NHS GRAMPIAN
PHYSICIAN ASSOCIATE INTERN
PACK
August 2023
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CONTENTS
1) Introduction
2) Registration
3) Governance Structure
a. Supervision
b. Responsibilities and Duties of Physician Associates
c. Professional Indemnity Cover
4) Portfolio and Appraisal
a. General Guidance
b. Physician Associate Portfolio Guidelines
c. TURAS Portfolio
d. TURAS Appraisal
5) Professional Development
a. Continuous Professional Development
b. Study Budget and Study Leave
c. Recertification
d. TURAS Learn
6) Appendices
a. Job Plan & Personal Development Plan Example
b. Multisource Feedback Form Example
c. Patient Feedback Form Example
d. CPD Categories and Requirements
e. Procedural/ Surgical Logbook
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Introduction
Firstly, welcome to NHS Grampian and congratulations on passing your National
Exams.
To gain the most benefit from your Intern Year you should be provided with a
supportive learning environment to allow you develop and expand your skills and
competencies in your clinical areas. Your first year of employment should be more
supported and allow you develop with on-the-job-training. It is hoped that this will allow
you to consolidate your core knowledge and skills and demonstrate your competence
to practice.
As with all new employment, it can be daunting as a newly qualified PA moving to a
new specialty. This document intends to provide advice and guidance to Physician
Associate (PA) Interns within NHS Grampian for their first year post qualification.
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Registration
Physician Associates (PAs) do not currently have a recognised regulatory body,
although active efforts are underway to establish statutory regulation for PAs.
The Faculty of Physician Associates (FPA) was established in 2015 by the Royal
College of Physicians along with other health education bodies. As a qualified PA you
can join the FPA and become a member of a professional body that campaigns for
progress in the profession, advises government and takes part in national debates on
medical, clinical and public health issues.
Currently, the annual fee to become an FPA member is £211 per annum. This
membership will include being added on the Physician Associate Managed Voluntary
Register (PAMVR) and free access to the CPD diary. You can find more information
at: https://www.fparcp.co.uk/fpa-membership/qualified-pa
The FPA maintains a Managed Voluntary Register (MVR). NHS Scotland, and NHS
Grampian, stipulate that as part of the condition of employment, all PAs must be
registered on the MVR. The MVR allows supervisors, employers and members of the
public to check whether a PA is qualified and safe to work. In order to join the MVR a
PA must have:
- Completed an approved qualifying PA programme
- Completed the FPA National Exam
All UK-based PAs are strongly encouraged to join the MVR as it will form the initial list
of PAs to enter statutory register when established. As soon as a statutory register is
in place, those on the MVR are expected to be transferred onto the statutory register,
the title physician associate will become protected and only those on the statutory
register will legally be allowed to practice as a PA in the UK. You can find more
information at: https://www.fparcp.co.uk/pamvr/overview/
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Supervision
A PA is described as a dependent practitioner and should therefore always work under
the supervision of a designated doctor. Supervision can be in different forms such as;
direct (with the supervising doctor physically present) or indirect (where the
supervising doctor is not physically present). However, the supervising doctor should
always be readily available for consultation.
Similar to other healthcare professions, a PA is responsible for their own practice,
although the supervising doctor always maintains ultimate responsibility for the
patient’s care.
Upon starting your intern year, please make sure you are aware of who your
Clinical/Educational Supervisor is. They should carry out your induction meeting at the
beginning of your placement and your Appraisal at the end of your placement.
Should your supervisor have any questions regarding this please get in touch with the
NHS Grampian PA Committee (xxxx.xx@xxx.xxxx),
(PA
Supervisor contact) or
(NHS Grampian PA Intern Lead). They
can also find forms and documents to guide them on the FPA website.
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Responsibilities and Duties of a Physician
Associate
Summary of Duties
PAs provide assistance to doctors and trainees in the provision of a high quality,
patient centred service. PAs can participate in all appropriate aspects of the care
pathway and will be expected to perform delegated duties with a high degree of clinical
skill and knowledge.
PAs work alongside the medical team. They assess and examine patients, present
them, initiate and interpret investigations and recommend treatment. They liaise with
other professionals and specialities as required and complete necessary
documentation relating to their patients.
