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Department of Health backs larger physician associate pilot

The Department of Health is managing a wider pilot on the role of physician associates (PAs) in Irish healthcare, the Medical Independent (MI) has learned.

According to a draft paper on a wider pilot, which the RCSI submitted to the HSE in June, PAs can offer “flexibility that medical locums or trainees cannot” and introducing PAs “is an effective strategy for increasing medical workforce capacity and reducing costs without jeopardising quality in frontline clinical services”.

Constraints may include “willingness of staff to work with newly-qualified PAs within the multidisciplinary team”, while strategic risks include “possible opposition to the project by industrial relations unions”.

In 2016, the RCSI launched Ireland’s first postgraduate course to qualify PAs, with tuition fees of €12,000 per year.

It is envisaged that current Irish-qualified PAs who are in employment will provide the sample for the wider pilot, according to the draft paper. “It is expected that there will be 18 PAs in-post across the public and private sectors in the near future, with nine more PAs due to complete the programme in December 2019.”

The RCSI piloted the PA role in four services within the surgical directorate of Beaumont Hospital, Dublin, between July 2015 and October 2017.

According to a letter in March from head of the RCSI Medical School Prof Arnie Hill to Dr Colm Henry, HSE Chief Clinical Officer, part of this pilot included an independent evaluation commissioned by the Department of Health.

“A letter dated 6 December 2018 from Ms Sorcha Murray [of the Department] indicated that, due to the limitation of the pilot, it was not possible to draw enough from the results to make a quality or informed national level decision on its outcomes,” wrote Prof Hill.

“The letter further suggests the exploration with the HSE of the consideration of a wider pilot project, which would better inform future deliberations.”

Prof Hill wrote that “we are aware of the need to account for all of our graduates, as healthcare professionals, in the system and we are currently registering them on our voluntary register within the newly-formed Irish Society of Physician Associates (ISPA). We are particularly keen to move to the next steps, in particular to progress regulation of this role, because indemnity will prove a challenge, especially in the primary care setting.”

An RCSI spokesperson told MI: “The pilot is being managed by the Department of Health and contact is ongoing. The next stage of this pilot will be led by the HSE and Department of Health and we do not have further details.”

Graduates of the RCSI’s two-year PA programme run the ISPA and the College provides support in booking venues for meetings, said the spokesperson.

There are 18 students currently enrolled in the PA Studies Masters programme at the RCSI.

“The programme is focused on graduating physician associates for Ireland. To date, 15 out of 19 graduates are employed. They are employed across public and private sectors in primary and secondary care,” said the RCSI’s spokesperson.

The IMO has no official position on the grade of physician associate. The Irish Nurses and Midwives Organisation had not commented by press time.

PAs are dependent healthcare professionals trained in the medical model and work under consultant or GP supervision. They undertake medical histories, physical exams, interpret tests, diagnose and treat illnesses, and give preventive health advice. In the US, they have prescriptive authority. Generally, they have prior healthcare experience before undergoing postgraduate training to qualify as PAs.

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