Primary Care funding – employer resources: PA FAQ

1. Where should I direct my enquiry about the inclusion of the PA apprenticeship role in the Additional Roles Reimbursement Scheme (ARRS)?

Please direct all enquiries to england.primarycareworkforce@nhs.net

2. Where should I direct my enquiry if I wish to undertake the PA apprenticeship training offer?

For support please connect to your Training Hub.

3. Where can I get support to enrol a staff member onto an apprenticeship course?

Please see a summary of the programmes offered by the 10 universities currently approved to deliver the PA apprenticeship and detailed course information here. For support please connect to your Training Hub.

4. How do I enrol in the courses?

Please see a summary of the programmes offered by the 10 universities currently approved to deliver the PA apprenticeship here and detailed course information here. For support please connect to your Training Hub.

1. What is the PA apprentice role?

The PA apprentice role has been introduced to support the pipeline of PAs to the medical workforce, across primary and secondary care.

Like all PAs in training (and other healthcare students), PA apprentices will undertake duties in line with their experience level and sign-off of key competencies.  This can include a range of clinical skills, including taking observations and history taking.  As the PA apprentice gains experience their range of skills, and ability to use them without direct supervision can expand. You can download a template job description for the PA apprentice.

2. What is the PA role?

PAs are healthcare professionals with a generalist medical education who work under the supervision of a doctor to provide medical care. They work across primary and secondary care, including mental health settings.

Case study data from 11 NHS primary care organisations across 4 NHS England regions has provided an overview of how the PA role is being used effectively in primary care settings:

• PAs in primary care mainly provide routine and acute appointments with some variation between practices in terms of whether these are triaged first
• PAs see a lot of patients with chronic conditions (e.g., chronic pain and type 2 diabetes) but typically do not see complex patients or very young children
• Appointment durations with patients tend to be longer than those offered by GPs with length reducing as experience in the role increases
• The scope of practice for the PA role increases over time, with many pursuing specialist interests (e.g., minor surgery or contraceptive implant insertion)
• Many PAs work in urgent treatment centres and walk-in-clinics, whilst others are trained in frailty and undertake independent weekly care home rounds
• Currently PAs are unable to prescribe and are not permitted to request ionising radiation. In future the PA workforce will become a regulated profession, with GMC registration. A move to prescribing rights for PAs will become possible following the introduction of regulation
• A £5000 preceptorship support payment is available for PCNs/GP practices employing newly qualified PAs (or those moving from secondary care)

 

The following links provide a range of information about PAs working in general practice.

• Physician associates and GPs in primary care: a comparison
• Health Careers – Physician Associate role
• Faculty of Physician Associates – Physician Associates in General Practice

 

3. What is the added value/benefits of introducing PA apprentices?

The PA apprentice role has the potential to support with meeting supply and retention challenges across the medical workforce. Demand is growing for PAs to be developed in support of the delivery of the new service models outlined in the NHS Long Term Plan (LTP), particularly in primary care. Growing recognition that PAs have a key role in supporting the new primary care workforce is also reflected in the GP Contract 2020/21 Additional Roles Reimbursement Scheme (ARRS).

Creating a more flexible and adaptable workforce are ambitions set out in both the NHS Long Term Plan and NHS People Plan. The forthcoming Long Term Workforce Plan (LTWP) will include PAs, presenting an ambition to grow the pipeline with a particular focus on expanding numbers outside of secondary care.

By embedding an additional, flexible, entry route to train as a PA, employers are enabled to improve their recruitment offer, attracting a more diverse pool of people into the medical associate workforce, a highly evidenced key contributor to better care outcomes for patients. Until now the only route to becoming a PA has involved direct entry postgraduate self-funded study. The benefits to widening participation through an ‘earn and learn’ apprenticeship offer are likely to be significant for prospective learners against a backdrop of Covid-19 economic recovery, including an escalating cost of living crisis.

Furthermore, the introduction of the PA apprenticeship route has the potential to help with building a more adaptable workforce through widening routes into the NHS and addressing geographical (particularly rural) and specialty issues, impacting positively on recruitment and retention in underserved areas. Some employers may find themselves able to identify existing employees who are eligible to become PA apprentices and ‘grow-their-own’ PA workforce.

4. How can I recruit a PA apprentice?

The PA apprentice role has recently been introduced into the Additional Roles Reimbursement Scheme (ARRS). PCNs can immediately start recruiting to the role and can claim reimbursement for the salaries and some on-costs of these staff (up to a maximum reimbursable amount).

To receive ARRS funding staff will need to be enrolled on an approved apprenticeship programme in line with the Network Contract DES.

The apprenticeship course can be paid for in a couple of ways. Access a summary of apprenticeship funding here. The amount of government funding varies depending on whether the employer is a levy payer or non-levy payer. You can find more information on HASO’s Funding and Levy page. 

