Post Graduate Diploma Physician Associate Studies 1st Year Placement Handbook
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Post Graduate Diploma
Physician Associate Studies
st
1 Year Placement Handbook
Placement Handbook for students based at Manchester School of Medicine
Physician Associate Pilot Programme Cohort 2 – February 2017
Page
Introduction …………………………………………………………………………………………………………………………. 3
Background ………………………………………………………………………………………………………………………….. 3
Partners ……………………………………………………………………………………………………………………………….. 4
Faculty of Physician Associates …………………………………………………………………………………………….. 4
Roles and Responsibilities ……………………………………………………………………………………………………. 4
Placement Allocation …………………………………………………………………………………………………………… 5
Funding Model ……………………………………………………………………………………………………………………… 5
Indemnity ……………………………………………………………………………………………………………………………… 6
Programme Structure …………………………………………………………………………………………………………… 8
Placement 1 ………………………………………………………………………………………………………………………….. 8
Placement 2 ………………………………………………………………………………………………………………………….. 11
Placement 3 ………………………………………………………………………………………………………………………….. 11
Supervision …………………………………………………………………………………………………………………………… 12
Suggest Structure GP Placement …………………………………………………………………………………………… 14
Suggested Structure Acute/Specialist Placement 14
Employment Overview …………………………………………………………………………………………………………. 17
Recruitment …………………………………………………………………………………………………………………………. 17
Travel Expenses ……………………………………………………………………………………………………………………. 18
Changes to Personal Information …………………………………………………………………………………………. 18
Hours of Work ……………………………………………………………………………………………………………………… 18
Attendance Management ……………………………………………………………………………………………………. 19
Reporting Sickness and Absence ………………………………………………………………………………………….. 20
Annual Leave ………………………………………………………………………………………………………………………… 21
Additional Employment ………………………………………………………………………………………………………… 22
Career breaks ……………………………………………………………………………………………………………………….. 22
Training ………………………………………………………………………………………………………………………………… 22
Raising Concerns …………………………………………………………………………………………………………………… 24
Evaluation and Feedback ……………………………………………………………………………………………………… 25
Uniforms ……………………………………………………………………………………………………………………………… 25
Additional Information …………………………………………………………………………………………………………. 26
Alcohol and Drug Misuse ……………………………………………………………………………………………………… 27
Contact Details ……………………………………………………………………………………………………………………… 28
Lead Employer Self Certification Form ………………………………………………………………………………… 29
Lead Employer Return to Work Interview Form …………………………………………………………………… 30
Manchester Training Plan Year 1 ………………………………………………………………………………………….. 32
Manchester Training Plan Year 2 …………………………………………………………………………………………. 33
Manchester Training Plan Key ……………………………………………………………………………………………… 34
Lead Employer Expenses and Mileage Claim Form ……………………………………………………………... 35
This handbook has been produced in partnership with Manchester School of Medicine
and St Helens and Knowsley NHS Trust as the Lead Employer.
Page | 2
Physician Associate Pilot Programme Cohort 2 – February 2017
Introduction
This handbook is designed as a guide and should be read in conjunction with any information/handbooks
provided to you by the university at which your student/s Physician Associates (sPAs) is/are based.
In order to ensure continuity and shared understanding all sPAs on programmes have been issued with a Student
Handbook which clearly details their roles and responsibilities in relation to their employment and study
obligations. They will also have been provided with further information by their university on their required
learning outcomes for clinical placement, level of professionalism and responsibilities as a student.
Background
Regionally and nationally the appetite for introducing Physician Associates as a new way of working is growing
steadily primarily in response to the shortage of doctors in a number of specialities.
The role of the Physician Associate provides a new way of working that is aimed at strengthening the multi-
disciplinary team.
A Physician Associate, whilst not a doctor, works to the medical model with the attitudes, skills and knowledge
base to deliver holistic care under defined levels of supervision.
A qualified Physician Associate can, for example:
formulate and document a detailed differential diagnosis, having taken a history and completed a
physical examination when necessary;
work with patients, and where appropriate their carers, to agree a comprehensive management plan in
line with the patients’ diagnosis and needs;
perform diagnostic and theraputic procedures;
interpret diagnostic studies and undertake patient education, counselling and health promotion.
maintain and deliver clinical management in collaboration with patients and on behalf of the supervising
physician whilst the patient travels through a complete episode of care;
As part of their Workforce Transformation programme Health Education England’s North West office (HEENW)
are working with a range of partners to support a pilot programme of student Physician Associates, across
Cheshire, Merseyside, Greater Manchester, Cumbria and Lancashire.
