Now that there are UK universities educating PAs, there will be many homegrown PAs looking for jobs so it will be necessary to recruit locally.
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Some American PA students have come to the UK for an elective rotation. PA students training in the USA who wish to come to the UK for a rotation should have their clinical coordinator contact their counterparts in the UK PA programmes directly for consideration.
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