They will be supervised by a designated consultant and will also have individual
mentors to overview their career development.
PAs are involved in the activities of the Department they work in, including co-
ordinating patients on ambulatory pathways related to their specialty, review patients
admitted to their ward(s) and provide subsequent management of their case in
conjunction with the medical team. The role is generally developed flexibly over time
in accordance with the PAs clinical interests and in line with the needs of the service.
Responsibilities of a PA
- To have, develop and maintain specialist medical knowledge
- To keep up to date with current guidelines and maintain best practice
- To be accountable for the care given and to comply with the Fitness to Practice
and Code of Conduct standard as established by the MVR and subsequently
the appropriate statutory regulating body when in place.
- To work within the framework of the scope of professional practice
- To work within the multidisciplinary team to ensure effective team working in
the provision of acute medical care to patients on a day-to-day basis.
- To support and contribute to timely discharge planning including completing
discharge summaries and support optimising bed capacity
- To abide by the Clinical and Corporate Governance policies of NHS Grampian.
- To take part in the administration of the department and the involvement in the
management of resources
- To fully document all aspects of patient care, and complete all required
paperwork.
Limitations
Due to lack of statutory regulation at present, Physician associates cannot currently
prescribe/ transcribe medications or request ionising radiation.
In addition, please note that Physician associates cannot sign legal documentation
such as Adults with Incapacity forms (AWIs), Medical Detention certificates, Sick
Notes etc.
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Professional Indemnity Cover
Physician Associates require professional indemnity cover to practice in the UK.
The Medical Defence Union (MDU) (www.themdu.com) and Medical and Dental
Defence Union of Scotland (MDDUS) (www.mddus.com) both provide professional
indemnity for qualified Physician Associates.
Within trusts the practice of physician associates is covered by the Department of
Health 2012 Clinical Negligence Scheme for Trusts (CNST). However, qualified PAs
are strongly encouraged to have their own personal professional negligence
insurance from one of the medical defence organisations listed.
In primary care, it is imperative that a PA have their own indemnity. The annual PA
census by the FPA shows in the majority of cases the cost of PA indemnity in
primary care is covered by the employer and it is recommended GP employers
contact their own indemnity provider for guidance on this.
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General Guidance
It is recommended, at the initial supervisor meeting, a structured programme of
specific educational goals are developed to support the PA Intern through their first
year of employment.
At this meeting, you should attempt to discuss the following;
- Identify times for dedicated supervision
- Identify opportunities that currently exist in the organisation for both learning
in the clinical environment such as clinics, ward rounds, and opportunities to
clerk patients for PAs in secondary care or long term condition clinics,
procedural clinics or home visits for GP based PAs.
- Identify areas for Audit or service improvement project which could be
undertaken within your first year.
- Establish what current competencies and skills you have experience and
confidence in and how these could be developed and utilised by the team.
- Identify skills and competencies where you feel you need more guidance and
development and how this can be best achieved over the first 12 months.
- Discuss goals to be achieved within your first year of practice and set dates
for meetings to review progress at these time points.
- Agree any additional procedural skills to be taught and assessed and number
of DOPS for each
- Identify potential courses and learning opportunities
- Establishing review dates
There are competencies which you are expected to achieve throughout your Intern
year within NHS Grampian. These can be found in the table below;
On Qualification
On Completion of
Internship
History and Consultation
Will be able to carry out
Able to carry out a thorough
focused history and produce focused history, and be able
an appropriate list of
to identify appropriate co-
differentials
morbidities, predisposing/
risk factors in order to
interpret most likely
differential and reasons
Examination General
Starting to be able to
Supervising doctor has
abbreviate their examination confidence in PA findings
to become more focused.
and in the PA using their
Becoming confident in ability clinical findings to justify the
to distinguish normal from
differential diagnosis.
abnormal during clinical
examination
Interpreting evidence and
Understand diagnostic tests
Confidently articulate
Investigation
to rule out key negatives.
findings and investigation
Become aware of the
results.
limitations of investigations
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Clinical Judgement and risk
Able to narrow list of
Identify main diagnosis and
management
important differential
justify reasoning.
diagnoses.
Aware of best venue to
Consistently identify high
nurse patients e.g. ITU vs
risk conditions requiring
medical ward
immediate attention.
