Category: Reimbursable Role Summaries

Concise summaries of the new, reimbursable roles, accompanied by links to additional reading and resources.

Nursing Associates

Nursing ASSOCIATES

A new role in England, bridging the gap between care assistants and registered nurses

NURSING ASSOCIATES

Deliver hands-on, person-centred care for people of all ages, and in a variety of settings in health & social care

Nursing Associates

The NMC became the regulator for this role, in England, in July 2018

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What can nursing associates do?

What benefits can nursing associates bring?

What should I look for from a nursing associate?

What is their scope of practice?

What benefits can nursing associates bring?

How much training do they have?

Can I receive funding to employ them?

Can I see some case studies?

Am I eligible for the apprenticeship levy?

What academic qualifications should an NA have?

Any example job descriptions?

Any sample interview questions?

What clinical supervision do I need to provide?

Who can supervise a trainee nursing associate?

What ongoing support can I provide?

What can nursing associates do?

The nursing associate role is a new role in the NHS, bridging the gap between a healthcare support worker and a graduate registered nurse. Nursing associates are qualified at foundation-degree level and work with individuals of all ages / backgrounds, across a range of health and social care settings.

Nursing associates work alongside registered nurses, carrying out much of the same clinical duties and care, but they do not share the same status and therefore cannot perform certain tasks

What benefits can nursing associates bring?

The nursing associate role was introduced in 2015, in response to the Shape of Caring Review from Health Education England. This document stipulated that healthcare assistants and nurses require high-quality education and training, if they are to provide the highest standard of patient care, and identified three key problems within primary care:

  • A lack of training / development opportunities for HCAs, despite their supporting the bulk of over 60% of care work
  • An aging population with increasingly complex needs which demanded nurses delegate tasks more, so that they are able to focus on these complex issues
  • A shortage of nurses in the NHS and social care

Including nursing associates in your MDT will help address these issues and convey the following benefits:

  • Improved service delivery and patient care
  • Improved staff retention
  • A ‘grow your own’ nurse workforce
  • A tried-and-tested nursing programme, accredited by the NMC
  • Nursing associates, once qualified, can go on to registered nurse status
  • Providing supervision and preceptorships can improve recruitment and retention rates
Sources

HEE’s Why hire a nursing associate?
Click here

HEE’s Nursing Associates page
Click here

What should I look for from a nursing associate?

The Standards for Proficiency for nursing associates, as set out by the NMC, outlines six standards:

  • Be an accountable professional
  • Promote health and prevent ill health
  • Provide and monitor care
  • Work in a team
  • Improve safety and quality of care
  • Contribute to integrated care

Two annexes emphasise that nursing associates should be able to communicate effectively and sensitively, and to manage relationships with people, too.

For more information, please read the Standards themselves, by clicking the button below.

What is the scope of their practice?

Nursing associates work with people of all ages, in a variety of settings in health and social care; contribute to the core work of nursing; and free up registered nurses to focus on more complex clinical care.

Duties / areas nursing associates cannot perform:

  • Act autonomously to change the prescribed plan of care
  • Act autonomously in situations where there may be limits to confidentiality – for example, in safeguarding situations
  • Decide to make specialist referrals
  • Decide to share information across multiagency boundaries
  • Interpret and resolve risk issues (they must be able to identify risk and halt practice if necessary)
  • Decide to discharge an individual from a service
  • Manage situations of conflict or risk beyond immediate actions to maintain safety
  • Administer medicines under a patient group directive
  • Prescribe medicines
How much training do they have?

In addition to complying with the NMC’s Standards for Proficiency, registered nursing associates must have completed a foundation-level qualification approved by the NMC over the course of two years. This usually involves 2,300 hours of training and studying, split between academic and vocation-based learning.

A condition of the programme is that nursing associates must gain experience of all nursing areas: mental health, learning disability, adult, and children, to ensure they have the breadth and depth of knowledge and experience needed to support and enhance the quality of care. This is achieved by trainees taking on placements outside of their usual employment setting.

