To think Physician Associates are (mostly) a false economy?

What is your problem with pharmacists?
You do realise that they stop doctors killing in injuring you when doctors make mistakes when prescribing?
I agree that using PAs is very concerning.

England is on the new contract, rest of uk on the old. If you Google max working hours doctor 2016 or 2002 it summaries limits on hours.

Exception report if exceeding on new contact. Request hours monitoring diary card if on the old contract

No nights in f1 is v common, I didn't do them in f1 in Lincolnshire (granted nearly 10y ago now), they often have twilight midnight finishes instead

Damn, yes forgot to add to my post that although PAs doing specialist surgery tasks is undoubtedly safer than them being in primary care, that then undermines the training of junior doctors who rotate so often that every procedure they miss out in being trained on significantly undermines their ability to develop.

I can't help feeling that PAs counterintuitively might make more sense in a system with more spare capacity than the NHS. The Doctor's Assistant band 4 post that does legwork, admin, chasing and support makes far more sense for most of the departments I have ever worked in.

Sorry for your experience, it does sound awful.

I now work in paediatrics but I recall working in adult medicine as an F1/F2.

The team on a given day would consist of 1 consultant, 1 or 2 registrars, 1 or 2 SHOs (FY2-just below registrar level) and 2 FY1s. And we were often understaffed. So we might have 5 doctors in total, and 2 of those 5 really with the lowest level of experience possible (FY1s). The consultant and frequently the registrars needed to leave in the afternoon to undertake their procedures list or their clinics.

During busy periods the team had to manage up to 60-70 inpatients and furthermore the registrar might have to see new patients as they arrived or give specialist advice for a patient under another team. We all also might become very busy indeed if there were 1 or 2 very unwell patients to manage.

The consultant couldn't physically see or even maintain an awareness of all of the patients every day, even if the round was split with the registrar this did not leave enough time so some of the patients each day would have to be seen by / known only to an SHO. So generally the consultant would just see the new patients and any patients of particular concern

We could not have a handover of each and every patient every day (only the unwell / concerning or new ones) so for the majority of patients information is transmitted only from the notes not firsthand. And staff change not quite every day but there isn't the same team every single day because of night shifts, days off and cross cover of staff absences in other teams.

It was like an endurance race every day to get through them all. As an FY1 you usually write in the notes to help the senior SHO/registrar or consultant get around faster. You have to try to write as fast as they speak.

The day is at best 8 hours long, possibly only 4 of those hours with a senior present - minus any breaks or emergencies - and if there are 60 patients taking 5 minutes each that already adds up to 5 hours of ward round. But is 5 minutes a day enough to fully address the complexities of a 80 year old with about 10 complex intersecting chronic health conditions as well as whatever has brought them in?

You are absolutely right about the care the patients deserve but it very difficult to give personalised care facing these kinds of numbers day in day out. It dehumanises the patients almost by necessity.

From my junior perspective the chief priority was to do the paperwork necessary to get the patients out of the door to make room for the never ending flow of new patients.

Much more needs to be done to keep patients safely out of hospital, and to give them safe destinations to be discharged to. Until adult social care is prioritised and adequately funded, patients in hospital will not be able to get good care no matter how well things are organised, not when they outnumber senior experienced doctors 20 or 30 to 1.

Imo PA's have a role as cheap labour to perform repetitive highly differentiated tasks (eg specific procedures) or administrative tasks (eg discharge summaries). The problem is they may then procedurally deskill doctors, they aren't actually cheap, and it seems that they are being used to medically assess undifferentiated patients (v dangerous imo).

This is only the doctors' perspective I can't speak to nurses.

I think the BMA supervision guidance is helpful (which is why it was a bit of a bomb going off when it was issued) - PAs shouldn't be working with undifferentiated patients in primary care, and shouldn't be seeing children at all. They shouldn't be holding bleeps that allow them to make unsupported clinical decisions in hospitals either. There referral rates are high compared to GPs, but not as high as they should be.

I can easily imagine a PA being helpful with eg a healthy living clinic for people living with chronic health conditions- if you have tricky heart conditions or asthma or past strokes, you might need something more specialist than Weight Watchers, and some one like a PA who can flag up clinical concerns would add value.

Ironically it makes far more sense to use PAs in specialist surgery, which as far as I know is what they do in the USA (there's an American PA in my partner's family). Doing specific very technical procedures to a small group of selected patients wuth heavy team oversight, surgeons around, nurses looking after the patient - I can see that working. But if UK surgery looks very different and is thinly staffed compared to the US (which it might be), that's more worrying.

