NHS Lothian is looking to the US in its latest initiative to combat ill health linked to deprivation.
Four ‘physician assistants’ will be joining GP practices in Edinburgh and West Lothian in October as part of a two-year trial which, if successful, could see the establishment in Scotland of a new kind of healthcare professional.
Physician assistants – long-established healthcare workers in the US – work under the direction of supervising GPs.
Two of the physician assistants will work in Edinburgh, developing and running an integrated chronic disease management service for diabetes and chronic obstructive pulmonary disease (COPD) for patients across Edinburgh.
The remaining two postholders will work in West Lothian under the direction of the West Lothian Community Health and Care Partnership.
Bob Anderson, interim chair, NHS Lothian, said: “NHS Lothian is committed to exploring new ideas and the latest thinking in our efforts to deliver the best possible healthcare for the people of Lothian. This is all part of our commitment to ensuring that NHS Lothian continues to improve services for patients”.
Dr Charles Swainson, medical director, NHS Lothian, said: “These new roles will add value to our nurse and GP-led primary care clinics by increasing our capacity for looking after patients with chronic diseases. Our new colleagues will also help the efforts we are making to target people who we find are hard to reach with our current approaches. In doing this, they will assist us in the vital task of reducing inequalities in access to healthcare services.”
NHS Lothian is participating in a trial of the physician assistant concept run by NHS Education for Scotland. At present, physician assistants will not be able to prescribe drugs but this is under review.
NHS Lothian is part of national efforts to develop new modes of working in the wake of substantial challenges to the previous status quo in healthcare services. These challenges include the European Working Time Directive and major changes to the way in which doctors are trained.
The development of both enhanced roles for nurses and other healthcare professionals, together with the potential creation of new posts, is central to the successful delivery of Delivering for Health, the Scottish Executive’s vision for the future of Scotland’s health services.
Case studies featuring the new physician assistants can be obtained below.
Notes to Editors
Physician assistants are neither doctors nor nurses. They are licensed healthcare professionals from the USA who can practise medicine with minimal supervision.
They are trained professionals who can provide a wide range of diagnostic and therapeutic services and can provide care to patients, undertaking a full range of tasks from taking a history to providing appropriate clinical management.
They work under the supervision of a doctor and are part of the healthcare team. There are over 60,000 PAs currently working in the USA. NHS Education for Scotland is working with five health boards in this project: NHS Lothian, NHS Grampian, NHS Lanarkshire, NHS Tayside and NHS Western Isles.
Physician assistants undergo two years of a general medical training programme, often alongside conventional medical students who go on to become doctors.
The concept first became popular in the US in the 1970s, with many of the first physician assistants being former military medics with experience of the Vietnam conflict.
The physician assistant course is a postgraduate course and most have a life sciences degree before embarking on PA training.
Research in the US has shown very good results for physician assistants in terms of patient satisfaction with their work, quality care, patient throughput and cost effectiveness.
John Bradford is swapping Salt Lake City in Utah for Edinburgh’s Leith Community Treatment Centre as one of NHS Lothian’s four new physician assistants.
Bradford, 46, is looking forward to bringing his extensive experience of dealing with patients with diabetes, hypertension and chronic lung disease to NHS Lothian.
His previous roles include working as a physician assistant in the primary care side of Salt Lake City’s Veterans’ Administration Hospital and teaching at the University of Utah.
Bradford said: “I’ve worked with people with diabetes and chronic airways diseases in the past and that is the population I’ll be working with here. My role will involve a mixture of seeing clients in primary care and providing continuity of care and advice to these patients, both in the centre and in the clients’ homes.”
The former nurse added: “Lifestyle choices play a role in the increase of these types of chronic diseases. The States is probably ahead of the curve on this but I know from work I’ve done in the South Pacific that these conditions are on the rise there and the rest of the world is catching up on these conditions where sedentary lifestyles are a factor.
He continued: “I think that one of my main roles will be in education – about encouraging patients to make healthy lifestyle choices and to properly manage their chronic conditions so that their problems don’t get any worse.”
Bradford qualified as a physician assistant three years ago after a 14-year career as a registered nurse. He chose to go back into education in the US to take the PA masters qualification as he wanted more autonomy. In his last role, which was providing urgent medical assistance to patients in a primary care service operated by the Salt Lake City’s VA hospital, John had prescribing powers for most drugs, though he required his supervising physician or doctor to countersign prescriptions for narcotic drugs retrospectively.
“I was looking for the next level in my career and for more autonomy in my practice. I considered going back to school to become either a nurse practitioner or a PA and the PA training followed a more medical model, which was more appealing to me.”
The concept of a physician assistant is now well-established in the US, leading to a great degree of public acceptance and knowledge of the role. “The position has been evolving in the US for 40 years and there’s a high degree of public knowledge about it. In some areas, the concept is known as ‘physician extenders’ and it’s not unusual to have four or five physician assistants working in one practice,” said Bradford, who has moved to Scotland with his wife and daughter.
Bradford has never had any negative feedback from patients who feel they would rather see a doctor. “I’m straight-forward with people, I explain what I can do for them, I make sure they know what I am and I let them know they can request an appointment with a doctor if they prefer and I’ve never had anyone ask for a doctor instead.”
Ed Schuurman will be based in West Lothian, providing care to patients at Bathgate and Blackburn health centres. Schuurman began work on Monday, the 2nd of October and will be working closely with patients with diabetes and chronic lung conditions.
The 33 year-old trained as a physician assistant after stints working as an emergency care technician (a form of paramedic) on the completion of his first degree. His last role in the US was in rural Pennsylvania. “I worked as part of a very small team in a very rural setting in Family Practice, which is the US equivalent of your general practice or primary care. I worked on chronic disease management and am looking forward to working with colleagues and patients with these kinds of conditions in West Lothian,” said Schuurman, who has moved to Scotland with his wife and four children.
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