Currently the role of a Physician Associate is managed by the Royal College of Physicians Faculty of Physician
Associates under a Managed Voluntary Register. As a non regulated profession even when qualified Physician
Associates are dependent practitioners but they do have the knowledge, skills and expertise to practise
independently and make independent decisions. This is enabled by a collaboration and supportive working
relationship with their clinical supervisors
NB - As a non- regulated profession they are currently unable to
prescribe medications;
request ionising radiation (e.g. X-rays and CT scans).
In November 2016 Rt Hon Jeremy Hunt the Secretary of State for Health announced
Page | 3
“There is a real appetite for Physician Associate roles in the NHS and with this comes the issue of regulation of
such groups. I am therefore keen to consider this in earnest and will be consulting on the issue early next year to
establish whether, as happens in other countries where the role exists, Physician Associates should be regulated”
We, at HEENW, await further information/developments and will keep you fully informed.
The Physician Associate Programme in the North West is delivered in partnership by
Health Education England North West Office
Manchester School of Medicine
Liverpool University Post Graduate School of Medicine
University of Central Lancashire (UCLan) delivering the
programme at both Preston and Whitehaven
Health Care Providers/Clinical Placements across the
North West
St Helens and Knowsely NHS Trust (Lead Employer)
The Faculty of Physician Associates
The Faculty of Physician Associates (FPA) is the professional body representing UK Physician Associates.
The FPA is based at the Royal College of Physicians www.rcplondon.ac.uk/fpa
The function of the faculty is to develop and represent the UK Physician Associate profession as a whole,
including:
o supporting education and professional development;
o achieving statutory regulation of the profession;
o managing the national certification and recertification examinations;
o accrediting physician associate education programmes within universities;
o administering and overseeing the running of the Physician Associate Managed Voluntary Register
(MVR).
Roles and Responsibilities
Health Education England North West Office (HEENW)
Have, within the pilot programme, a regional overview on the development and delivery of the North Wests
Physician Associate programme working alongside the partners as indicated above. HEENW is also responsible
for the funding of the sPAs salaries and placement tariff plus the provision and quality assurance of the
4|P a g e
required clinical placements - aligned to the Competence and Curriculum Framework for the Physician Associate, 2012. Partner Universities Are responsible for all academic elements of the programme’s education, training and assessment, they also allocate the sPAs to the placements provided to them by HEENW informing both the sPAs and the clinical placements of these allocations, other than for UCLan students where a local arrangement is in place for HEENW to inform the placements once the university have completed their allocations. The university are also responsible for signing off the student at the end of the 2 year Post Graduate Diploma in order for the sPA to be eligible to sit the national exam. Working closely with the clinical placement sites the university plays an active role in monitoring student progress throughout the programme. You will receive contact details for a named member of academic staff who will visit students on placement and provide support to Educational/Clinical supervisors where required. NHS Organisations/Clinical Placements Are responsible for supporting the education and training of sPAs whilst on clinical placement including the provision of Education and Clinical Supervision, they are also responsible for the day to day supervision and management of the sPAs whilst on placement - line management. St Helens and Knowsley NHS Trust (Lead Employer) Are the technical and legal employers of the sPAs throughout their 2 years of training and are responsible for the management of all the employment elements in the programme providing the sPA with a 2 year Fixed Term Contract of employment. Placement Allocation Clinical placements are mapped to the sPAs required learning outcomes with the university allocating students to the quality assured clinical placements provided to them by HEENW. You will find the 2 year training plan for the programme at the back of this handbook and further information on the required minimum standards for each placement are summarised here. You will receive greater detail from the university when a student is placed with you. In order to meet the requisite learning outcomes the programme operates a rotation programme for clinical placement meaning sPAs will be required to travel to their allocated placements. Some placements, depending on where the sPA lives, may require travel in excess of an hour. HEENW and the sPAs university will try to keep travel to a minimum and do take into consideration, wherever possible, personal circumstances. Given potential travelling time and the fact that as graduates many of our sPAs also have family commitments we would appreciate your support for any reasonable request for flexibility with regards to start and finish times, meal breaks etc. This should be discussed and agreed between the sPA and their Educational Supervisor during their first meeting in week one. 5|P a g e
Funding Model for Cohort 2
Please note this is the funding model for cohort 2, a sponsorship model is in place for cohort 1 and if you are a
sponsoring organisation you will have details of this model and your 2 year commitment to cohort 1 students
remains in place.
HEENW pay the students a training salary of –
£14,500 in the first year and
£15,500 in the second year
HEENW will pay a placement tariff of
£250 per week = £2,000 for an 8 week placement to organisations/practices supporting a student on
placement.