Can I receive funding to employ them?

As an employer, you can fund your nursing associate programme through the apprenticeship levy scheme. This is paid by all employers who have an annual bill of £3 million or more, which they can claim as funding for a max of 15,000 per employee.

Nursing associates are commonly taken on by employers via the apprenticeship route, but there are a number of self-funded university-level courses.

You can find out more about how you can employ nursing associates through the apprenticeship route below.

NAs and the apprenticeship levy: A quick guide for employers

To read this document from HEE, please click here.

Apprenticeships Procurement Toolkit: Guidance for Employers

To read this document from HEE, please click here.

Using the apprenticeship levy

To read this article from NHS Employers, please click here.

Your Future Nursing Associates infographic

To view this infographic from NHS Employers, please click here.

Can I see some case studies?

There are a number of case studies available from HEE, with many NHS Trusts across England – including Devon, Birmingham, Pennine, and Mersey – having employed nursing associates.

You can access these studies below. Please do note, though, that many of them pertain to settings other than primary and social care.

Am I eligible for the apprenticeship levy?

Employers with a payroll of more than £3 million can use their apprenticeship levy contributions to pay for places on apprenticeship programmes. Any business with a payroll below £3 million is eligible for government funding that will cover at least 95% of the cost of an apprenticeship course.

As an employer, you must be able to meet any costs exceeding the 15,000 per employee allowance, and this includes clinical supervision. For more information, please click the button below.

What academic qualifications should an NA have?

A nursing associate should have:

  • A foundation-level qualification accredited by the Nursing and Midwifery Council, completed over two years
  • This must include 2,300 hours of on-the-job training and academic study, with varied clinical placements
  • This is principally achieved through an apprenticeship or self-funded university route

Additionally, trainee nursing associates must:

  • Be employed within healthcare, for 30 hours+ per week
  • Have the support of their employers
  • Confirm eligibility for apprenticeship funding *
  • Have evidence of study at level 3 (e.g., A Levels, BTEC Health & Social Care, or evidence of ability to study at or above this level)
  • Level 2 / GCSEs in Maths and English, at C+
  • Have an Enhanced DBS Adult and Child Workforce, dated within the last 12 months
  • Have occupational health clearance from their employer

* Please note: entry requirements will vary between universities

Any example job descriptions?

At present, HEE have not issued any job description for the nursing associate role. However, it is clear that this will likely cover and include experience, skills, and attributes described in previous sections as core to the nursing associate role.

Once qualified, a nursing associate will be able to undertake skills including, but not limited to, compression bandaging, drug administration, cervical cytology and childhood immunisations.

Any sample interview questions?

At present, there are no guidelines on job interview questions. But HEE shall be releasing some guidance on the job description details for nursing associates in the near future.

What clinical supervision do I need to provide?

Trainee nursing associates are assigned a practice supervisor, a practice assessor, and an academic assessor. Practice supervisors can be any registered health and social care professional, though it is typically a registered nurse, in the case of nursing associates. Practice assessors cannot simultaneously be the supervisor for a student.

Supervision is outlined by the NMC’s employer guidance as follows:

  • Sharing, demonstrating, and providing support
  • Confidence building
  • Encouraging and developing reflective practice
  • Developing appropriate skills and competence
  • Supporting learning
  • Providing any required guidance, signposting, and information
  • Helping the trainee nursing associate to make progress

Additionally, whilst in your employ, trainee nursing associates should have:

  • A thorough induction into work
  • Preceptorship * and mentoring (especially if newly-qualified)
  • Ongoing access to professional development

For more information on supervision standards, supervision codes of conduct, and the * principles of preceptorship, please look below.

Standards for student supervision and assessment

To view this document from the NMC, please click here.

Practice supervisor preparation

To read this article from the NMC, please click here.

Principles of preceptorship

To read this article from the NMC, please click here.

Who can supervise a trainee nursing associate?

