This is dependent on a PA's experience. If registrars with 8 years' experience (five years of medical school, two foundation years and an ST year) start on 30-minute appointments, then it follows that new graduate PAs should be given similarly reasonable times. They may also need time to get signatures for medications or imaging. Appointment times should decrease every few months in the beginning - with negotiation and based on a PA's comfort and experience.
Over time, PAs should have 10-minute appointments, but how the individual surgery deals with signing medication/imaging will affect times. If a PA is required to discuss medication, but only has a 10-minute appointment, then in essence they are being asked to see patients faster than a doctor, as a PA has to wait to speak about the medication with their supervising GP within the 10-minute appointment time.
This depends on how the surgery works and if they discuss the medications. Ideally, this should be the next free or duty doctor. A new PA should always discuss every medication recommendation until the doctor is completely happy with the medication proposals.
Some PAs run the minor surgery weekly clinic, but only if the one GP with up-to-date skills is in the building. The clinic cannot run if the appropriate doctor is not in the building. This is a safety issue.
A PA has a biomedical science background, and is trained in the medical model specifically for the position in medicine. The PA is not an extended practitioner. They do not work to set protocols and can see a wide variety of undifferentiated patients.
An ANP has trained in nursing and has usually spent many years in healthcare learning the skills for the job, completing courses to advance their knowledge. They tend to work in a specialist area and have a mixed skill set.
ANPs tend to be able to prescribe. PAs have the requisite knowledge and skill to prescribe, although lack of statutory regulation currently renders them unable to do so. There are enough patients in the system to enable all professional groups to work in a complementary way to deliver high-quality patient care.
PAs do not fit into the hierarchical system used for grading doctors. While this may seem confusing, it is important to remember that the seniority of the PA is dependent on their skills and experience. For example, a PA who has worked in secondary care since qualification may have skills and experience more superior for their work area than a PA who has 5 years' experience in general practice who has only recently begun work in secondary care. Equally, a PA who has been working in one particular specialty may become very skilled in that clinical area, but must maintain their generalist skills in order to recertify every 6 years. Employers should be mindful of this, and create job plans that allow continued practice of a PA's fundamental clinical skills.
As more PAs enter the workplace, trainees are becoming more aware of the role that a PA can play within a team. Employers seeking to employ PAs should be aware that trainees can be misinformed on what a PA can do, as well as the variability of a PA's practice dependent on their level of experience. It is suggested that trainees are made aware of the role that PAs are playing in the organisation at their induction, so that any misconceptions or concerns are dealt with early on.
The funding for PA posts will vary dependent on the reasoning for employing them. Typical reasons include the need to reduce excessive locum spends and reconfigured rota systems, which could reduce ward- level continuity. PAs are not an alternative to doctors. PAs can add value and offer a continuous presence, as they do not tend to rotate. Consequently, the benefit of a PA becomes more apparent over a period of time.
PAs enable the workforce to work more efficiently. The limitations of their scope of practice should be borne in mind when designing a job plan for a PA working in secondary care. PAs will need to work alongside healthcare professionals who can order radiation - and prescribe - to prevent delays in access to investigations or treatment. This could be pertinent, for example, if PAs are working out of hours. On a day-to-day level, it is unlikely that these limitations have any direct disadvantages, as most PAs work alongside medical teams. It is suggested that PAs work alongside doctors of at least full GMC registration, rather than pre- registration foundation year doctors.
Many trusts allow PAs to transcribe medications to drug charts, but each transcription requires the signature of a fully registered doctor who assumes ultimate responsibility for the prescription. A move to electronic prescribing may prevent this inconvenience in the future. It is strongly recommended that PAs do not use any form of electronic prescribing, in order to prevent any practice outside their competence. When the PA profession is regulated, the regulator will determine what additional training is required for PAs to be allowed to prescribe.