All Wales Physician Associate Governance …

1 All Wales Physician Associate Governance framework Physician Associate Task and Dianne Watkins Finish Group Membership Dean for International, College of Biomedical and Life Sciences Richard Quirke Cardiff University Deputy Medical Director (CYNGOR Representative). Cwm Taf University Health Board Amanda Farrow Charlette Middlemiss Head of Speciality School for Emergency Associate Director Medicine WEDS ( Wales Deanery Representative). Gail Harries-Huntley Jacinta Abraham Modernisation Manager Consultant Oncologist WEDS Velindre Trust Cathy Brooks Andy Jones Senior Business Partner Advanced Paramedic Practitioner Aneurin Bevan University Health Board Welsh Ambulance Service NHS Trust Anne-Marie Rowlands Andrew Powell Assistant Director of Nursing Assistant Director Family Health Services Betsi Cadwaladr University Health Board Powys Teaching Health Board Peter Durning Nigel Downes Assistant Medical Director Royal College of Nursing Cardiff and Vale University Health Board Partnership Forum Ruth Alcolado Duncan Williams Consultant Physician GP.

2 Cwm Taf University Health Board Hywel Dda University Health Board (Royal College of Physicians Representative) Michelle Denning Senior Locality Development Manager Clive Morgan Hywel Dda University Health Board Assistant Director of Therapies and Health Science Paul Myres Cardiff and Vale University Health Board Professional Lead Primary Medical Care Advisory Team Beverley Edgar Public Health Wales Director Workforce and Organisational (Royal College of GPs Representative). Development Abertawe Bro Morgannwg University Secretariat Health Board Sian Rees WEDS. 2 NHS Wales Physician Associate Governance framework INDEX Page 1. Purpose 4. Introduction 2. Training and Education 5. Recertification Internship 3. Scope of Practice 6. Definition Regulation Limitations Supervision in the clinical setting 7. Delegation 8. Code of Conduct 8. 4. Employment 9 Workforce planning and redesign Employers' responsibilities 10. Indemnity Relationship with the extended team 5. Compliance and Reporting 11.

3 6. Evaluation and impact of the role 11. 7. Flow Chart 12. 8. Useful Links 14. 9. References 15. NHS Wales Physician Associate Governance framework 3. 1. Purpose Introduction This Governance framework has been The shortage of skilled staff in many developed to ensure consistency of specialities, on-going advances in application and to support successful medicine, higher public expectation, implementation of the Physicians increased demand for services and Associate role in both primary and continuing austerity are some of the secondary care and within a cross section reasons driving the need for workforce redesign. One solution to support workforce 4 redesign is through the introduction of the Physician Associate role. This is a new role of clinical specialties. in Wales but is well established in the United States of America and numbers are The purpose is to: increasing in other parts of the United Kingdom. Provide an assurance mechanism to Boards, managers, staff and patients The development and introduction of this role was endorsed by the Welsh Support the development and Government and NHS Wales in November implementation of the role 2015.

4 Ensure consistency and standardisation of practice Support the management of the role Support clinical practice. The all Wales Physician Associate framework will set out the training and NHS Wales Physician Associate Governance framework educational requirements, the scope of practice and the employers responsibilities with regard to the role of the Physician Associate . 2. Training and Education Recertification The Physician Associate is a graduate In order to work in Wales , once qualified who is then trained in line with the the Physician Associate should enter onto Competence and Curriculum framework the managed voluntary register. As a for the Physician Assistant (previous title condition of remaining on the voluntary of the Physician Associate ) to achieve register Physician Associates have to either a post graduate diploma or MSc recertify every 6 years by undertaking a obtained from one of the universities multiple choice examination. They are recognised and approved to provide the given three attempts to sit and pass the training in the UK.

5 Alternatively, a recertification examination. If they fail Physician Associate may have achieved they will be taken off the Physician an equivalent qualification from a Associate Managed Voluntary Register recognised university in another country. and their employer will be notified. They The purpose of the role is to support and will then be required to take the assist medical staff. qualifying examination and to enter on to the register again. 1. Physician Associate training is currently a full time two year programme comprising Should this situation arise Health 50% theory and 50% clinical practice. Boards/ Trusts should invoke the Once qualified the Physician Associate will relevant internal policies capability be required to undertake 50 hours of CPD and/or disciplinary policies, as they annually. would with any other member of staff who does not fulfil the requirements of A qualified Physician Associate can fulfil their contract of employment. the following remit with supervision: Formulate a detailed differential Internship diagnosis having taken a history and completed a physical examination In order to consolidate learning after qualifying the Faculty of Physician Work with patients and service users Associates advises that following to agree a comprehensive qualification Physician Associates should management plan considering undertake an internship.