Therapeutics and
Broader understanding of
Start to justify choice of
prescribing
medication choice for
medication. Able to
presentations of common
understand the impact of co-
and important conditions.
morbidities and other
Aware of contra-indications,
medications (poly-
interactions and monitoring. pharmacy) on agent choice
and prognosis.
Learn to develop and
explain to patients their
Confident in explaining to
clinical management plan
patients their clinical
and be able to modify plan
management plan and able
according to age and co-
to modify plan according to
morbidity.
age and co-morbidity.
Developing consultation
skills to enable shared
patient practitioner decision
making.
Clinical Planning and
Aware of risks and benefits
Able to implement
procedures
of common procedures,
management plan including
have basic competence in
proficient basic procedures
simpler procedures and
and develop more advanced
some experience of seeing
procedures.
this in action.
Beginning to be able to
manage complications and
review patient
Professionalism
Consistently behave with
Have completed 10 TABS
integrity and sensitivity, be a within the 1 year and
good role model and
beginning to deal with
ambassador, maintain
‘difficult patients’.
effective relationships with
the MDT and contribute to
Be part of training for other
the clinical learning
Intern PAs and/ or teaching
environment.
PA and other healthcare
students.
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Physician Associate Intern Portfolio Guidelines
This document contains material that you are required to complete on commencing
your Physician Associate Intern post within NHS Grampian.
These documents are mandatory to complete as part of your Continuous Professional
Development (CPD). By completing these recommended development documents
there will be a record within the Service as part of supporting evidence that the
Physician associate is competent within their role. The documents will form part of the
Physician associate’s CPD and Appraisal.
The NHS Grampian Appraisal system for Agenda for Change is via TURAS Appraisal.
Each Physician Associate is required to populate their portfolio annually prior to their
appraisal. As a Physician Associate Intern you should have a brief appraisal meeting
at the end of each of your rotations.
The Faculty of Physician Associates suggest that a Physician Associate in their first
12 months following qualification should complete the following as part of their
portfolio.
Assessment
Recommendation of minimum
numbers per year
Case Based Discussion
8
Mini Clinical Evaluation Exercise
8
Direct Observation of Procedural Skills
At least one per procedure below
Reflections
3
Multisource Feedback (MSF) (Appendix
10 TABS per year
B)
Patient Feedback (Appendix C)
5
Mandatory and Statutory Training (as
As per health board requirements
per health board)
Your DOPS within your first 12 months should include:
- Venepuncture
- IV cannulation
- Arterial Blood Gas in an Adult
- Blood culture
- Subcutaneous Injection
- Intramuscular Injection
- Perform and Interpret ECG
- Suturing
- Urethral Catheterisation Female
- Urethral Catheterisation Male
- Airway care including simple adjuncts
- Using a Nebuliser
Other practical procedures can be carried out as part of a mutual agreement between
a PA and clinical supervisor. These should also be recorded as a DOPS,
In addition to the above paperwork every Physician Associate should complete;
1) A Job Plan (Appendix A)
2) A Personal Development Plan (Appendix A)
3) A procedural logbook (if relevant to your department) (Appendix E)
These should be reviewed and updated at your appraisal meeting.
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4) Each of your Personal development points will be recorded as a ‘Learning
Need’. For each point you must record which KSF Dimension it corresponds
to.
5) For each PDP point/ ‘Learning Need’ you will require to add a ‘Learning
Activity’. This is a description of how you will achieve your ‘Learning Need’
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6) Each of your ‘Learning Needs’ or ‘Learning Activities’ can be supported with
PDP documents which can be uploaded at the bottom of the Tab.
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7) Under the Objectives Tab you should record clear statements that set out
what you want to achieve at work. Objectives help you to be clear about
what is expected of you and what matters to you in your job. You should
have no more than 6 objectives.
8) The KSF tab allows you to record your progress against your KSF post outline.
You can set the levels for each dimension – these should be agreed with
your reviewed in your Appraisal meeting.
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Continuous Professional Development (CPD)
‘Continuous Professional Development’ is a process that enables individual PAs to
maintain and improve standards of medical practice through the development of
knowledge, skills, attitudes and behaviours.
All PAs are responsible for maintaining their own CPD. This is a mandatory
requirement by the FPA and shortly by the GMC.
