Secondary Care Case Studies

Case 1

Abel Getachew

When did you qualify? How long have you worked in your current trust/general practice?

I qualified as a PA in 2018 and worked in a district general hospital in Somerset, Yeovil Hospital, since my qualification.


Where do you work now and a brief overview of your job role.

I currently have a general medicine job, which involves 50% Respiratory medicine (6 months) and 50% Geriatrics. I now work in elderly care within a team of junior doctors, nurses, and allied health professionals, all under one consultant geriatrician's supervision. I participate in daily consultant-led ward rounds, patient reviews, and the opportunity to be involved in inter-departmental teaching and research opportunities. I also work as a Physician Associate Ambassador for HEE in the southwest. My work consists of developing a network for PAs in the southwest to network, collaborate, and learn from each other.


What was your background before becoming a PA?

Before qualifying as a Physician Associate, I trained as a biomedical scientist with a particular interest in microbiology. I was intrigued with the profession as it provided a means to build off the prior knowledge and experience I gained and apply it to clinical medicine. Also, as it was a new profession, I was excited to part of shaping its future.


Your favourite part about being a PA/ what you think PA's bring to the team.

My favourite part of being a PA is the consistency I can bring to my team, which I have seen across all departments I have worked in. PAs are a stable continuous workforce that can bring a real impact to patient care and team morale.


The main challenge/barrier you face as a PA.

The two main challenges I have faced as a PA is the inability to prescribe and a lack of awareness of the profession. The team I work with is incredibly supportive, and we work together to circumvent the current prescribing restrictions to ensure effective and safe patient care is delivered. As my trust is a district hospital, my PA colleagues and I have rapidly spread the word of what PAs can do but additionally, rotating through different departments was an excellent opportunity to demonstrate PA capabilities first hand.

Case 2

Alex Stevens

When did you qualify? How long have you worked in your current trust/general practice?

I qualified as a PA from the University of Birmingham in 2009 and have been a PA in acute medicine at my current trust for the last eight years. Prior to that I was one of the first PAs in the ED at Leicester for four years. I’ve also been involved in PA education for the last seven years.


Where do you work now and a brief overview of your job role.

I currently have roles in education, as a PA clinically, and with HEE as the Lead PA Ambassador for the South-West of England.


I’ve been the Programme Lead for MSc PA Studies at UWE Bristol for the last five years. At UWE I’ve helped shape our current programme, increase awareness of the profession in the region, establish and strengthen placement partners and successfully qualify four cohorts of PAs that all contribute to the primary and secondary care workforce making a real difference to patient care. Before this I was a clinical lecturer on the PA Programme at Plymouth. I joined Plymouth when it was a new programme and I got to experience and contribute to the start of this now well-established course. Through Plymouth I also undertook my clinical education qualification which reinforced and nurtured my passion for PA education.

I’ve always kept clinically active alongside these other roles as this is at the heart of the PA profession and is important when educating future generations of PAs.

My first PA posts were in the ED, initially at Bristol and then at Leicester. Over four years at Leicester I worked as one of a small team of new PAs in the trust. As part of the ED team I would see patients mostly in majors and resus, which was a steep but rewarding and stimulating learning curve. Having very good senior support was fundamental to my growth and the success of PAs. Over this time I built up my clinical experience and acumen and felt integrated as part of the permanent ED clinical team. I enjoyed becoming trained in extended procedural skills such as fascia iliac blocks, biers blocks and digital ring blocks, as well as consolidating on core PA skills.


Being a PA in acute medicine since ED has allowed me to solidify a lot of these experiences and also nurtured a deeper insight and a more inquisitive mind-set around medicine. I was lucky enough to join a small but slowly establishing team of PAs in acute medicine and this allowed for easier integration and further growth within my role such as leadership, management, networking and eventual lateral progression into PA education. Acute medicine also enabled me to gain competency in additional skills such as ascitic drainage and paracentesis, ultrasound guided thoracentesis and drainage and lumbar puncture.

Over the last year I have been a PA Ambassador with Health Education England (HEE) which now encapsulates the various activities I had been undertaking and links them together - such as clinical work, university work, networking and partnerships and increasing the visibility and awareness of the role Over the last few months I have been lucky enough to become the lead HEE PA Ambassador for the SW of England.


What was your background before becoming a PA?

I studied human and biological sciences as an undergraduate, followed by a masters and postgraduate research in neuroscience before training as a PA. In my younger years I was a semi-professional surfer, originally hailing from North Devon.


Your favourite part about being a PA/ what you think PA's bring to the team.


