As we continue to digest everything contained in the recently released NHS long term workforce plan, it is becoming increasingly clear that physician associates are expected to play a key part in the future of the NHS.
In a previous article, we highlighted the plan aims to grow the profession to a point of 1,500 PA students qualifying every year by 2031/32.
1,500 a year may pose a significant challenge, requiring major investment in expanding placement capacity for PA students. Many universities and PA courses are already struggling to find sufficient venues for students to complete their clinical placements across primary care, mental health, and hospital settings.
With the number of medical students expected to double too to almost 15,000 a year, there will be even more competition for a limited number of places to train all of these learners. We clearly need to expand medical school numbers and PA graduates too, to grow the clinical workforce to care for patients. Nobody denies that there are chronic workforce shortages that are affecting every aspect of the NHS.
The long-term workforce plan emphasises the importance of directing more PA’s towards primary care and mental health services as particular areas of need; however, unless students high quality clinical placements in those areas, I suspect it will be difficult to convince people to take up those jobs.
Clinical placements in primary care, for example, need to be of significiant duration to allow the learner to embed within the team and experience the full range of presentations in GP surgeries. Clinical supervision of those learners must be in place to ensure patient safety, which is not always easy to achieve. The buildings and estates in primary care are also constrained, sometimes there just aren’t enough free clinic rooms to place a student in the surgery.
So, how can we begin to tackle these issues. One way of improving placement capacity should focus on expanding the number of organisations who offer placements. This will require a lot of work in educational departments in hospitals and training hubs in primary care. More resource and money will need to be allocated to expand surgeries who have not traditionally taken students. This change of culture will likely be slow, and there may be some hesitation to taking physician associate students into these areas in particular. So I believe work such as this may become a key part of the work of local PA ambassadors in their areas.
Expanding the range of clinical settings that are available for placements might also be another tactic, such as placing more student into long-term care facilities, prison medicine and ‘virtual wards’.
The use of virtual reality technology might also facilitate clinical placements. PA students may be able to gain experience in clinical settings that they would not otherwise have access to through virtual reality. Whilst this technology is not rapidly available in every university yet, I suspect it may start playing an increasing role in clinical placement education and simulation in the future.
We will also need to think about training qualified PAs and other staff to act as supervisors for the increased number of learners. Stretching the number of existing supervisors across more learners will inevitably cause problems. Perhaps we will need to create new models of clinical supervision, such as team-based supervision or using peer-to-peer supervision. And train up physician associates with several years of experience to become supervisors for PA students and medical students, to allow inter-professional learning. Overall, we will need to invest in training and development for clinical supervisors so that they have the skills and knowledge they need to effectively supervise PA students.
So it isn’t just as easy as the workforce plan makes out. Doubling the number of medical school places, or increasing the number of PA students, are both laudable aims. The plan, in my opinion, needs to set out more resources and plans on how we will achieve those aims, and consider the longer-term impacts of creating more doctors and PAs, such as increased places in the foundation year programme (and post-graduate training) for doctors, or more jobs for PAs so that we don’t produce graduates who end up unemployed.