Training pilot; cohort of 14 multidisciplinary AP trainees (from experienced nursing, physiotherapy, and paramedic backgrounds)

2-year MSc in advanced practice at local university (2015–2017)

Scheme jointly funded by HEE and local CCG; coordinated, supported and employed at NHS band 7 by local lead practice

Trainees on placements in a single practice for 1–2 years

By end of training trainees expected to:

• recognise and manage a range of clinical presentations;

• make differential diagnoses; and

• understand and analyse results of laboratory and diagnostic tests and take appropriate action, including referral

In line with national regulation, APs are not permitted to sign sickness or death certificates

Training pilot; cohort of 160 trainees (nine placements offered in local area across approximately six general practice sites), majority with science background but little clinical experience

2-year postgraduate diploma or master’s degree in physician associate studies at regional university medical schools (2016–2018)

PA trainees employed during training by a hospital trust at NHS band 6; coordinated by HEE; local GP provider brokered introductions to potential practice placement sites; practices received flat fee for hosting with each taking a number of different students; course fees for nine trainees paid by local CCG; indemnity covered by HEE

Part-time work placements in both secondary and primary care, rotating between care settings (90 hours in total in primary care comprising 8-week placement in year 1 and 6-week placement in year 2)

By end of training trainees expected to:

• make differential diagnoses based on history taking and physical examination;

• tailor management plans to individual patients and/or carers;

• maintain management plans under supervision of a physician;

• perform diagnostic and therapeutic procedures and suggest medication subject to necessary legislation

• request and interpret diagnostic tests; and

• provide patient education, counselling or health promotion

PAs are not regulated to independently prescribe or order X-rays

Local CCG commissioned service from 2017; led by hospital trust provider organisation; pharmacists employed by hospital trust organised into five neighbourhood teams (one NHS band 8a pharmacist leading team of band 7 staff in each neighbourhood — some IP qualified)

30 pharmacist posts planned to work across primary and secondary care (working in general practices on a sessional basis)

Aim to provide practices with pharmacist cover at one pharmacist per 10 000 patient population

Service intended to contribute to achievement of locally commissioned service standard for general practice focusing specifically on achieving ‘medicines optimisation’ domain containing standards on medicines safety and drug monitoring

Service works to specified KPIs including measures on number of medicines reconciliations or medication reviews undertaken and time saved for practice staff