The FPA has produced a CPD diary for PAs to record and evidence your learning and
reflections. All FPA members have free access to this.
Credits given by the FPA for CPD should be based on one credit equating to one hour
of educational activity. There is a requirement of 50 credits/ hours of CPD to be
undertaken per year to remain on the MVR. At least 25 of these credits/ hours must
be ‘External’.
CPD should include activities both within and out-with NHS Grampian.
On the CPD diary a PA can enter their activity under a number of headings (further
information on these in Appendix D);
- External
- Internal
- Clinical
- Non-Clinical
- Personal
On addition of the activity, you will be required to complete a reflection (private) and a
simple feedback for external activities (this will be shared with the provider) to receive
the relevant number of credits.
At the end of the each year a certificate is available summarising the categories and
number of credits achieved. There also a rolling five year summary and certificate.
To allow for unexpected or special circumstances, the FPA run a 5 year rolling
programme for CPD requirements. The total number of credits that are required over
5 years is 250 CPD credits. Of these 250 credits, 125 should be Clinical External and
at least 25 should be Non-Clinical External.
Every year the FPA carry out a validation on 5% of all CPD Diaries to review that
participants are meeting the required credits and have kept a true record of their
activities.
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Study Budget and Study Leave
Due to the CPD requirements that are essential for a PAs progression, NHS Grampian
supervisors must provide support in access to your Study Budget and Study Leave.
Each PA in NHS Grampian is entitled to
- 10 Days of study leave each year (this will be split between your 2x 6 month
blocks – 5 per block)
- £500 Study budget each year (this will be split between your 2x 6 month blocks
- £250 per block).
Your Study budget will be claimed retrospectively from your department for any funds
required to your study leave. This includes; conference fees, travel expenses and
accommodation required to attend an event.
Recertification
Recertification is the process that will ensure that a registered PA remains up to date
and fit to practice. PAs are no longer required to take a Recertification Exam every six
years. This will now be based upon your CPD and Appraisal. This is currently being
further developed by the GMC and FPA.
TURAS Learn
The NHS Grampian PA Committee has created a PA TURAS page – go to TURAS
Learn and search ‘Physician Associate TURAS Learn’. This can be used to find
educational resources and useful information for PAs in North East Scotland including
CPD events/dates and useful resources.
There is also a PA section on the ‘NHS Grampian: corporate induction’ page. This
page also contains all the mandatory training modules that are required by NHS
Grampian to keep up to date. These modules should be completed by all PAs
(including GP PAs employed by NHS Grampian).
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Appendices
Appendix A
Job Plan
You should include a Job Plan in your portfolio. There will be opportunities at review
meetings and appraisal to discuss areas that require work or need additional help to
ensure that the PA is working to their full potential.
Your Job Plan should include;
- Your name
- Department and Hours of Work
- Supervising Consultants name
- Operational Line managers name
- Date of Review
- Summary of duties and responsibilities (both core and departmental specific)
- Timetable of Weekly Practice
- Development – including your personal development plan
- Appraisal Aims
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Example of Job Plan for a Surgical PA
Name: Mickey Mouse
Department: Urology
Place of Work: Aberdeen Royal Infirmary
Hours of work: 37.5 hours/week
Band of Pay: Band 7
Contract: Permanent
Supervising Consultant:
In the absence of supervising consultant, supervision will be provided by duty
consultant as per on call rota
Operational Line Manager:
Date of review of document:
Summary of Duties
-
To provide assistance to the consultants, speciality doctors and senor trainees in the
provision of high quality, patient centred care.
-
To participate in all appropriate aspects of the care pathway
-
To perform delegated duties with a high degree of clinical skills and knowledge
-
To assess and examine patients, present them, initiate and interpret investigations and
recommend treatments.
-
To liaise with other professionals and specialities as required
-
To complete all documentation related to a patient’s care to a high quality
-
To assess and admit patients to the care of urology and providing subsequent
management of their care alongside others in the medical team.
