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Physician Associates in general practice: Induction and preceptorship

Publication date: 09 October 2024

Introduction

This guidance is for GP practices that employ Physician Associates (PAs). It summarises employment checks, induction and the Preceptorship Programme.  It forms part of a set of guidance for GP practices on PAs in general practice and should be read in conjunction with the College’s policy position on PAs, as well as related RCGP guidance (on Supervision and Scope of Practice). Patient safety is paramount, and this guidance is written with that in mind.  

A seated woman wearing a black jacket facing forward sits between two seated patients facing away from the camera.
Induction for Physician Associates in general practice

PAs are dependent healthcare professionals who, in general practice, work as part of the multidisciplinary team with supervision from a named GP Clinical Supervisor (GP CS).  PAs will also have an Educational Supervisor (GP ES) who oversees their educational and professional development during the preceptorship period.

Some of the processes described in this guidance relate specifically to England, in particular the Preceptorship Programme (NHSE, 2023)i. But the principles related to the safe and effective utilisation of PAs in general practice are intended to be applicable to the four countries of the UK. The RCGP would like to see Preceptorships available and funded across the UK where PAs are working in general practice.

This document will be reviewed in 12 months and the RCGP commits to monitoring the situation and reviewing the document as the evidence  in this area develops. 

While it is not within the RCGP’s remit to enforce this guidance, it may be taken into account by NHS Resolution and the Medical Defence Organisations in a case of alleged negligence or clinical or professional mistakes. Ultimately, it is the decision of employers whether to follow this guidance, and the employer’s responsibility to ensure the appropriate treatment and handling of existing PA contracts.

Pre-employment checks

In addition to the usual checks made on employing new members of staff, GP practices must ensure that those applying to work as a PA appear on the Physician Associate Managed Voluntary Register1 or, once GMC-regulated, on the GMC’s Register of PAs.

The employer must be satisfied, prior to employment of the PA starting, that the PA has in place adequate professional indemnity insurance, or that the practice will provide it.  NHS Resolution provide information on indemnity arrangements for PAs working in general practice in England (NHS Resolution, 2024)ii.

1 PAs on the Register have successfully completed the university programme and passed the PA National exam. It is advisable to only hire PAs who appear on this list, until such time that PAs are regulated by the GMC.


Induction

Induction into the GP Practice is vital for both PAs on the Preceptorship Programme (see below) and those who are not. Induction must take place whether the PA has worked as a PA in another GP practice. This is because each practice has its own rules and processes and may be in a very different area geographically and culturally to the previous place of employment.  

PAs must have a minimum total induction period of two weeks, full time equivalent, to enable:

  • The practice to make available to patients and practice staff information about the PA role and the circumstances in which a patient might consult with a PA. Information must include the lines of accountability, the role of the PA and how the patient will know who is treating them.  It must be made clear to patients that they can ask to see someone other than a PA (indeed this should be offered for all members of the MDT).  If a patient does not want to see a PA, a conversation must take place between patient and practice and a shared decision taken on who will consult with the patient (Healthwatch, 2024).iii
  • The practice to discuss with the PA its rules on how PAs must introduce themselves to patients, and that they must always correct any wrong assumption that they are a doctor. The RCGP recommends that there should be transparent and accurate methods of introducing all members of the MDT to patients, including information on the practice website, on consulting room doors, on name badges and when appointments are booked (FPA, 2023).iv
  • The GP CS, GP ES and PA to prepare, together, a gap analysis and learning needs assessment of the PA’s knowledge, skills and confidence in general practice and a structured educational plan which must be reviewed periodically and, in the first year of employment, ideally every three months. The GP CS and GP ES will need to know what their incoming PAs are likely to have covered in their training to date in terms of knowledge, skills and professionalism.
  • On the basis of the learning needs assessment, the GP CS, GP ES and PA to agree a job plan, that is clear about what the PA’s role will be and which is within the PA’s defined scope of practice (see Scope of Practice guidance).
  • The GP CS to determine the PA’s clinical competencies, so the PA does not have to prove capability on numerous, separate occasions. This means that, once a PA has shown their competency in a particular task, they are 'signed off' and do not need to demonstrate that same competency repeatedly to different staff members, unless a concern is raised.
  • The PA to settle into the practice and familiarise themselves with the practice ethos, governance, staffing, emergency processes (e.g. fire/ emergency equipment), supervisory structures and support mechanisms. 
  • The practice team to understand the PA role, how it fits in and how it differs from that of other healthcare practitioners within the practice.
  • The PA to complete mandatory training.  A list of mandatory training topics is contained in the UK Core Skills Training Framework (CSTF,2023).v

The PA must not commence clinical duties until agreed by the GP CS and not normally during their first week in the practice

The induction period can be extended if necessary. 