Placement Tariff payments will be made at the end of each placement rotation.
You will be sent a template invoice mid way through the placement. You need to complete this template and
return it to Rebecca.marland@hee.nhs.uk Rebecca will then set up your payment ready for it to be activated in
the final week of the sPAs placement with you.
Any delay in you returning the template may result in you being late in receiving your payment.
Indemnity
When working in the acute sector students are covered by Crown Indemnity. When in GP Practices they have all
been covered by personal indemnity; which they have been instructed to bring with them on their 1st day on
placement.
This cover is facilitated by the Lead Employer and provided by MDDUS under Associate Membership.
The conditions of the sPAs indemnity in GP practice being they are required to be supervised or have access to
supervision at all times.
.
6|P a g ePostgraduate Diploma in Physician
Associate Studies
Manchester School of Medicine
7|P a g eProgramme Structure
The programme is provided under the medical model and as such is delivered at university under the auspices of
the medical schools and at HEENW by the School of Physician Associates as part of the postgraduate medical
directorate (PGMD); Dr Kate Burnett being the Head of School.
Physician Associate training follows a combined apprenticeship & preceptorship model where it is the sPAs
responsibility to ensure that they learn and the provider’s responsibility to ensure that they are able to work with
a suitably diverse range of patients.
The Physician Associate training programme requires sPAs to complete 50% academic learning and 50% clinical
placement across the 2 years of the programme. All elements of the programme are required to be passed, by
their university, as satisfactory before the sPA can advance onto taking the national exam/s.
Students are required to pass the national exam before they are entitled to join the Managed Voluntary Register
and call themselves a Physician Associate.
NB Completion of the university programme alone does not lead to qualification as a Physician Associate.
The programme is designed to take into account guidance from the National Curriculum and Competency
Framework (CCF), for a total of 1,600 hours of clinical learning across the programme. The CCF divides 1,070
hours of that total across the two years of the programme, broken down as shown in the list below, leaving the
remainder to be specified by each programme. Second year placements are shown in red text. Other areas may
be covered in both first and second year (for example, emergency medicine, general hospital medicine and
primary care).
Community Medicine (180 hours)
General Hospital Medicine (350 hours)
Front Door Medicine* (180 hours)
Obstetrics and Gynaecology (90 hours)
Mental Health (90 hours)
General Surgery (90 hours)
Paediatrics (90 hours)
*The CCF does not require that all 180 hours of ‘front door medicine’ to be spent in the Emergency Department
however as much exposure as possible is extremely beneficial to the sPA.
The first year of the programme starts with a four month intensive study block where the sPAs develop their
understanding of the essential basic and clinical sciences. This focus on central university based teaching
continues across the two years of the programme.
The curriculum is built around a core of common clinical situations organised according to their relative
complexity and biomedical interdependence.
The first year core academic block is followed by a single primary care placement and two secondary care
placements (not necessarily in this order). Second year placements are between three and six weeks in duration
and cover a range of specialities, as above, plus additional GP and medical placements.
8|P a g eIn the first year placements should enable the sPA to encounter the common pathologies listed below. However,
this should not be viewed as an exhaustive checklist. The sPAs will have the opportunity to revisit much of the
content in the second year of the programme and there may be circumstances where they are not exposed to all
of the pathologies listed during first year placements.
You are not required to put on any additional taught sessions for the sPA whilst they are on placement with you
but access to any relevant training that is being provided for other students/staff in your organisation/practice
would be beneficial.
Placement 1
By start of their first placement the sPAs should be able to demonstrate a relatively detailed understanding of the
theoretical basis of diagnosis and management of:
Hypertension
Diabetes mellitus (T1DM & T2DM)
Thyroid dysfunction
Angina
Cardiac conducting system defects and ECG abnormalities (bundle branch block, fibrillation and flutter
etc.)
Myocardial Infarction
Acute coronary syndrome
Atrial fibrillation
Cerebrovascular disease (including stroke, TIA and haemorrhage. Excluding vascular dementia)
Pulmonary Embolism
Asthma
Chronic obstructive pulmonary disease
Anaemia
Heart failure
Pneumonia (bacterial and viral)
Dyspepsia
Gastric ulcer
Ulcerative colitis
Acute kidney injury
Common musculoskeletal injuries (this material has been delivered by a team of specialist
musculoskeletal physiotherapists)
Common dermatological conditions
The sPAs knowledge in these areas only may be considered approximately equivalent to that of a third year
medical student. However, you should not expect a great deal of knowledge towards the periphery of the
material covered, as the PA’s education is less broad than that of a medical student and focuses on common
patient presentations. In addition the sPAs may have a less detailed understanding of the molecular and clinical
biosciences (except where essential for safe clinical practice) than a medical student at the equivalent level of
study.