The curriculum framework states that supervision can be provided by an appropriate manager or any registered health professional (e.g., a registered nurse (across any of the professions)) working in practice that has been prepared to take up the role and is up-to-date on the knowledge and experience relevant to the student.

Supervision can be provided directly / face-to-face or indirectly / virtually.

What ongoing support can I provide?

You can:

  • Assign supervisors for each trainee nursing associate on placement
  • Manage both poor performance and recognise good performance — and, legally, you are responsible if a nursing associate carries out duties beyond their defined capacities and this results in errors or harm
  • Conduct annual appraisals, to review the progress and performance of nursing associates in your practice
  • Take all steps to improve management of the employee’s fitness to practice

You can read more about the support you should provide and your responsibilities by clicking the button below.

Additional literature
HEE's easy-read

To download HEE’s easy-read guide on nursing associates, click here.

Additional A/V resources
New Roles: Nursing Associate

To watch HEE’s video on the work of nursing associates and their invaluable opportunity the role provides, in the words of an nursing associate ambassador, please click here.

[This video was published on 25/10/19]

Becoming a nursing associate

To watch HEE’s video on becoming a nursing associate and joining the wider nursing team, please click here.

[This video was published on 08/01/20]

Additional Roles Hub

NR Hub

A landing page for information on the new roles in primary care

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Summary pages

Universal resources

South West ARRS Workforce Summit recordings [15/10/20]

On Thursday 15 October, NHS England & NHS Improvement ran a three-session South West workforce summit to discuss and share some of the opportunities and challenges for general practice and the wider system, and to strength workforce planning linked to the introduction of the Additional Roles Reimbursement Scheme (ARRS), alongside other initiatives focused on general practice recruitment and retention.


Session 1: 09.30 to 11.30
Presenting case studies on AHPs, social prescribing link workers, health and well-being coaches, and care co-ordinators

To watch this session, click here.


Session 2: 12.00 to 14.00
Presenting case studies on clinical pharmacists, pharmacy technicians, first contact physiotherapists, and physician associates

To watch this session, click here.


Session 3: 14.30 to 16.30
Presenting cast studies on mental health practitioners, community paramedics, and nursing associates (inc. trainees)

To watch this session, click here.


Please note: you can download the full agenda for the day, with more information on what each session covered, here.

Role-specific resources

Care co-ordinators
Sample resource pack

Produced by NHSE / I, this resource pack includes:

  • Sample job description
  • Sample person specification
  • Sample job advert
  • Sample interview questions

To download it, please click here.

Dieticians
Sample JD and person specification

This sample job description and person specification has been produced by NHSE / I. To download them, please click here.

First contact physiotherapists
FCP Job Description

To download this job description template for FCPs, please click here.

HEE easy-read

To read HEE’s concise, easy-read guide about the first contact physiotherapist role, please click here.

HEE roadmap

To read HEE’s roadmap to practice for the first contact physiotherapist role, please click here.

Implementing FCPs video

To watch NHSE / I’s video on the national roll-out and implementation of FCPs, please click here.

[This video was published on 17/02/20]

Health & well-being coaches
Sample resource pack

Produced by NHSE / I, this resource pack includes:

  • Sample job description
  • Sample person specification
  • Sample job advert
  • Sample interview questions

To download it, please click here.

Nursing associates
Becoming a nursing associate video

To watch HEE’s video on becoming a nursing associate and joining the wider nursing team, please click here.

[This video was published on 08/01/20]

HEE easy-read

To read HEE’s concise, easy-read guide about the nursing associate role, please click here.

New Roles: Nursing Associate

To watch HEE’s video on the work of nursing associates and their invaluable opportunity the role provides, in the words of an nursing associate ambassador, please click here.

[This video was published on 25/10/19]

Occupational therapists
Sample JD and person specification

This sample job description and person specification has been produced by NHSE / I. To download them, please click here.

Paramedics
Sample JD and person specification

This sample job description and person specification has been produced by NHSE / I. To download them, please click here.