The control I can take over my life!

Being from North Devon and as a passionate surfer (and lover of all things outdoors), I was looking for something in my professional life that allowed me to apply my studies whilst still maintaining some control over where I live and enabling me to strike a good work-life balance. I love every part of my clinical and professional roles as described above and feel lucky to have had the opportunities I have pursued as a PA to date.


The main challenge/barrier you face as a PA.

Getting other educational leaders to acknowledge the requirements and intensive nature of delivering PA education – this will no doubt be helped somewhat by upcoming GMC regulation and programme evaluations. Inability to prescribe and request ionising radiation studies is limiting, but often times within a team working solutions can be found. Awareness of the PA role and profession is probably the most common challenge I come across. This spans both the clinical and educational/placement fields and is most likely to continue for some time until the number and continuation of PA roles dilute down this uncertainty, although it may never fully disappear. The presence and work of HEE PA Ambassadors, along with clinical PA lead roles, are valuable in helping with some of these issues.

Case 3

Rudo Chimbghandah

When did you qualify? How long have you worked in your current trust/general practice?

I qualified in March 2019. I have been in this trust since then and have rotated through Medicine, Paediatrics, Urology, Trauma and Orthopaedics and now I am in General Surgery.


Where do you work now and a brief overview of your job role.


North Devon District Hospital in the General Surgery Team.


My daily job is mainly ward based. I attend ward round with Surgeons and action the daily plans of patient management. I review patients in the later part of the day and speak to therapy and nursing teams in order to get a full picture on the patients daily progress. When the patients are unwell I review them and initiate a plan, then have a discussion with the senior Doctors regarding the patient and management initiated.


During some weeks I assist in theatres with operations as needed.


I do general surgery oncall weeks, we rotate the weeks along with the other PAs based in the other surgical specialties. During this week, I see GP or ED referred patients. I take a history, examine, initiate some investigations and early management before discussion with the Registrar or Consultant oncall.


What was your background before becoming a PA?

I studied Medical Biochemistry at the University of Leicester. I was always interested in clinical work earlier on but unsure what would be most suitable for me. I came across the PA role whilst looking into it and decided to apply for it. I am glad I did.


Your favourite part about being a PA/ what you think PA's bring to the team.


My favourite part about being a PA is that we are able to work in any speciality and are able to change between them easily.


Certainly in the trust I work we are able to bring continuation of care, we are mainly ward based and work normal days within our teams whereas the doctors work on a shift pattern.


We are able to bridge the gap and maintain patient care during changeover periods. We change over a month before the doctors do and serve to help the incoming doctors adjust to the new specialty.


Being supernumerary we also add to the numbers of medically trained personnel looking after patients.



The main challenge/barrier you face as a PA.


The biggest challenge I faced when I initially qualified was understanding my place within the team, figuring out how I fit in and what my responsibilities are. This was made harder when working with healthcare professionals that were not familiar or open to working with PAs. This resulted in being under utilised within the team and relegated to do core procedures and discharge paperwork. However this has changed greatly as more PAs have joined the trust and we have worked across most specialties. Most teams are familiar with our capabilities and are happy with us taking on more responsibility.


At present the hardest challenge is our inability to prescribe medications and ionising radiation. This is mostly the case when I am oncall and need to request imaging and write up drug charts with regular medications and its out of hours where we have reduced staff. Fortunately the junior doctors I work with are very accommodating and can complete these aspects of work with ease when they are available. However this is not always easily accomplished on busier days. I am aware that this is something that will change in the future and am looking forward to it.

Case 4

Lorraine Nazer

When did you qualify? How long have you worked in your current trust/general practice?

I qualified December 2018 and passed in the March 2019 have been working since.


Where do you work now and a brief overview of your job role.

I work within North Devon District Trust within the trauma and orthopaedic department. I am lucky enough to be given opportunities to be on call, scheduled time within trauma theatre and elective theatre and on the ward. I have also been offered the time to train in radiologically guided joint injections, with the views to have my own independent list.


What was your background before becoming a PA?

My first degree was in Biomedical sciences where I did a placement year within a molecular biology laboratory. Throughout this time in university, I worked as a HCA and also trained as a Phlebotomist.


Your favourite part about being a PA/ what you think PA's bring to the team.


I adore finding my own place in a very busy and dynamic team, to feel like a cog that keeps the whole process and system moving really excited me and makes me get up in the morning. For PAs to integrate in a team it brings stability due to the consistency of work flow and pattern. It also allows professional relationships to build with the senior team as well as the nursing team. Given the variety of backgrounds that PAs have, I believe it to be refreshing to have different building blocks of a medical team member.



