In September 2003, I started work as a PA at a family practice clinic in the United Kingdom (UK). This clinic—or general practice surgery, as they are called— is located in a low-income, high-need area, and the business partners had struggled to find a full-time physician to replace the one who had retired. Eventually, they turned to US-trained PAs for a solution. On a smaller scale, their situation was not unlike the one that launched the PA profession in the United States, and they sought out a profession that has long been committed to providing care in underserved areas.
This was an exciting opportunity for me, because I would be able to promote the profession on an international level. Since becoming a PA, I have passionately believed that we can help meet medical needs worldwide— and I even found evidence supporting that belief when I wrote my research thesis as a student. I do believe that PAs will eventually have international representation and unification similar to other medical professions. I also wanted to practice in a country with a national health system so I could experience firsthand the pros and cons of such a system. And, I wanted to be able to travel.
I was hired on a 2-year work contract. As part of the contract, I am also part of a pilot research project commissioned by the Changing Workforce Programme of the UK Department of Health. My days include working in the clinic, doing home visits (a routine part of the primary care service here), attending meetings to assist in the promotion of the PA profession in the UK, and collecting and recording data as needed for the pilot study. I work on a team with two doctors, one nurse practitioner (who mainly sees patients with diabetes, COPD, and asthma), and a practice nurse who performs duties similar to that of a LPN. Nursing titles and nursing training differs from those in the States.
9:00 AM
I arrive at the clinic and finish any paperwork not completed from the previous day. This time is also reserved for answering any incoming phone queries from patients.
9:30 AM
Clinic starts. I typically see 15 patients in the morning. The appointment times are set 10 minutes apart, with approximately 12 slots booked and 3 left open for patients requesting appointments that day. One of the new mandates set out by the UK National Health Service (NHS) is the access target. These targets were established in response to patient demand. For primary care, the mandate stipulates that a patient should be offered an appointment with a health care practitioner within 24 hours and an appointment with the doctor within 48 hours.
In addition, we have the new General Medical Service (GMS) II targets. These reflect clinical and administrative goals and reward good clinical practice. For example, points are given if 80% of diabetic patients on the practice register have an A1C less than 7.4% and if smoking status has been ascertained and cessation advice given for persons older than 16 years.
All goals set by the NHS ultimately are linked to reimbursement. Clinicians are encouraged to try to address the GMS II goals opportunistically when seeing patients. This is often difficult to manage in a 10-minute appointment with a patient who has two or more problems, however, so the practice makes the effort to schedule appointments specifically to address GMS II goals.
The range of patients and presenting problems that I see are similar to those of a PA working in the United States, with a few exceptions. These include people requesting OTC medications (certain people qualify for free medicine) and those requesting “sick notes” (forms issued by the doctor signing a patient off of work). Sick notes are issued for varied reasons, but they can be given for conditions as simple as the common cold. Patients who are off work for more than 7 days need a note from their doctor explaining why.