Supervision of PAs registered in the PA General scope of practice

Period of supervision

Permanent and ongoing.  

Primary supervisor specifications and delegation

A PA registered in a PA general scope of practice must have an employer-approved primary supervisor who is a vocationally registered doctor in a scope of practice relevant to the PA’s area of practice.    

The primary supervisor must provide onsite supervision to the PA. At any time that the primary supervisor is not available onsite, they may delegate to a secondary onsite supervisor. Delegation may be made to: 

• another vocationally registered doctor; or 
• a doctor registered in the general scope of practice provided they: 
  • have 5 years of experience in a similar area of practice as the PA. 
  • are not undertaking vocational training or appointed in RMO non-training positions.  

Onsite supervision requires the primary supervisor, or any doctor that they delegate onsite supervision responsibilities to within this framework, to work in the same facility as the PA and be available on a day-to-day basis to provide medical input, guidance, and advice to the PA.  

The employer-approved primary supervisor retains overall accountability and supervision responsibilities as set out below.  

Accountability and responsibility

The employer (via the Chief Medical Officer, Clinical Director (PHO), or Clinical Lead (general practice or urgent care) is responsible for:  

• Appointing a primary supervisor and ensuring appropriate supervision is in place, in line with the requirements in this framework.  
• Ensuring appropriate reporting from the primary supervisor to the employer is in place.  
• Ensuring there is protected time for the primary supervisor and PA to meet.  
• Using the Ministry of Health credentialling framework to credential the PA to define the specific clinical responsibilities that they are assigned (based on their qualifications, training and experience) in each specific service environment in which they practise (within the PA General scope of practice). This includes undertaking a credentialling review at least annually, or when clinical responsibilities change.  
• Ensuring the PA and primary supervisor are provided with credentialling reports of the PA, and any other employer guidelines.  
• Ensuring a system is in place for the primary supervisor to obtain feedback from any onsite supervisor.  

The employer-approved primary supervisor is responsible for:  

• Monitoring the performance of, and providing feedback to the PA, within:  
  • this framework  
  • the PA’s employer-credentialled clinical responsibilities, and  
  • the PA General scope of practice.  
• Providing clinical input to the employer in relation to initial and annual credentialling of the defined clinical responsibilities of the PA in each workplace.  
• Providing supervision in line with this framework, including ensuring that onsite supervision is available.   
• Holding regular, scheduled meetings with the PA and providing constructive feedback (including any feedback reported to them from any other doctors who have provided onsite supervision). Meetings between the primary supervisor and the PA can be in person or conducted virtually.   
• Supporting the ongoing professional development of the PA through encouraging their engagement and participation in:  
  • multi-disciplinary team meetings  
  • peer review of difficult cases  
  • grand rounds (if applicable)  
  • journal clubs.  

The PA registered in the PA General scope of practice is responsible for:  

• engaging in all aspects of the employer-led credentialling process  
• promptly raising with their employer and/or primary supervisor any issues relating to the effectiveness, functionality, or logistics of their supervision  
• ensuring the ongoing delivery of culturally safe practice  
• practising consistent with any employer guidelines.  

 The PA registered in the PA General scope of practice must also meet the expectations of the primary supervisor and seek their feedback and input both on a day-to-day basis in relation to specific clinical cases, and in terms of their general performance. 

Meetings and reporting

Meetings between the primary supervisor and the PA can be in person or conducted virtually.     

Periodic reporting to Council is not required for PAs registered in the PA General scope of practice. However, documentation of supervision and employer-credentialled activities must be maintained by the employer and may be requested by Council in the event of a notification about the PA to Council.    

The PA’s employer-approved primary supervisor will be required to confirm each year, when the PA applies for a practising certificate, that the PA is complying with their supervision and employer-credentialled requirements.     

Existing Council processes will apply if a PA is reported by the primary supervisor or employer not to be satisfying the required standards or whose practice may pose a risk to patient safety. That is:  

• Council staff will liaise with the supervisor to ensure there are no immediate patient safety concerns.  
• A remediation plan should be implemented by the employer.   

Changing employment or area of practice in the PA General scope of practice

When a PA registered in the PA General scope of practice is newly employed or changes the area of practice in which they are working, the employer must promptly credential the PA to determine and define their clinical responsibilities in each specific service environment in which they practise.     

The employer must also ensure that appropriate induction and orientation is undertaken, and that supervision is in place in line with this framework.      

Regular, scheduled meetings should be held between the PA and primary supervisor during the induction period.