That said many of our sPAs have backgrounds in anatomy, physiology and the biomedical sciences.
Across the partner universities a range of supplementary topics are also covered including:
9|P a g e Infectious disease
Common musculoskeletal injuries
Common dermatological conditions
These topics may not be covered in the first academic block and as such the sPAs knowledge of them may not be
apparent until at least their third placement in the first year.
By the time they start their first placement our students will have been ‘signed off’ (tested in simulation or using
simulated patients) on the following skills:
Record and interpret a 12-lead ECG & rhythm strip
Perform ‘fingerprick’ (‘BM’) glucose testing
Take samples of venous blood
Undertake venous cannulation
Administer oxygen
Take a sample of arterial blood from the radial artery
Demonstrate the use of an inhaler (in Asthma/COPD)
Measure peak flow and perform basic spirometry
Perform immediate first aid and give basic life support (students have completed resuscitation council
accredited ILS training)
Measure blood pressure by auscultation using a manual sphygmomanometer
Measure INR and monitor anticoagulation status
Assess fluid status and administer fluids
Evaluate GCS, apply NEWS
Demonstrate a working knowledge of nutritional assessment
In addition to taking a full history, students have been taught the following general examinations:
Cardiovascular
Respiratory
Abdominal
Musculoskeletal/locomotor
A partial neurological examination (neurology is a second year topic but the peripheral examination is
covered in first year, e.g. in the context of diabetes etc.)
Dermatological
Head and neck
Lymph node
Vascular
Students will also be able to interpret the following test and investigation results in the context of the
cases/pathologies that that they have studied at University:
Full blood count
HbA1c
Haematinics
Lipid profile
Urea and electrolytes
10 | P a g e Liver function tests
Thyroid function tests
Blood gas analysis
Chest and abdominal X-Ray evaluation (simple, for the identification of abnormalities associated with
conditions listed earlier in this document), CT Pulmonary Angiogram (with some theoretical knowledge of
ventilation-perfusion scans), CT Head (basic understanding, identification of haemorrhage).
Cardiac troponin, D-dimer assay, clotting screen etc.
Interpret a ‘group and save’ and have an understanding of blood component/product transfusion.
Further more PA students will have received training in:
How to take a history using the Calgary-Cambridge framework
Exploration of ideas, concerns and expectations
Breaking bad news
Dealing with ‘difficult’ patients/colleagues
Explaining the PA role to patients and colleagues
Placement 2
By the start of the second placement the sPAs will have studied the theoretical basis of the following
pathologies/health conditions as PBL cases in addition to those listed in the previous sections:
Pneumothorax
Hypovolemic shock
Gastro-oesophageal reflux disease
Irritable bowel syndrome
Inherited and acquired platelet disorders
Urinary tract infection & renal calculi
Benign prostatic hyperplasia
Alcoholic liver disease
Consultation and examination skills:
Perform a digital rectal examination (in simulation)
Insert a urinary catheter (in simulation)
Identification of non-accidental injury in children and vulnerable adults
Discuss smoking, alcohol and substance use/misuse
Promote behaviour change in adults (using the TENT Pegs method)
Placement 3
By the start of the third placement the sPAs will have studied the theoretical basis of the following
pathologies/health conditions as PBL cases in addition to those listed in the previous sections:
Barrett’s oesophagus & oesophageal cancer
Prostate cancer
Osteoporosis
Cellulitis
11 | P a g e Hepatitis (HBV & HCV)
Paracetamol overdose
Meningitis
Multiple Sclerosis & optic neuritis
Supervision
All students are required to have an Education Supervisor (who must be a consultant or GP) who is responsible
for their overall support and guidance whilst on placement. SPAs can work with, and be taught by, a range of
clinical supervisors including members of the wider multi disciplinary team; although it is expected that the
majority of the sPAs time will be spent working with doctors.
GMC guidance defines an Education Supervisor as being … a trainer who is selected and appropriately trained to
be responsible for the overall supervision and management of a trainee’s (sPA) trajectory of learning and
educational progress during a placement. Every trainee (sPA) must have a named educational supervisor. The
educational supervisor helps the trainee (sPA) to plan their training and achieve agreed learning outcomes. He or
she is then responsible for bringing together all relevant evidence to form a summative judgement at the end of
the placement (HEE Educator Development Spring 2016).