Employers and universities undertake a joint recruitment process. Universities specify their entry criteria for the PA apprenticeship programme, set in conjunction with employers.  This must demonstrate a student’s ability to study at a master’s degree level and consider experience along with qualifications. Access detailed entry requirements for the 10 available programmes.

5. Is there a cap on numbers for PA apprentices?

No, is not capped.

6. How long do the courses take / when can I expect my enrolled PA apprentice to become eligible for reimbursement?

PA apprentice courses are 30-36 months long.  Enrolled PA apprentices are eligible from the date they enrol on the programme.

7. Are there any entry requirements for the PA apprenticeship?

PA apprentices complete a 30-36 month long education programme, working towards becoming a PA with an award of Postgraduate Diploma (PGDip) or Master of Science (MSc) in PA Studies, Masters in PA Studies (MPAS) or MSc PA.   The course combines work-based and academic learning between the employer and university. Employers and universities undertake a joint recruitment process.

Universities specify their entry criteria for the PA apprenticeship programme. These must be set in conjunction with employers, demonstrate a student’s ability to study at a master’s degree level and consider experience along with qualifications.

The (Level 7) PA apprenticeship standard suggests that entry requirements might comprise: holding a bioscience-related first degree OR  current registration as a Nursing and Midwifery Council (NMC) Registered Nurse or Midwife, or a Health and Care Professions Council (HCPC) registered Allied Health Professional. Candidates are also expected to have some healthcare experience.

Apprentices without Level 2 or equivalent English and Maths will need to achieve this level prior to completing the endpoint assessment.  Most universities require evidence of this, requesting GCSE English and Maths at grade 4 (C) or higher, or functional skills Level 2. Many will support candidates to achieve this prior to, or during the course. Universities have guidance around how non-UK graduates can demonstrate eligibility. They assess applications on a case-by-case basis. Access detailed entry requirements for the 10 available programmes.

For those with an education, health and care plan (EHCP) or a legacy statement, the English and Maths minimum requirement is Entry Level 3. British Sign Language qualifications are an alternative to English qualifications for whom this is their primary language.

8. Is there any limit to the amount of time someone can spend out of the GP practice?

Apprentices receive on-the job opportunities to gain the knowledge, skills and behaviours needed to complete course requirements. They are also allocated protected study time (around 40%) to attend academic study, complete assignments and undertake placements that offer further off-the-job learning opportunities. Whilst PAs are allocated to one specific area, they need experience working across both internal and external placements to gain an appreciation of the different areas of local healthcare service and meet the programme requirements.

9. What if that takes them beyond 2023/24?

Reimbursement for the PA apprentice role will be possible for the length of the programme of study.

10. Does this mean that the training course is funded, or just the salary paid? If the latter, where can I access funding for the course?

The ARRS covers salary costs (plus some on-costs) up to a maximum reimbursable amount.

The apprenticeship course can be paid for in a couple of ways. Access a summary of apprenticeship funding here. The amount of government funding varies depending on whether the employer is a levy payer or non-levy payer. You can find more information on HASO’s Funding and Levy page. 

1. What are apprenticeships?

Apprenticeships are work-based training programmes designed to help employers train people for specific job roles. Apprenticeships bring several tangible benefits to NHS and other organisations. They can create skilled, motivated and qualified employees and, if used properly, can help to address skills shortages across the workforce.

The NHS Interim People Plan highlights that apprenticeships are critical in attracting people to the NHS from less well represented groups and supporting the development of new roles. The government is therefore committed to significantly increasing the quantity and quality of apprenticeships in England. The People Plan also highlights the significance of apprenticeships in the Integrated Care Systems (ICS) approach to whole-system workforce planning and development to deliver the NHS Long-Term Plan.

It is recognised that further action is required to increase participation and progression from under-represented groups into postgraduate medical and clinical training and education. The number of entrants from deprived socio-economic backgrounds remains low compared to all entrants to higher education. The government intends to address regional inequalities which impact productivity and earnings through a Levelling Up Agenda which is focused on infrastructure, education and skills. The offer of a PA apprenticeship plays an important part in decreasing educational inequalities whilst helping to support productivity and skills, provision of NHS services, workforce diversity, social mobility and levelling up.  Supporting implementation of the apprenticeship route will be of particular benefit to employers in underserved areas in England, therefore effectively responding to the Health Disparities White Paper.

2. Is there any assistance/ support for the apprenticeships?

Primary Care employers can access a range of support from their local training hub

Primary care employers are not generally large enough to have a levy pot. They can either pay a 5% contribution to tuition costs, where the government pays the other 95%, or they can receive a levy transfer from a larger organisation (although this can’t be guaranteed). NHSE can facilitate this process. Please contact talentforcare@hee.nhs.uk

3. When will the apprenticeships be available?

Universities are offering the programme with rollout across the nine universities – further details here

1. What funding is available for the apprenticeship PA roles and training?

Primary Care Networks can claim reimbursement for the salaries and some on-costs of PA apprentices hired through the Additional Roles Reimbursement Scheme (ARRS). Details of the scheme, and available levels of funding can be found in the Network Contract DES

A summary of apprenticeship funding is provided. The amount of government funding varies depending on whether the employer is a levy payer or non-levy payer. You can find more information on HASO’s Funding and Levy page. 