The Physician Associates’ Preceptorship Programme

All PAs who wish to work in general practice for the first time must undertake a Preceptorship Programme. A PA undertaking a Preceptorship Programme is known as a Preceptee. A Preceptorship is a period to guide, develop and support newly registered PAs to build confidence and competence as they transition into general practice.  It is normally 12 months. The focus of the Preceptorship Programme must be ‘standard’ general practice and not up-skilling of PAs to deliver specialist clinics, such as women’s health or chronic disease clinics. 

The formal Preceptorship Programme for PAs is currently only available in England. If a Preceptorship scheme is not available in the short term, practices should consider constructing one of their own, perhaps as part of a PCN or cluster of practices. The RCGP would like to see Preceptorships available and funded across the UK where PAs are working in general practice.  This would enable a preceptorship allowance to be paid to the GP practice to support the supervision and educational needs of the PA, as has already been started by NHS England. 

The GP practice must devise and deliver a structured Preceptorship Programme that is suitable for the practice’s needs and takes into account guidance from the organisation funding the Preceptorship. 

In addition, the RCGP recommends that:

  • the PA, GP CS and GP ES must have protected learning/teaching/supervision time
  • the frequency of review meetings between the Preceptee and GP CS will depend on the experience of the PA and whether any areas are identified where the PA requires additional support. Initially we would recommend that all new PAs are supervised contemporaneously, i.e. the patient does not leave the practice until the GP CS is satisfied with the consultation and its outcome. With time, and this will depend on the competence of the PA and confidence of the GP CS and GP ES that the PA is safe within their scope of practice, this could become a ‘hot review’ at the end of a surgery of appointments, with the PA also seeking advice on any patient they are not sure about.
  • as many GPs do not work full time it may be necessary and also beneficial for another clinician to supervise some teaching sessions with the PA preceptee, for example a GP with an extended role in dermatology or a first contact physiotherapist for musculoskeletal disorders. However, the GP CS and GP ES are ultimately responsible for these teaching sessions.

Educational resources for the preceptee

Some NHS regions offer primary care mandatory weekly teaching programmes that PA preceptees are expected to attend. However, it may be that the GP CS and PA have identified a different course of study through a PA’s learning needs analysis or development plan. The funding for preceptorships allows for the cost of a postgraduate certificate (or specific modules that form part of a programme of study) if appropriate, to meet the requirements of the preceptee’s learning objectives and service context. GP CSs and GP ESs may also want to identify other educational resources that may be suitable for PA preceptees through their local training hubs, primary care networks or local medical committees.

ePortfolio and Workplace Based Assessment (WPBA) for the preceptee

PA preceptees are required to maintain an ePorfolio which is currently available on the FPA website. However, future arrangements are yet to be determined.

The GP CS and ES should determine what WPBA is necessary for the PA to demonstrate safe practice.  The WBPA will be undertaken by the GP CS or ES.

NHS England preceptorship guidance (NHS England, 2023) stipulates minimum WBPA for a PA preceptee, which can be used as an optional guide:

  • at 3 months: 3x Case Based Discussions (CBD), 3X Mini-Consultation Evaluation Exercises (mini-CEX) or Consultation Observation Tools (COTs)
  • at 6 months: 3x CBD, 3X Mini-CEX or COTS
  • at 12 months: an overall total of 8 x CBDs, 8 Mini CEX or COTS

Other WPBAs are encouraged by NHS England.

There must be a clear process of ensuring that any Preceptee that does not fulfil the WPBA standards is supported to undertake additional training or leave the programme.

PA induction references


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