Steve Barclay seems to have slid through and got away with supporting this expansion and then slid out of being Health Secretary again without any comeback. There were probably others who did too - Hancock?

Are you talking about England or the whole of the UK?

Contracts vary significantly in different parts of the country. And conditions vary in different deaneries. For example London F1s apparently don’t have to work nights. Though medical school graduates are able to show a preference for where they may want to work, they can be allocated anywhere, and have to accept the pay and conditions that prevail.

Depends on your age. Mammograms are more accurate in older breasts, ultrasounds in younger breasts (my referral was about age 25 and the only investigation is ultrasound due to breast composition

She needs to be exception reporting daily if those hours aren't exaggerated for effect... our legal max hours is 72h per week

GPs get PAs fully funded for free which is why they're in growing number there, in combination with so many GPs max exodus from the job as they're treated awfully and crazily overworked

It's definitely a worrying progression. I've been totally incorrectly examined by a PA ... to feel for blood clots through jeans and knee high leather boots, I didn't even raise it at the time as felt so god awful and knew I didn't have a dvt but still

I agree completely with this. Medicine needs to have a heavy duty of responsibility and take a long time to get through. The opioid crisis in America and the testing of children via gender affirming care shows how vulnerable the system is to predatory practices.

@NLG17 I don't. But a full proper check of blood pressure, chest, etc with a PA on the day, was better than a wait to see the GP.

What.is the actual role of Physcian associate?
I took my Son to Dr's last week and we saw one ,he's severely autistic and Been eating a lot of beetroot and his urine was red i wssent at all concerned by this as i know it can be a side affect but his special schools wanted it checked out as he's non verbal etc and can't say if he's any pain
Anyway we saw one who took the history and then said needed to speak to the GP who them asked me the same questions and said he had no concerns,
Which made me think seeing the physcians associate first was a bit pointless ?

So, would respectfully ask,how do you know there weren't findings that should have alerted a PA that other investigations were required? No red flags.

Getting 30 mins to feel enough time to explain symptoms alongside basic obs does not equate to clinical safety.
A PA isn't trained to interpret findings, or read results, or refer for scans, or prescribe.

Because they don't learn medicine. They learn lists to rote.
A GP supervising relies on a PA case presenting to them.
Relying on someone to present on something they are literally clueless on is not going to capture what is needed unless incredibly simple presentation.

But the red flag for pts should be why aren't they regulated and haven't ever been?
Because regulation is there to provide professional boundaries & pt safety
Without that it's the wild west as PAs constant posting about pts on tictoc shows.

Coroners have issued warnings to GPs in our area after preventable deaths.
So whilst 30 mins with nice person seems good would trade for 10 mins GP regulated with 10 yrs experience & training any day
Even having to wait weeks with inthe meantime getting basic obs done by HCA prior to any appt
Or clinic nurse if long term condition
Anything but a PA

My DM saw a PA a fortnight ago with 3hrs notice, with me in attendance.
I was very happy.
She was given a full MOT in a 30min appointment. She promised to chase a referral, and after the PA consulted with Dr and raised an appropriate prescription.

Overall I have been incredibly impressed with the care my DM has received via various parts of the NHS over the past 3 months, and very impressed by her GP surgery.

It’s a route to an inferior health service I believe. It wouldn’t surprise me if it was partly politically motivated. The tories seem to resent doctors and not want to pay them a proper market rate in what is a global market for their skills.

How can someone with inferior training to a doctor deliver the same quality of service? I’d be interested to know which other countries do this and what the health outcomes evidence is.

You don't get 30 mins or indeed sometimes any appt time with a GP because the govt has put limits on how many GPs can be employed.
The fund put in place to top up GP practices with essential staff excludes GPs.

On top of that the govt has also reduced and capped how many GP training places can exist.
So hundreds applying for each place just to train.
Thousands unable to be employed
At a time of GP shortage

Introduction of PAs has been happening for several years - it's a clear plan to replace Drs across the NHS without the public noticing. It's been so insidious that even hospitals like Great Ormond St using them in surgery. Bet parents haven't been told- our kids treated there and we certainly weren't.

If you assume PA training is akin to say senior nurse training you are wrong.
It's a 2 yr post grad very low level cse where 100% pass rates guaranteed when you only have to pass 30% of the paper ( see Reading uni or any other prospectus.) No science degree needed. A BTEC in sports science will do. No GCSE or A levels sciences needed.
Parents of those revising for GCSE biology will have kids who've done more anatomy and physiology.

Dr's are now taking their own regulatory body to court about this.

