Ria Agarwal has a dual role as a Physician Associate in primary care in Sheffield and is part-time at Sheffield Hallam University as a Senior Lecturer for the PA course and mentor to Sheffield preceptorship PAs. She is an allied health professional representative for RCGP SYNT South Yorkshire North Trent.
With the ongoing pandemic there is a need to ensure that our expanding workforce is supported appropriately so that all healthcare professionals can play their part in tackling the increasing workload in general practice. Some PAs (Physician Associates) may be lucky in accessing this support from a regional scheme or an insightful supervisor; hopefully both. Recently published research examines the Sheffield primary care preceptorship scheme which funds half a day per week protected learning time following a signed agreement from the employer for the PA’s first year of primary care.1 This enables them to attend bespoke educational sessions, have mentorship from the preceptorship lead, and role-specific support from an experienced primary care PA*.
…there is a need to ensure that our expanding workforce is supported appropriately…
Schemes such as this were not available when I first qualified and are still not widespread, especially in regions with smaller pockets of PAs. Yet the recent incentives such as Additional Roles Reimbursement has led to increasing interest in the PA role, which isn’t always well understood by the employers who are then asked to supervise them. I remember my own performance anxiety on being asked to have part of my clinic observed by an important sounding GP from Health Education England who didn’t have much experience of PAs. She later told me she wasn’t that keen on the ideas of PAs initially but that sitting with me had changed her mind!
As a ‘Northener’ (to be specific, from Scunthorpe) I travelled to St George’s University of London in 2011; the only course in the country at the time. My love for a primary care career largely came from a wonderful placement experience and a very supportive supervisor, alongside an inspiring GP that taught us consultation skills at University. I wasn’t sure if I’d ever make it back home as there was less than a handful of primary care jobs in the Yorkshire and Humber area, but I was fortunate enough to secure one. As per my contract I worked 40 hours over 5 days a week, using spare time around this to manage my internal nerves of making the leap from student to employee.
There were three PAs at my first practice; two of us newly qualified and a third PA from Alaska, Keith, who had many years of USA experience. This setup enabled informal educational support from Keith, alongside mutual peer support for shared role-specific disgruntlements over lunch, such as the heartsink of waiting for a GP to have finished with their patient so we could get our prescriptions signed; something Keith wasn’t used to. This is a reasonably historic issue now due the magic of electronic prescribing systems, although there was much to be gained from entering a GP’s consultation room; such as overhearing the way in which they consult with patients on the telephone. Consultation techniques are incredibly personal, and within the scope of the Sheffield preceptorship scheme it has been fantastic to observe and reflect upon the consultations of my more junior PA colleagues, having taught many of them also at Sheffield Hallam University when they were PA students.
Life ‘BP’ relied heavily on patience, time and support from the GPs at my employing practice, which has certainly shaped my own clinical style; their wealth of knowledge often comes from experience rather than textbooks or guidelines. However there are other challenges to being in a less autonomous role. For example, the way in which one GP manages patients can differ to another, and sometimes I ended up managing a patient in a particular way depending on the GP on duty. As my own clinical breadth of experience has grown over the years, there were also a minority of occasions where I felt undermined. Looking back, I am sure this was not the GP’s intentions. With the added experience of jointly overseeing the junior PA at my own surgery, I realise this is often about the supervisor’s own clinical anxiety. It cannot be easy for a GP to supervise a role they are unfamiliar with, and add to their own increasing workload. However over the years it was helpful to have the ‘safe space’ to discuss such issues with my peers, and I can see this being a huge benefit with the Sheffield preceptorship scheme. In fact, the PAs even have their own Whatsapp group where the common queries around med3 and flu jab involvement can be answered by others within the group.
It cannot be easy for a GP to supervise a role they are unfamiliar with.
The Sheffield preceptorship PAs also have access to weekly educational sessions organised by the preceptorship lead, Julie Hoskin, which are shared amongst primary and secondary care PAs here. In contrast, at my first practice I fondly recall my invention of ‘PA Problem Based Learning’, in which one of us would present interesting cases and learning points over lunchtime once a month. Evenings and weekends were often spent learning about conditions we had seen in practice, and trying to keep up to date with the evolving pace of primary care. Overall my first year was intense but exhilarating. It was an emotional and educational rollercoaster. I am delighted to see that such preceptorship schemes are in place to more formally support newly qualified PAs, alongside the newly developed PA Ambassador roles; individuals who have lived experience of being a PA and the connections to make change happen. I hope that the forthcoming regulation of our profession will also significantly help with educating others about the PA role as it becomes more established.
*Since the COVID19 pandemic, the educational sessions are virtual rather than face to face, although the preceptorship Whatsapp group appears to be much more active. We haven’t found a suitable mechanism for consultation observation from the experienced PA at present and this has been put on hold.
1. Hoskin J, Agarwal R ‘Preceptorship scheme for newly qualified Physician Associates working in general practice in Sheffield’ Clinical Medicine Nov 2020 DOI: https://doi.org/10.7861/clinmed.2020-0221