The main challenge/barrier you face as a PA.


There are plenty but even within the short period of time that I have been working, they have improved.

It goes without saying the issues surrounding prescribing and having a statutory regulating body. I do feel that this discredits a lot of our work due to the responsibilities that we cannot have by law. In many circumstances because our signature will not give rise to the prescription of drugs or radiation, we are overlooked from the input we can bring outside of this. Also having to tell everyone who asks that you're not a doctor or a nurse! Much of the time you have to convince people that you are ‘worth seeing’. Although hopefully attitudes will continue to change when more awareness is brought to our role.

Case 5

Lauren Morgan

When did you qualify? How long have you worked in your current trust/general practice?

I qualified Oct 2019, been working at the Bristol Royal Infirmary since November 2019 and rotating through general medical wards including; gastroenterology, covid wards, care of the elderly.


Where do you work now and a brief overview of your job role.

I now work on a covid-19 elderly care ward. My job role involves seeing patients with my senior colleagues or by myself on the ward round, generating medical plans, contacting relatives of patients, discussing with other medical specialities. I have also been organising physician associate teaching within the hospital.


What was your background before becoming a PA?

I studied medical physiology at the University of Leicester; I went straight onto studying to be a PA.


Your favourite part about being a PA/ what you think PA's bring to the team.


I enjoy being independent and seeing patients with myself but knowing I always have someone more senior to ask for, for help. I enjoy learning procedures and teaching them to others. I enjoy taking on a leadership role and orientating new colleagues to the ward.


The main challenge/barrier you face as a PA.


The frustrations of explaining to other colleagues why we cannot prescribe and not knowing when this will be.

The unknown of the current potential career progression.

Case 6

Sophie Nicholls

When did you qualify? How long have you worked in your current trust/general practice?

I qualified from UWE Bristol 1 year ago and have been working as a PA in secondary care since.


Where do you work now and a brief overview of your job role.


I work in Gastroenterology at Musgrove Park Hospital which is part of Somerset NHS Foundation Trust. Currently my job is mainly ward-based working with the junior doctors and the MDT, but I also support the day case ascitic drains and the fibroscan clinic.


What was your background before becoming a PA?

Trained as a Cardiac physiologist but never worked once qualified. I then went straight on to train as a Physician Associate.


Your favourite part about being a PA/ what you think PA's bring to the team.


Continuity for the team and for the patients. Particularly around change over but also day to day as I work regular hours I’m consistently present on the ward while due to weekends and nights some of the junior doctors aren’t. This means I get to know patents and what has happened with their treatment so far. At changeover I know how the ward runs and can help make even the simple things such as where things are kept or how to request certain things which are specific to gastro that little bit easier.

I like how open everyone has been to the PA role, from staff to patients and have been lucky not to face any negativity to the role.


The main challenge/barrier you face as a PA.


A more central support system/overall management for PAs within the trust would be beneficial. I am lucky to have a very supportive team that I work with but there has been questions and problems we have come across which I feel would benefit from having a more central lead to ask and to help provide a trust wide approach, both for me and my supervisor. Aspects such as appraisals and portfolio have been challenging and while we have come up with what works best for us there may be a different way of managing this for other PAs.

Case 7

Katie Cobain

When did you qualify? How long have you worked in your current trust/general practice?

I qualified in October 2018. I initially worked for a year in Emergency Medicine before joining my current trust in November 2019.


Where do you work now and a brief overview of your job role.


I currently work in Acute Medicine at the Bristol Royal infirmary. My role includes clerking on the medical take, participating in post-take ward rounds, and helping in the acute medicine clinic. When clerking a patient I take medical histories, perform examinations, organise and interpret investigations, perform clinical skills and create a management plan.


What was your background before becoming a PA?

Prior to becoming a PA I did a degree in Medical Science. During this degree I specialised in pharmacology and neuropharmacology.


Your favourite part about being a PA/ what you think PA's bring to the team.


I thoroughly enjoy working as a PA. My favourite part is being a consistent part of the team; this allows good continuity of care whilst the multidisciplinary team rotate. In addition, working as a PA allows a good work-life balance.

I think PAs bring consistency to the team. As PAs develop in their area, they become competent at clinical skills. This allows them to perform skills unsupervised and even teach other healthcare professionals.


The main challenge/barrier you face as a PA.


Working as a PA does have its limitations. The main challenge I face on the acute medical unit is not being able to request imaging including x-rays and CT scans. Fortunately my colleagues are really understanding of the role and are always happy to help out. Hopefully in the future this will not be a barrier once regulated by the GMC.