Pharmacy technicians
HEE easy-read

To read HEE’s concise, easy-read guide about the pharmacy technician role, please click here.

Sample recruitment pack

Produced by NHSE / I, this resource pack includes:

  • Sample job description
  • Sample person specification
  • Sample job advert

To download it, please click here.

Podiatrists
Sample JD and person specification

This sample job description and person specification has been produced by NHSE / I. To download them, please click here.

Social prescribing link workers
HEE easy-read

To read HEE’s concise, easy-read guide about the social prescribing link worker role, please click here.

Sample recruitment pack

Produced by NHSE / I, this resource pack includes:

  • Sample job description
  • Sample person specification
  • Sample job advert

To download it, please click here.

Social prescribing & the future of general practice video

To watch The King’s Fund’s video on the significance of social prescribing for general practice going forward, please click here.

[This video was published on 20/11/18, after having been recorded at The King’s Fund’s Social Prescribing: Coming of Age event]

Physician Associates (PAs)

Physician associates

Use their generalist medical education to work with GPs, physicians, and surgeons

Have been in the UK for over ten years, with the knowledge, skills, and attitude to deliver supervised holistic care in general practice

The Department of Health predicts there will be 1,000 qualified PAs across the country by the end of 2020

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What can a physician associate do?

What should you look for from a PA?

What is their scope of practice?

How much training do they have?

Can I receive funding for a PA?

Can I see some case studies?

How should I go about recruiting a PA?

What academic qualifications should a primary care PA have?

Any example job descriptions?

Any sample interview questions?

What clinical supervision do I need to provide?

What ongoing support can I provide?

What should practice induction include?

What can a physician associate do?

All PAs can:

  • Access, manage, and treat patients with a variety of acute conditions
  • Conduct telephone consultations
  • Develop and deliver appropriate treatment and management plans
  • Formulate differential diagnoses and management plans
  • Perform diagnostic and therapeutic procedures
  • Perform peak flow examinations
  • Perform physical examinations
  • Perform urine dip sticks
  • Provide health promotion and disease prevention advice
  • Request and interpret diagnostics studies
  • Review laboratory test results
  • See patients with undifferentiated diagnoses
  • Send out referrals
  • Take medical histories from patients
  • Triage patients

Some PAs can:

  • Carry out home visits (including to care homes)
  • Offer specialised clinics, including family planning
  • Run checks for COPD, asthma, diabetes, and anticoagulation

With more experience, PAs can:

  • Provide service development and design, serve as clinical placement leads for students, and undertake minor operations
What should you look for from a PA?

When identifying PAs to join their PCN, GPs should look for candidates whom:

  • Are recognised and qualified by the Faculty of Physician Associates (FPA) register
  • Are on the Managed Voluntary Register (click here to learn more)
  • Have completed their postgraduate medical training in PA studies
  • Have trained in the UK
What is their scope of practice?

A PA’s scope of practice covers:

  • Taking medical histories from patients
  • Carrying out physical examinations
  • Seeing patients with long-term chronic conditions
  • Formulating differential diagnoses and management plans
  • Performing diagnostic and therapeutic procedures
  • Developing and deliver appropriate treatment and management plans
  • Requesting and interpreting diagnostic studies
  • Providing health promotion and disease prevention advice for patients
Can I see some case studies?

Click here to read Physician Associates and how they could help your practice.

This document, produced by NHS Castle Point and Rochford, pertinently features a piece on the day-in-the-life of a physician associate, as well as some discussion of how they are educated and trained, and how to supervise a graduate PA in practice.

Click here to read about several examples of PA graduates working in general practice.

This document was produced by the University of the West of England.

Click here to find five more case studies from and about five PAs, ranging from students to senior PAs, at the RCP’s Faculty of Physician Associates site.

