Physician Associates in Geriatric medicine

Dr Natalie Powell is a Consultant in Acute and Geriatric Medicine at Surrey and Sussex Healthcare NHS Trust. She tweets at @NPowellNataliephysician assistants

Looking back I wonder how I ever coped without our Physician Associates (PAs).  Still a relatively new role in the NHS, PAs have been working in the United States for over 40 years.  They work to the medical model and are holistic practitioners with a variety of skills ideally suited to caring for older people. They are able to provide continuity for patient care on the wards; a familiar face for patients, relatives and ward staff to get to know.  They go that extra mile to make sure older people get the care and attention they deserve.

My journey with PAs began as a specialist registrar in Geriatrics.  Faced with almost 50 patients with one FY1, a bright enthusiastic individual proudly introduced herself as my PA student.  She was organised, meticulous and most of all committed to providing good patient care.  Four years on I am proud to say Rachel is now one of our Acute Medicine PAs.

Surrey and Sussex Healthcare NHS Trust appointed 6 PAs in 2013. Four of the PAs work in acute care and one each in Cardiology and Respiratory.  Two of the PAs, Sam and Lori work in Acute Geriatrics on the Acute Elderly care ward that I co-run.  Each new patient is completely reassessed with an attention to detail that becomes the medical Comprehensive Geriatric Assessment.  The small things that often bug a Geriatrician when missed are never forgotten by our PAs, like needing an urgent dental review to allow a patient to eat.  Every day they review, examine and provide direct care to patients, proactively seeking to update relatives and gain invaluable collateral information.  Prior to discharge our PAs run through discharge plans and medications to ensure that older people and their carers are involved thus ensuring a smooth transition out of hospital.  It is not unusual for me to do rounds with just my PA, Sam. I’m not complaining, the patient summaries are up to date, investigations completed and even my Ward Safety Checklists are completed!  Our safety dashboard for the ward has never looked better.

Our Geriatric and Acute PAs also have sessional commitment on the Acute Medical Unit including ambulatory care during the on-call.  This gives them front line experience of frail elderly admissions and they are helping to develop pathways of care with our ED colleagues so that we get it right from the moment older people come into the hospital.   They also have sessions in supporting the Older People’s Advice and Liaison Service, which outreaches to the surgical wards.

Perhaps what I find most inspiring about PAs is their genuine love of Medicine.  They are not work-shy and have a thirst for learning and development.  Although their profession is in its relative infancy in the UK, I can see a bright future for them in the NHS. Regulation would allow more scope of practice (they are currently unable to prescribe despite being trained to do so) and the medical profession need to support PA development.  Specialist Societies such as ours can play a vital role in encouraging this by embracing this new profession.  With moves toward seven day working and concerns about a reducing junior workforce, PAs may be one solution to providing early access to specialist Geriatric care at the point of need.

Anyone interested in finding out more about the Physician Associate role is welcome to contact me.  Further information about how PAs are received by doctors in the UK can be read in Lori’s excellent article in the April edition of Clinical Medicine.

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