Case 8

Emily Gwinnell

When did you qualify? How long have you worked in your current trust/general practice?

I qualified in 2017 and completed an intern year, rotating through vascular surgery, AMU and ED. I moved to Gloucester Royal Hospital nearly 2 years ago and have continued working in AMU.


Where do you work now and a brief overview of your job role.


I am very fortunate to be able to work part-time in AMU at Gloucester Royal Hospital, as well as working on the PA course at the University of Worcester as a lecturer and module lead.

In my clinical role, I split my time between clerking new admissions and looking after patients on the ward, as well as organising PA and student teaching, and running M&M for acute medicine.

My university role mainly consists of teaching skills and weekly simulation sessions, along with overseeing placements and OSCEs.


What was your background before becoming a PA?

My undergraduate degree was a BSc in Cellular and Molecular Medicine at the University of Bristol. I then spent a year working as a support worker for adults with learning disabilities before starting the PA course.


Your favourite part about being a PA/ what you think PA's bring to the team.


There are so many things I love about being a PA! I love having the flexibility to be able to design your own career path – acute medicine is such a varied and exciting speciality to work within and it’s great to be able to continue developing my clinical knowledge and skills whilst pursuing my interest in education. I really enjoy being a permanent member of the AMU team and being encouraged to develop new skills – I currently perform and teach lumbar punctures and US guided cannulation, and have plenty more on my to-do list. It’s great getting to know lots of different rotations of junior doctors, whilst working closely with the other PAs, consultants, nurses and ward team to provide great continuity of service and care.


The main challenge/barrier you face as a PA.


I find the most challenging part of being a PA is navigating the barriers that come with any new profession, in that there is limited understanding of the role and therefore often challenges when working with specialities that haven’t come across PA’s as often, for example microbiology and radiology. I am hopeful that regulation and developing a capacity in which PA’s can prescribe and request ionising radiation will help to overcome this.

Case 9

Will Fryer

When did you qualify? How long have you worked in your current trust/general practice?

Qualified in 2019 and working in one post since 11 Nov 2019 at the Bristol Royal Infirmary.


Where do you work now and a brief overview of your job role.


I am currently undertaking six month rotations. Over the last 14 months I have worked in:

Older Persons Assessment Unit

Acute general medical ward

Medical take

Acute stroke unit


What was your background before becoming a PA?

I was an advertising copywriter specialising in direct marketing. I also ran an advertising agency and several mail order businesses.


Your favourite part about being a PA/ what you think PA's bring to the team.


Helping people, patients.

The variety.

Being part of a team.

Feels like I am doing something useful.


The main challenge/barrier you face as a PA.


I am older than a lot of consultants. Consequently a lot of people think I am a consultant. I have to disabuse them of this.

Case 10

Janaka Wijesinghe

When did you qualify? How long have you worked in your current trust/general practice?


I qualified as a PA in 2019. I have been working at Torbay and South Devon foundation Trust since then and I have rotated in Paediatric, Trauma and Orthopaedic and General Surgery.


Where do you work now and a brief overview of your job role.


Torbay and South Devon Foundation Trust


I have been working in my permanent job in general surgery since March 2020. There are two of us (PAs) working in the surgical department.


I work with the hot week (Emergency) consultant for 2 consecutive weeks, 1 week with the upper GI and the other week with the colorectal consultant. Here, I attend the ward rounds for the whole 2 weeks and manage the outliers and coordinate with the junior doctors in the surgical wards and with the on-call consultant.

In the other two weeks, my main role is ward support: helping the junior doctors in the surgical wards for preparing for the ward round, making referrals, doing procedures, and reviewing the patients. In addition to this, I work in the two weeks waiting colorectal clinics (I am currently training) and work as a theatre assistant.

Two of us rotate every two weeks between hot week and ward support.


What was your background before becoming a PA?


My background is nursing. Prior to my PA training, I worked as a charge nurse in the cardiology department in Torbay hospital and worked as part of a flight medical crew in the capital air ambulance (fixed wing aircraft). My decision to become a physician associate arose as I wanted to broaden my knowledge and skills.


Your favourite part about being a PA/ what you think PA's bring to the team.


PA is an evolving profession. There is no limitation and you can expand your knowledge and skills.

Being a permanent member of the team, PAs can provide the continuity to the team. PAs are a good asset to the junior doctors, especially when they rotate every 4 months. We can help them to integrate to the team and share our knowledge and experience with them. PAs can help with junior doctors’ training, as well as medical students’ training.