A named clinical supervisor is a trainer who is responsible for overseeing a specified trainee’s (sPA) clinical work
throughout a placement in a clinical or medical environment and is appropriately trained to do so. He or she will
provide constructive feedback during that placement. He or she will provide feedback on the trainee’s clinical or
medical practice throughout the placement that will contribute to the Educational Supervisor’s report (HEE
Educator Development Spring 2016).
Competence can be signed off by anyone who is themselves deemed competent in the task being undertaken.
As a minimum Educational Supervisors should hold 3 formal meetings with their students during an 8 week
placement and 2 for shorter placements – the middle meeting being omitted for shorter placements:
Week 1 – The sPA should come to this initial assessment with some of their own aims and objectives
prepared for discussion. During the initial meeting, background information regarding previous
experience can be reviewed. The sPA at this meeting should review, with their Educational Supervisor,
any learning objectives generated from their previous placement. This will help you support them in
regards to long term goals in addition to specific assessment focused goals. Any initial uncertainties (for
example, regarding timetables, hours of work and roles) should be explored and discussed. It is also
important during the initial meeting to discuss the requirements and expectations of the sPA during the
placement and guide them on how best these can be achieved.
Mid placement - briefly discuss progress over the first half of the placement. NB - Most meetings will
have a positive outcome but concerns should in the first instance be referred to the Academic Lead for
Student Welfare and Professionalism at the university your sPA is attending; you will be provided with
their contact details. If concerns re competence and or capability persist the Lead Employer should be
informed and you find further details relating to the process for this on page 24.
End of placement – the sPAs educational supervisor at this meeting is required to ‘sign off’ the student’s
placement using the assessment criteria. The university will provide you with further information on the
assessment process once a student has been allocated to your organisation/practice. Prior to this
meeting, feedback should be obtained from other members of the team or department to guide the
assessment of the student’s overall performance; this may be by informal discussion with nursing teams,
junior doctors, qualified physician associates and consultant or GP colleagues.
12 | P a g eThe sPA should be able to evidence their development throughout the placement and all meetings should be
recorded in the student’s portfolio; with the student driving the process of handling and submitting the required
documentation.
The sPA is expected to make good progress across the three year one placements in terms of practicing the
clinical skills (including procedural, examination and communication skills) as taught at their university. This
should be evidenced by direct observation during UPSA assessments of the sPA when performing examinations or
procedures, taking histories, or interpreting test and investigation findings. SPAs are also expected to
progressively develop their clinical reasoning skills throughout the programme.
The sPAs have received intensive clinical skills training both in their first 16 week academic block and throughout
the programme. This training being provided by medically qualified clinical skills tutors. As such the sPAs should
be comfortable undertaking these skills on placement and should be provided with the opportunity to practice
them, under supervision at first, on patients with a range of relevant pathologies. Once a clinical supervisor has
deemed them ‘Safe to Practice’ they can then undertake basic skills without supervision but with appropriate
support available if required.
Given the training provided, the sPA should perform procedural skills safely but allowance should be made for
their inexperience in much the same manner as for a third year medical student.
Appropriately qualified professionals should provide guidance and mentoring to students in the development of
their clinical skills during placements.
Where trust/practice policies require that training be repeated (e.g. for cannulation and venepuncture) it is very
important that such mandatory training is available to the sPA as soon a possible so that they are able to practice
these essential procedural skills during placements.
NB Across the region several organisations have adopted an approach of observing procedural skills that the sPA
has been instructed in at university and/or signed off as being competent in prior to agreeing that the sPA can
safety practice these skills on placement without the necessity for further mandatory training.
Professional behaviour, the acquisition of clinical skills and fitness to practice is monitored throughout the 2 year
programme.
Academic achievement is measured by institutional assessment across the 2 years and national assessment at the
end of the programme.
Further information on all of the above will be provided by the university in their Minimum Standards Document
and Portfolio Guidance.
To note
SPAs should not perform intimate examinations unsupervised. However they may observe and participate
in such examinations under supervision where appropriate.
SPAs will not have covered any surgery, psychiatry, obstetrics or paediatrics during year one of the
programme. However, incidental exposure to patients with pathologies from these specialities should not
be seen as a problem.
Each sPA must complete all of the scheduled UPSAs by the end of their second year. This process is led by
the sPA and although supervisors are not responsible for ‘chasing’ students they should discuss
procedural skills signoffs at the above supervisory meetings.