Description of Duties
-
Participate in daily ward rounds
-
Participate in ward work
-
Attend MDT every second Tuesday
-
To go to theatre 3 times a week
-
To attend outpatient clinics at least twice a month
-
To attend on ward teaching weekly
Core Procedures
-
Venepuncture
-
IV cannulation
-
Arterial blood gasses
-
Blood Cultures
-
Subcutaneous Injections
-
Intramuscular injections
-
Perform and Interpret ECG
-
Urethral Catheterisation in males and females
-
Airway care including simple adjuncts
-
Using a nebuliser
-
Suturing
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Department specific
-
Bladder Ultrasounds
-
Flexible Cystoscopy
-
Complex catheterisation including Suprapubic catheter insertion
-
Drainage of abscess
Responsibilities of a PA:
-
To have, develop and maintain specialist medical knowledge
-
To keep up to date with current guidelines and maintain best practice.
-
To be accountable for the care given and to comply with the Fitness to Practice and
Code of Conduct standard as established by the UK Physician Associate Register
(the PA Managed Voluntary Register) and subsequently the appropriate statutory
regulating body when in place.
-
To work within the framework of the scope of professional practice.
-
To work within the multidisciplinary team to ensure effective team working in
provision of acute medical care to patients on a day to day basis
-
To support and contribute to timely discharge planning including completing
discharge summaries and support optimising bed capacity.
-
To abide by the Clinical and Corporate Governance policies of NHS Grampian.
-
To take part in the administration of the department and the involvement in the
management of resources
-
To fully document all aspects of patient care and complete all the required
paperwork.
PA Timetable for Urology Department
Monday
Tuesday
Wednesday
Thursday
Friday
08:00-12:30
Theatre
Theatre
Ward
Theatre
Ward
12:30-13:00
Lunch
Lunch
Lunch
Lunch
Lunch
13:00-14:00
Admin/ CPD
MDT
Ward
Admin/ CPD
Teaching
Teaching
14:00-16:00
Admin/CPD
Theatre
Ward
OP Clinic
Ward
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Development
Personal Development Plan
-
Participate in Audit and Quality Improvement work throughout the year
-
Improve Surgical Skills
o To assist in theatre
o To attend all common urological procedures at least once to gain
knowledge of how these are carried out
-
To participate/ Observe in outpatient clinics
-
Improve knowledge and clinical skills
o Attend Medical Conferences
o To expand my knowledge and skills by reading up-to-date research
papers
o Attend ILS/ ALS course
o Participate in e-learning courses
o To be competent in difficult catheterisation (female and male)
o To observe, participate in and be competent in flexible cystoscopy
-
Safety and Quality
o Have twice yearly meetings with supervisor to discuss progress
o Attend regular morbidity and mortality meetings
o Complete all Portfolio paperwork to ensure clinical standards are
maintained.
-
Communication, partnership and teamwork
o Ensure that MSF and patient feedback forms are completed by end of
year
o Endeavour to contribute to teaching and training of both colleagues and
students
Appraisal
My yearly appraisal will cover all areas of work, including;
-
Knowledge and skills
-
Workload
-
Teamworking as part of the multidisciplinary team
-
Safety and Quality
-
Feedback and complaints
-
Health and Probity statements
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Appendix B
Multi Source Feedback (MSF) – Colleague Extended Questionnaire
Physician Associate Name
PAMVR Number
Date
Grade of Assessor
I have
Below
Good
Outstanding Unable to
concerns
expectations
comment
Diagnostic Skill
Performance of
practical/ technical
procedures
Management of
complex clinical
problems
Appropriate use of
resources
Technical Ability
Conscientious and
reliable
Availability for
advice and help
when needed
Time management
Committed to
improving quality
of service
Keeps up to date
with knowledge
and skills
Contribution to the
education and
supervision of
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student and
colleagues
Spoken English
Communication
with colleagues
Communication
with patients,
families and carers
Is polite,
considerate and
respectful to
colleagues of all
levels
Shows
compassion and
empathy towards
patients and their
relatives
Values the skills
and contributions
of
multidisciplinary
team members
Takes leadership
role when
circumstances
require
Delegates
appropriately
Do you have any concerns about the probity or
Yes
health (physical or mental) of this physician
associate that may impact patient care
No
Any further comments?
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Appendix C
Patient/ Carer / Public Feedback Questionnaire
Physician Associate Name
PAMVR Number
Date
Please tick the column that applies.
Yes,
Yes, to
Not really
Definitely
Does not
definitely
some extent
not
apply
Was the
physician
associate polite
and considerate?