All employers with a pay bill of over £3 million each year (typically trusts) pay the apprenticeship levy which can only be spent on apprenticeship training. Apprenticeship leads, who normally work within their organisations training or HR department, will be able to help employers access the apprenticeship levy. Primary Care employers can access support from  local Training Hub.

Primary care employers are not generally large enough to have a levy pot. They can either pay a 5% contribution to tuition costs, where the government pays the other 95%, or they can receive a levy transfer from a larger organisation (although this can’t be guaranteed). NHSE can facilitate this process. Please contact talentforcare@hee.nhs.uk

There is no tariff funding payable for providing placement to PA apprentices. NHSE are planning to offer employers of PA apprentices educational support grants, intended to provide support to the system with introducing and embedding the apprentice PA role. These grants of £10K per learner (likely to be payable to employers for course starts in 2023/24 and 2024/25) can be used flexibly to cover the establishment of educational infrastructure to develop and support PA apprentices, including during placements. Employers may benefit from system-level planning to develop approaches to using this funding to develop effective, sustainable processes and inter-organisational relationships in support of quality placement provision and other educational support.

2. Can individual GP practices claim additional roles reimbursement for PA apprentices?

 The Network Contract DES sets out that ‘Additional Roles must:

1. be embedded within the PCN’s Core Network Practices and
2. be fully integrated within the multi-disciplinary team delivering healthcare services to patients’

 

Staff can be employed either by the PCN (if it has set itself up as an organisation, rather than a collaboration of practices), by individual practices within the PCN or by a third party.

Reimbursement for staff flows through a ‘nominated payee’ (either the PCN, if an organisation, or a lead practice within it). As such, the PCN will be able to claim and distribute reimbursement to GP practices within their network, or providers they have commissioned to deliver services on behalf of the network.

We expect that, in most cases, the PA apprentice will work closely with a single GP, or a small number of GPs, and primarily in a practice setting.

3. Can I receive ARRS funding from April 2023 onwards for a PA apprentice who is not yet started an apprenticeship programme?

 PA apprentices can receive ARRS funding from the time they are enrolled on the programme.  The Network Contract DES states:

1. 6A       Apprentice Physician Associate

A.1 Where a PCN employs an apprentice Physician Associate under the Additional Roles Reimbursement Scheme, they must ensure that the apprentice Physician Associate:

1. Is enrolled on a postgraduate degree apprenticeship from the approved national framework of providers[1]; and
2. gradually builds experience against the tasks outlined in the Physician Associate job description through on-job training, in line with the Physician Associate apprenticeship standard.

 

A.2 During the initial phase of the apprenticeship, all apprentice Physician Associate work activities should be under direct guidance and supervision of a registered medical practitioner. As the apprenticeship progresses, following discussion and agreement with mentors and supervisors, supervision and guidance may be both direct and indirect.

4. Once the PA apprentice has completed training and moves to a qualified PA role, are they still eligible for funding?

 Yes. The PA role is also reimbursable under the ARRS.

5. Will there be any funding support for training courses for clinical duties?

The ARRS scheme provides reimbursement for salary costs and does not provide funding for training courses. The apprenticeship course can be paid by claiming the apprenticeship levy (including through levy transfer) or through government co-investment. Please see section on apprenticeships funding.

There is no tariff funding payable for providing placement to PA apprentices. NHSE are planning to offer employers of PA apprentices educational support grants, intended to provide support to the system with introducing and embedding the apprentice PA role. These grants of £10K per learner (likely to be payable to employers for course starts in 2023/24 and 2024/25) can be used flexibly are to cover the establishment of educational infrastructure to develop and support PA apprentices, including during placements.  Employers may benefit from system-level planning to develop approaches to using this funding to develop effective, sustainable processes and inter-organisational relationships in support of quality placement provision and other educational support.

Will there be any support offered for GP practices/PCNs or will this be the responsibility of the GP practice?

Primary care employers can access support around apprenticeships from their local Training Hub

The higher education institution will also provide support around the PA apprentice’s educational experience.

The Faculty of Physician Associates (FPA) offer resources to understand and support the PA role. NHSE Regional Teams contain PA Workforce Leads and PA Ambassadors (PAAs) / PAA Leads who are positioned to help support PA apprentices and their employers. See guidance for employers here along with PAA contacts.

A £5000 preceptorship support payment is available for PCNs/GP practices employing newly qualified PAs (or those moving from secondary care)