13 | P a g ePlease be aware that for many sPAs their first placement will be their first direct experience of working within the
NHS and as such your support in introducing them the wider practices, multi professional teams and nuances of
the care sector would be greatly appreciated; over 49% of our second cohort have not previously worked in the
NHS. Others will be health professionals with many years of experience of working in their former profession (e.g.
as a nurse, pharmacist, physiotherapist, radiographer etc.) – please take time to get to know your sPA as this will
ensure that appropriate levels of support can be offered in the crucial first days and weeks on placement. Equally
as a heterogeneous and slightly more mature group the sPAs bring a wealth of prior experience regardless of
their former careers.
Suggested structure for a GP placement
Local induction to the practice should be provided to all sPAs during which they meet the team, receive
information on local polices, understand the sites fire drill etc. All sPAs have undertaken a 2 day NHS
induction aligned to the Core Skills Framework (you will find further information on this in the
employment section of this handbook).
SPAs, regardless of where they on in their training, should initially observe consultations during the first
week of the placement.
They should also have the opportunity to shadow other health professionals working in the practice. If
opportunities arise for sPAs to shadow District Nurses/Practice Nurses and or Advance Nurse
Practitioners please allow them to do so. SPAs could also shadow pharmacists and see the interactions
between community or hospital pharmacies and clinical teams for one or two days during a placement.
Equally sPAs should spend a small amount of time with front of house/reception or administrative staff.
This must not be for the purpose of performing routine administrative functions, but so they become
familiar with relevant procedures.
SPAs are permitted to go out on supervised home visits. NB sPAs are not covered under their indemnity to
visit patients in the community on their own and or to see/treat patients in practice unless a doctor is on
site that they can get advice and support from if required.
As the placement progresses sPAs should be given the opportunity to develop their skills under
supervision, slowly becoming more independent.
In the latter half of the placement we recommend that students are given the opportunity to consult with
and examine patients independently (where this is deemed appropriate by the supervising GP).
We recommend that supervisors discuss referral pathways with sPA where possible.
The above meaning for example, the sPA will see a patient before/after the same patient is seen by the GP – the
sPA and supervisor then meet for a discussion NB management is still provided by the GP – not the sPA.
Suggested structure for Acute/Specialist placements
Students should receive some induction to local trust policies and orientation to practices relating to
Health and Safety such as fire safety. A 2 day NHS induction aligned to the Core Skills Framework has
been given to all sPAs prior to them starting on placement; you will find further information on this in the
employment section of this handbook.
Each placement should provide the student with a local induction. This should include an introduction to
local policies and procedures not covered by the general induction, orientation to the placement area,
and an introduction to the wider multi-professional teams.
Clinical Supervisors should also advise students of who to contact for support in their absence. Each
Clinical Supervisor should have a nominated deputy for this reason.
Each placement should begin with a period of observation during which the sPA is oriented to the clinical
workplace and encouraged to spend time talking to patients and colleagues.
14 | P a g e The first week of particularly the first placement is likely to require some time for orientation; as noted
above many students have not worked in the NHS previously. Therefore the terminology, professional
roles and work structures associated with the hospital environment may be somewhat unfamiliar.
It can be helpful, for each placement, to produce a generic timetable and named individuals that a
student can shadow early on in the placement.
Placements should begin with the sPAs working in an observational capacity; being given an opportunity
to shadow a range of staff during their time in each department, however, the majority of their time will
be spent working with doctors. This should include a full range of activities, for example, ward rounds and
outpatient clinics.
It would also be appropriate and appreciated if sPAs can be included in any pre planned training activities
for medical staff.
15 | P a g eEmployment and Line Management
Information
16 | P a g eEmployment
Employment Overview
The second part of this handbook provides information and guidance in relation to the clinical placements
responsibility to ‘line manage’ the sPA whilst they are placed with them.
The sPAs are paid a salary for their time in clinical placements and are expected to work a 40 hour week – their
salary is paid monthly across the duration of the programme.
Whilst all sPAs will have a named Educational Supervisor they may/can be provided with a named ‘placement
manager’ for the purposes of day to day line management, this person is not required to be a doctor but will
assume responsibility for the monitoring of attendance/sickness etc.
In order to support the sPA with their required learning it has been agreed that independent study (i.e. time ‘in
the library’) for up to half a day a week should be permitted and included in the working week where appropriate.
We would not anticipate the sPA going off site for the purposes of this study other than if agreed with their
Educational Supervisor or university. If off site study is agreed it is the responsibility of the sPA to make either
their Educational Supervisor and/or their placement manager aware of the times they will be off site.
Recruitment as undertaken by HEENW, the Lead Employer and the partner universities
Entry criteria:
Hold a first degree, minimum 2:2, in life sciences or health.
Demonstrate, at interview, the values and behaviours required by the sector.