Did the physician
associate listen
to what you had
to say?
Did the physician
associate give
you enough
opportunity to
ask questions?
Are you involved
as much as you
want to be in the
decisions about
your care and
treatment?
Did you have
confidence in the
physician
associate?
Did the physician
associate respect
your views?
If the physician
associate
examined you,
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did he or she ask
your permission?
If the physician
associate
examined you,
did he or she
respect your
privacy?
By the end of the
consultation di
you feel better
able to
understand and/
or manage your
condition and
your care?
Overall, how satisfied were you
Very
Fairly
Not really
Not at all
with the physician associate
Satisfied
Satisfied
Satisfied
satisfied
that you saw?
Please make any additional comments about the physician associate in the
space below:
Thank you for your feedback
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Appendix D
CPD Categories
These categories ensure that there is a balance of activities undertaken throughout
the year.
Category Definition
- Clinical
o Any event which the educational content directly relates to clinical topics
- Non-Clinical
o Educational event that is not directly related to clinical issues
o E.g. Management courses, ethical and legal issues, appraisal training
- External
o Events outside NHS Grampian. These can be regional, national or
international meetings.
o E.g. attending conferences or study days
o Any external meeting not found by searching the CPD diary can be
entered under ‘Unlisted External Meeting’
- Internal
o Events within NHS Grampian (hospital/ trust/ GP)
o E.g. hospital grand rounds, journal clubs, local evening meetings etc.
- Personal
o Credits relate to study
o E.g. private reading, lecturing, researching
- Exemption
o Exemption credits can only be claimed in exceptional circumstances
when a PA is unable to meet the annual minimum requirements due to
illness, maternity leave or long absence from work.
o Advice regarding this should be sought directly through the Faculty of
Physician Associates
Credit Requirement per Year
- External
o Minimum requirement 25 credits
- Internal
o No restrictions or requirements
- Personal
o Only 10 personal credits can be claimed towards your yearly total.
However, you may record as many as you wish.
- Distance Learning
o Only the first 10 RCP approved Distance Learning credits will be claimed
towards your yearly total as ‘External’. The remainder can be claimed as
‘Personal’
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- MSc
o Only 12 ‘External’ credits can be claimed for an MSc or equivalent
activity each year. The remainder can be claimed as ‘Personal’
- Examining
o Only 12 ‘External’ credits can be claimed for FPA examining activities
each year. The remainder can be claimed as ‘Personal’
o
Examples of Educational Activities that qualify for CPD
- Work related MSc or equivalent (External)
- Unlisted External meetings (External)
- Internal CPD meetings (Internal)
- Participating in audit meetings or Morbidity and mortality meetings (Internal)
- Participating in Grand rounds or Specialy clinical meetings (Internal)
- Participating in Seminars/ Workshops (Internal)
- Internal trust or employer mandatory training (Internal)
- Carrying out information searches (Personal)
- Making new presentations at conferences (Personal)
- Reading Journals and texts (Personal)
- Refereeing articles and texts (Personal)
- Undertaking a research project (Personal)
- Undertaking QA/ Enhancement/ peer reviews (Personal)
- Writing examination questions or examining (Personal)
- Writing review articles and texts (Personal)
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Appendix E
Surgical Logbook Example
Physician Associate Name
PAMVR Number
Date
Procedure/ Operation
Outline procedure/ Theatre
PA Signature
Supervisor’s Signature
Performed
Involvement
1
2
3
4
5
6
7
8
9
10
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References
1)
Faculty of Physician Associates (2023). Available at: https://www.fparcp.co.uk/
(Accessed: 25 August 2023).
2) McCorgray, C. (2020) ‘NHS Grampian Surgical Physician Associate Portfolio
Guidelines’. Aberdeen: NHS Grampian
3) Seery, A. and Kulkarni, U. (2017) ‘NHS Grampian Physician Associate Intern Year –
Suite of Developmental Support Documents’. Aberdeen: NHS Grampian
4)
Professional medical indemnity for clinical negligence claims - The MDU. [online]
Available at: https://www.themdu.com.
5)
Medical
&
Dental
Indemnity
Protection
UK.
[online]
Available
at:
https://www.mddus.com.
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