The main challenge/barrier you face as a PA.


The main challenge I face in my day-to-day work is not being a registered profession (it is currently on the voluntary register). This has limited our role, as we are unable to prescribe, request CTs and x-rays, certify death and complete the death certificate, or sign for a sick note.

Another challenge is the lack of knowledge about PA role in the healthcare team as well as in the public. This puts a strain on communication and working abilities, as the expectations can vary hugely. With the increasing number of PAs, the situation is getting better, but our role is not fully understood by the public or our colleagues yet.

Case 11

Kai Jones-White

When did you qualify? How long have you worked in your current trust/general practice?


Qualified November 2019.

I started a full-time position in April 2020.


Where do you work now and a brief overview of your job role.


I work in Acute Medicine at Gloucester Royal Hospital.

My work is split between post-take ward rounds on the Acute Medical Unit (AMU), clerking shifts, and on the Acute Initial Assessment Unit (AMIA).

During ward rounds, I prep notes ready for the round, see patients with the consultant and then do any jobs needed for the patient, including any procedures, requests, updating families or referring to other specialities. Some patients I see independently if they have already been seen by a consultant. I can then verbally review the patient with a consultant if needed.

When clerking for the medical team I see patients referred to us by the Emergency Department (ED). I take a full history, examination, bloods, investigations, diagnose and create a management plan. Once all the relevant findings are back, I will then see the patient with a consultant who will review and finalise a plan.

When working in the Acute Initial Assessment Unit (AMIA) we see referrals from GP and ED who require investigations but are ambulatory and are fit enough to sit for some time whilst waiting for review and results etc. These patients are assessed and can either be brought back for further management/investigations, discharged with treatment or admitted.

I also co-ordinate PA teaching every week, and organise a guest speaker every other week.


What was your background before becoming a PA?


I studied Medical Science (BMedsci) at Oxford Brookes University.

I also spent two years prior, working as a healthcare assistant at my local hospital during my studies.


Your favourite part about being a PA/ what you think PA's bring to the team.


I love my job as a PA, every day is different and there are always opportunities to learn and develop. I get huge satisfaction from my job and love the feeling of making a difference in someone's life whether it be easing pain or just listening. It’s a feeling I don’t think I will ever lose.


PA’s are an asset to any medical team.

As we do not rotate, we are able to gain skills and knowledge in our department which is crucial when we have new rotations of medical staff.

We provide continuity of care for the patients.

We build rapport with the MDT, allowing them to approach us with any concerns or questions about patient care and management.

PA’s are able to conduct quality improvement (QI) projects and audits to help enhance or improve services and care.


The main challenge/barrier you face as a PA.


For me, PA’s are quite established in my department. I have never had a challenge with identity as I have heard from other hospitals. I think the largest barrier at the moment is not being regulated. Being unable to order ionizing radiation and prescribe can really increase work load and slow productivity. Currently, we cannot work nights, on calls or ward cover shifts due to this. Once regulation is sorted and prescribing in place, we would be able to work more efficiently and be a greater asset to the medical team.

Case 12

Beth Norman

When did you qualify? How long have you worked in your current trust/general practice?


I qualified from the University of Plymouth Physician Associate program in December 2017. I started working at Yeovil District Hospital (YDH) in March 2018, following my national exams.


Where do you work now and a brief overview of your job role?


I currently work 2 days a week on the University of Plymouth PA program as a clinical lecturer and work for the NHS for the remaining 3 days. I am the Lead Physician Associate at YDH and work in acute medicine. As the Lead PA, I am involved in developing the PA role at a trust level. This requires liaising with specialties to create PA jobs, as well as writing policies to support and safeguard the way we work. I also mentor the newly qualified PAs, organise student placements, and arrange regular PA teaching.


What was your background before becoming a PA?


Before applying to the PA course I studied Physiological Sciences at the University of Bristol.


Your favourite part about being a PA/ what you think PA's bring to the team.


My favourite part of being a PA is the freedom you have over your career development. I am in my fourth year of practice and already I have been able to take on roles in both academia and leadership in addition to my clinical responsibilities. This has allowed me to tailor my career specifically to my interests and means I have a lot of variety in my working week.


The main challenge/barrier you face as a PA.


Although my favourite part of being a PA is the flexibility in my career development, I feel there is a need for much more guidance and structure for PAs who wish to develop and progress clinically. I would like to see the development of postgraduate PA exams to promote continued learning in a recognised and validated format.

How have PAs impacted your department?