The students are employed by the Lead Employer on a 2 year fixed term contract working 40 hours per week.
The Lead Employer will have completing all necessary pre employment checks, including DBS, prior to the sPA
being issued with a contract of employment. A Health and Well Being Assessment has been undertaken on all the
sPAs with all necessary vaccinations being updated and/or provided. The Lead Employer will send you
confirmation of this and any additional required adjustments prior to the students starting on placement.
Students are also supplied with a uniform.
Before coming onto placement the students have completed a 2 day NHS induction aligned to the Core Skills
Framework. Covering:
Fire Safety;
Equality, Diversity and Human Rights;
Health, Safety and Welfare;
Infection - Prevention and Control;
Information Governance;
Moving and Handling;
Safeguarding Adults, Children, Mental Capacity, Disability;
Medicines Management;
Health Records;
Resuscitation.
17 | P a g eTravel Expenses
Travel expenses to and from placement are not routinely paid to sPAs but if you, as their allocated placement,
require the sPA to attend an alternative place of work, for example another surgery or another hospital, the sPA
can claim the miles/cost of travel from their allocated placement to their designated placement. The sPAs are
aware of the process for claiming this subsidy – this will require sign off by their Educational Supervisor or
placement manager.
Lead Employer Polices and Procedures
Throughout the sPAs 2 years on programme they are employed by the Lead Employer. As with all other contracts
of employment there are policies and procedures the sPAs must adhere to and these have been made clear to
them both at induction and in their student handbook – a copy of which will be sent to you for reference.
Additional to the Lead Employers policies and procedures you should ensure that the students are made aware of
any local policies they must comply with whilst on placement within your organisation/practice.
The following processes/flow charts have been designed to support you in your understanding of the sPAs
required actions in order for them to remain compliant with their employment obligation.
Changes to your personal information
The sPAs are aware that they must notify the Lead Employer, you and their university immediately and in writing
if any of the following changes occur:
Change of address;
Change of name;
Change of e mail address;
Change of telephone numbers.
Hours of Work
Over the two years of the programme/contract of employment the sPA whilst on placement is contracted
to work a 40 hour week exclusive of meal breaks.
SPAs are only paid for their clinical placement time but their salary is spread equally across the 24 months
of their fixed term contract irrespective of whether they are on clinical placement or undertaking your
academic studies.
The required hours of attendance whilst on academic study are managed by the universities.
Any shift patterns/arrangements applicable within each clinical placement should be agreed with the
sPAs Educational Supervisor either in advance or at their 1st meeting.
NB students are not be required to work outside the hours of 7:00 am to 8:00 pm Monday to Friday or at any
time on Saturdays, Sundays or Bank Holidays. They can though in agreement with their Educational Supervisor
and for the purposes of enhancing their learning experience only mutually and voluntarily agree to work outside
the hours noted above. Please note if they choose and mutually agree to work outside AfC social hours they will
not be paid any unsocial hour’s payment.
Any variation to hours worked is an agreed temporary variation to contract made between the student and you
their clinical placement and requires the student to seek assurance from their clinical placement that sufficient
supervision will be in place during the agreed times. It is the student’s responsibility to make both the Lead
Employer and their university aware, a minimum of 5 working days in advance of the proposed changes, of the
below;
18 | P a g eo the date and time/s of their amended attendance;
o their location at this time;
o the contact details for their supervisor during this period.
Attendance Management
For each period of absence a return to work interview must be completed ideally within the first 24 hours
of the sPA returning to work.
The Return to Work Interview should be undertaken by the sPAs Education Supervisor or their placement
manager and should contain the following information:
o the reason for the sickness absence;
o the length of the sickness absences, if there are repeated absences on a particular placement you
should also include the periods of good health in-between them;
o the result of any medical examination, if appropriate (this will not include confidential medical
information, but will relate to an individual's capability to carry out the duties of his/her post);
o Whether any concerns need to be further reviewed by the HWWB department
The Lead Employer operate an Attendance Management Policy, Lead Employer HR Direct Portal at
www.leademployer.nhs.uk, which provides robust reporting mechanisms to ensure health concerns of
student’s can be addressed promptly ensuring the right level of support can be identified in order to
ensure they are supported in remaining on the programme.
If any reported absence is due to a stress related illness or is Musculoskeletal (MSK) related, immediate
referral will be made by the Lead Employer for sPA to be seen by the Health, Work and Well Being
Department at Whiston Hospital.