6 This is similar individual characteristics, background to the foundation year undertaken by and circumstances doctors in the first year after qualifying and the preceptorship year following Perform diagnostic and therapeutic nurse training. An internship would procedures normally be between 6 and 12 months, during the period of internship the May request and interpret diagnostic Physician Associate will maintain a investigations as per local agreement. portfolio of cases and competencies (Not ionising radiation) which will be reviewed and signed off' by their supervising doctor and their initial With proper supervision and mentorship training institution. Physician Associates can work in any area of health care. 1. Faculty of Physician Associates (2015) Recertification. 5. NHS Wales Physician Associate Governance framework of the faculty and voluntary register as essential in the person specifications when recruiting Physician Associates. If a Physician Associate has trained in the USA they should have current and valid certification with the National Commission on Certification for Physician Associates (NCCPA).

7 For further information visit: NHS Wales employers should include membership of the faculty and inclusion on the voluntary register as essential on the person specification. Should an employer wish to check whether a Physician Associate is on the voluntary managed register they should contact the Royal College of Physicians membership office who will confirm the status of the 3. Scope of Practice Physician Associate in writing. Definition It should be noted that a number of other clinical professions within the NHS Wales will adopt the definition of health sector are currently not regulated the Physician Associate as set out in the and this does not prohibit their practice Competence and Curriculum framework audiologists. for the Physician Assistant'.*. Limitations The Physician Associate (PA) is defined as someone who is: In the absence of regulation Physician Associates do not currently have A new healthcare professional who, prescribing rights nor can they order while not a doctor, works to the radiological investigations.

8 Medical model, with the attitudes, skills and knowledge base to deliver Working with their supervisor and the holistic care and treatment within established team would allow the Physician Associate to gain experience on the general medical and/or general certain conditions and would allow them to practice team under defined levels suggest or advise on medications and of supervision. 2 investigations. Regulation Physician Associates are not regulated. The Faculty of Physician Associates was established in July 2015 and is based within the Royal College of Physicians. NHS Wales should include membership Assistant Managed Voluntary Register (2012) Competence and Curriculum framework for the Physician Assistant 6 NHS Wales Physician Associate Governance framework 3. Supervision in the Clinical This level of supervision will be necessary Setting until the supervisor has determined the skills and competence of the PA. This Supervision in this instance means time of supervision would include working working in the clinical setting to be able alongside the supervisor on the to assess the skills and knowledge of the same ward or in the same clinic individual.

9 Level two Indirect Clinical The supervisory relationship between the Supervision Physician Associate and the supervising doctor is a defining feature of the Indirect clinical supervision may remain development, successful implementation appropriate for delegated practice, or and on-going practice of the Physician may occur until the supervising medical Associate role. For the role of the practitioner is confident that the skills Physician Associate to be successful the and competence of the PA can progress individual must receive appropriate to level 3 supervision. This type of supervision in the clinical setting by the supervision would include working in the doctor responsible for managing the same hospital but not on the same ward. Physician Associate . Time should be built into jobs plans to ensure this happens. The nature of supervision and delegated autonomy for each Physician Associate may vary according to factors such as speciality, how sick the patient is, experience and competence.

10 The most appropriate supervision arrangements for a Physician Associate are determined by a number of factors, including their experience, the type of work they carry out and their individual needs The three levels of supervision detailed below have been taken from the Department of Health Queensland Government Physician Assistant Clinical Governance 3 and is supported by the GMC glossary of terms which describes three levels of supervision under the headings of supervised, closely supervised and directly supervised 4. Levels of Supervision Level one Direct Clinical Supervision Direct Clinical Supervision will occur until the PA becomes familiar with the role and the practice environment. 3. Department of Health Queensland Government (2014) Physician Assistant (PA) Clinical Governance 4. GMC. Glossary for Fitness to Practice. NHS Wales Physician Associate Governance framework Level three Remote Clinical The guidelines define delegation as: Supervision the process by which the Remote clinical supervision enables the delegator allocates clinical or PA to work with more delegated non-clinical treatment or care to autonomy for specific activities identified and agreed between the supervisor and a competent person.