How should I go about recruiting a PA?
Recommended guidelines:
  • Ensure that your GP practice is clear on what role they need to fill, and the duties involved in primary care
  • Write a clear job description* detailing the duties of the role / what is expected of the PA. Bear in mind that the PCN will need to grant the PA some variation in working hours when offering the job position
  • Produce a clearly-defined and thorough job plan for the PA, taking into account CPD / career progression and a means by which to monitor their progress in primary care
  • Remember that newly-qualified PAs will require regular supervision
  • Allow for one dedicated GP / supervisor whom can get to know the PA, and vice versa

* Example job descriptions can be found in the ‘Any example job descriptions?’ section.

Click here to read HEE’s guide on recruiting PAs in general practice.

Click here to read An employers guide to physician associates.

This document was produced by the Royal College of Physicians’ Faculty of Physician Associates.

What academic qualifications should a primary care PA have?

A PA should have:

  • A post-graduate qualification consisting of 2 years of study, with 1,600 clinical hours and 1,600 hours of theory
  • An undergraduate degree in biomedical science / life sciences
Any example job descriptions?

To download a generic job description for a PA position, please click here.

For another example of a generic job description for a PA position, please click here.

To download a generic PA person specification, please click here.

Any sample interview questions?
  • What made you want to be a PA, not a doctor?
  • Why do you want to be a PA in primary care?
  • How do you see the role?
  • How do you deal with stress / teamwork / decision making?
  • What would you want to specialise or work towards in primary care?

  • Questions based around safeguardingScenarios might include:
    • You have a patient with a high NEWS score whom you think needs admitting, and your supervisor says they are able to go home. What do you do?
    • You have concerns regarding domestic violence and the person has a child with them. What do you do?
    • You are asked to stay late and hold a clinic beyond your level of competencies. What do you do?
What clinical supervision do I need to provide?

Each PA employed will require regular and ongoing supervision to develop in their role and within the PCN, with newly-qualified PAs requiring more than more experienced PAs.

Click here to download GP Supervisor and Physician Associate Guide: A step by step handbook for the first year in general practice as a PDF.

And click here to download it as a Word document.

What ongoing support can I provide?
  • You should provide one dedicated supervisor (a GP or otherwise) per PCN, whom the PA can get to know and form a bond with, and vice versa
  • There should be a six-month probation period with a review
  • The PA should be appraised on an annual basis
What ongoing support can I provide?
  • Employers should meet with PAs in their first week of work
  • Assess their skills and knowledge in and around general practice
  • Create a structured programme of specific educational goals
  • Establish a review process, with yearly appraisals and reviews every 3 – 6 months
Can I receive funding for a PA?

From April 2020, the PA role will be reimbursed at 100% of its actual salary plus defined on-costs, up to the maximum reimbursable amount of £53,724 over 12 months, via primary care networks.

How much training do PAs have?

PA students already have an undergraduate degree in life science, and / or a significant background in health care. To become a PA, students must complete a two-year, full-time, intensive postgraduate course at diploma or masters’ level in Physician Associate studies, which includes over 1,400 hours of clinical placement experience in both acute and community settings.

A new route to becoming a PA, via a four-year undergraduate Masters’ programme, is being considered.

Once qualified, PAs must maintain 50 hours of CPD per year and sit a re-certification exam every 6 years.

Additional literature
UWE's quick-reference placement guide

To download UWE’s easy-read guide on hosting PA students, click here.

HEE's easy-read

To download HEE’s easy-read guide on physician associates, click here.

South West Physician Associate Network

The South West Physician Associate Network (SWPAN) was formed as a central hub for PAs across the South West, enabling them to network, stay up-to-date, and contribute to the betterment of the profession as a whole.

To visit their site, please click here.

Additional A/V resources
A day in the life of a PA

To watch HEE’s video on the day in the life of a physician associate, click here.

Karen's storey #1

To watch part 1 of HEE’s video on physician associates working in general practice, click here.

Karen's storey #2

To watch part 2 of HEE’s video on physician associates working in general practice, click here.

South West ARRS Workforce Summit case study

To download HEE’s easy-read guide on physician associates, click here.

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