NB As the Physician Associate programme is highly structured, in order to meet the requirements laid down in
the Competence and Curriculum Framework for the Physician Associate (Department of Health 2006, revised
2012), if a student has 4 weeks or more absence in any academic year for any reason other than their pre
allocated leave their university will conduct an academic review. The result of which could result in the sPAs
position on the scheme being suspended or terminated. Therefore while any episodes of sickness will be
sympathetically considered the sPAs need to understand that repeated episodes of sickness could jeopardise
their place on the programme and as such your contract of employment.
All contracts of employment will be terminated immediately and without notice if the university terminates the
sPA from their programme.
19 | P a g ePlease scroll down.
Reporting Sickness/Absence
The sPA must report any absence, including sickness, to the appropriate person at their placement
prior to the start time of the first day they will not be attending.
NB a text message or e mail from the sPA is not acceptable; initial contact must be made by phone call.
Calls from other people are not acceptable other than in very exceptional circumstances.
The placement must, on the first day, of any absence notify the Lead Employer, by e mail, at
Lead.Employer@sthk.nhs.uk providing the following details;
the students name;
university and placement;
reason for absence;
expected period of absence.
Please copy the sPAs University into this e mail to support their required tracking of all sickness and
absence. Contact details will be provided to you by the university.
The Lead Employer will update ESR and send the placement the relevant forms for completion on
the sPAs return.
On the sPAs return to placement they must on the first day notify you of their return.
The placement should then inform the Lead Employer, again by e mail with the SPAs University
copied in, that the sPA has returned from absence.
A return to work interview should be undertaken, this will have been sent to you by the Lead
Employer (an example can also be found at the back of this handbook) and attached to this e mail
with any self-certificates/fit notes provided by the sPA.
For other absences such as Special/Bereavement leave, the sPA should complete the relevant Lead
Employer form which will have been sent to you and return it directly to them.
If for any reason a back to work interview cannot be undertaken on the first day of the sPAs return
we would ask that you notify the Lead Employer/university, as above, of the sPAs return noting the
relevant documentation will follow within 3 working days.
20 | P a g eFor further information;
For absences of up to seven calendar days;
Following the initial contact the sPA should ring their agreed Educational Supervisor and or placement
manager daily until their return.
If the sPA does not make contact, as detailed above, they are considered to be absent and the placement
manager should inform the Lead Employer by e mail at Lead.Employer@sthk.nhs.uk so pay can be
suspended.
The sPA is responsible for completing and submitting a Lead Employer self-certificate form for all sickness
absences regardless of sickness length.
SPAs whose sickness includes a Saturday, Sunday or bank holiday or other rest days will automatically be
regarded as being sick on these days unless they have advised their placement manager of their fitness to
return to the course.
For absences over 7 days:
The sPA must produce a Statement of Fitness for Work (‘Fit Note’) from their General Practitioner to
cover the period following the first seven days.
If a student is on Long Term Sick a welfare meeting with the sPA will be arranged by the Lead Employer.
If during their time on placement a sPA goes on Long Term Sickness, Maternity, Adoption Leave Shared
Parental Leave you will be informed of this by the Lead Employer and/or university and the
management of the sPA in these circumstances will be undertaken jointly by the Lead Employer and
the university.
If at anytime you have concerns re a sPAs attendance, attitude behaviour etc. and have need to speak to them
informally we would ask that you document these episodes. If following informal meetings the student’s
attendance/conduct does not improve please e mail the Lead Employer for further advice and guidance. If these
episodes constitute greater concern please follow the Raising Concerns Process as detailed on page xxx
Annual Leave
The holiday year for the programme runs from your start date in the year up to the same date the
following year.
All holidays are set throughout the 2 years of the programme and have been allocated within the sPAs
training rota there can be no change to these arrangements without prior agreement from the Lead
Employer.
If for personal reasons a student needs to take holidays at a time different from those allocated they
must seek permission from the Lead Employer. If permission is granted and the holidays fall within a
clinical placement it is in the first instance the sPAs responsibility to inform their Educational Supervisor
and/or placement manager. The Lead Employer will also confirm this agreed change with the clinical
placement.
Any such changes will only be made in very exceptional circumstances. If granted this will be unpaid leave
and will count towards the sPAs overall absence level. SPAs are not permitted to work on clinical
placement outside the agreed timescales in order to ‘make up’ time.
Students are however entitled to request to ‘swop’ up to two designated leave days per leave year for
personal or religious reasons the Lead Employer who will have the final decision on all such requests. In
these cases the sPA has to have sought permission from their Educational Supervisor prior to requesting a
change in their holiday allocation. It is the sPAs responsibility to keep their Educational Supervisor and/of
placement manager informed of any agreed changes.
21 | P a g eYou can also read