Some PAs may be lovely ppl but they can't do differential diagnosis as a GP can because they don't have 10 yrs training.
If you want the destruction of primary care then accept to see a GP
But don't then complain you can't see the Dr that PA replaced.Because they're now unemployed

Young doctors often do not have a choice but to locus. There uis a huge shortage of places for speciality training. Only one in three applicants will get a place, made worse by PAs using up existing training resource.

Trouble is that PAs are also replacing locums.

DD is an F1. She is increasingly resigned to the fact that when she finishes F2 there probably won’t be a job for her and her options will be to move to Australia or do something else.

By then she will have invested eight years into studying medicine. She enjoys the work and seems to be good at it. The NHS will have betrayed her.

I presume you locum then, by your description? GP practices being stuck relying on locum doctors so much who are paid much much more for often less work than the regular GPs (in our PCN the locums don't deal with any correspondence/results at all for example) is also not a sustainable way to run general practices surely. I dont blame individual doctors for wanting to do that btw at all, it's a symptom of the broken system we have, but it's surely a good thing if practices can have some of their workload done by consistent, much much cheaper staff members like ANPs and PAs (who are actually basically free in GP land due to the ARRS which I'm sure you know), who do provide continuity for patients with things like referrals/test results/correspondence than using locum doctors who don't, and cost many more times to boot.

I get this all the time since the gp practice employed a pharmacist to review meds and deal with repeats. You have a telephone consult, they argue about everything, then do the Px with the wrong quantities and usually something I didn't need and missing something I do need. Then wait another few days for a gp, that I have never spoken to, to sign the Px.
The poor dispensing pharmacist at the chemist, who has know me for years, then has to call the surgery to try to help.
I can't see how this helps anyone.
I used to order my repeats online.
Still a few mistakes, but the time frame was shorter to rectify.

Collected a prescription that a PA ordered today(after getting signed by the dr)
same brand…. Wrong product and 1/10th of the usual amount on the repeat prescription for eczema ointment.
called the drs and the receptionist just sighed - I’m guessing it’s becoming a regular thing.

PA ‘s were used as a quick fix to create more ‘GP’ appointments , only not with a GP. 50 million new appointments!
Supposedly there is a shortage of GP’s but there are literally thousands , yes thousands , of GP’s who are struggling as practices won’t employ them , because this government decided to fund other roles instead.
And there will be hundreds more qualifying soon , who are worried about their future.
I’m a doctor with 24 years experience, 12 of them as a GP. I can only find work one or two days a week now , though willing to work all 5.
When I need to see a GP for myself , 4 out of 5 times, I get to see a locum ANP or a PA .
Not sure what the agenda here is or who pushes it and why, but surely this isn’t right.

@Kitcatmouse

I've just seen the nurse practitioner and had such a bad experience. I'm prone to chest infections and have asthma, I had pneumonia this time last year, and for the past 2 weeks I've had an infection which I can't shake off. It's not quite on my chest, but more my larynx. Either way, I've got a terrible productive cough, and I'm bringing up loads of thick green mucous.

I'm feeling really unwell today so I got an appointment, saw it was the nurse practitioner and hoped for the best, but it was dreadful. She listened to my chest and said it was a flare up of my asthma (it's definitely not that, I saw the GP last week and am on pred already as a precaution), she suggested a course of steroids and I had to point out I'm already on that and my asthma has not been affected by this current infection.

She then tried saying it was croup... and said green mucous doesn't need antibiotics. I had to disagree and said I am prone to these infections and they only get worse not better with me. I've been hospitalised before.. I asked her how do I get rid of the green mucous? She did not have an answer. I said I'm worried it will spread to my chest.. she said it wouldn't but would not offer an explanation as to why.

She did give me antibiotics but as I was going out the door she said I had not listened to her. This upset me as I had listened to everything she said. I feel she didn't like it because I know my body and rejected her diagnosis.

@LuluBlakey1

also I’m very sorry to hear about your Aunt’s experience
there is no reason not to meet her basic care needs or ensure the wards are cleaned.
please contact PALs about this!

@LuluBlakey1

Nurse practitioners aren’t the same as a PA.
Nurse practitioners are either someone like me (I’m an emergency nurse practitioner) who has a degree in nursing and has gone on to complete further education including Prescribing for example and we work independently, obviously we can consult with Dr’s/colleagues etc but we are accountable for our decision making and we are regulated by the NMC.
and you have advanced nurse practitioners who have a full Masters.
and are usually specialists in an area and invaluable with a wealth of knowledge.

PA as far as I understand are not regulated and therefore are dependent and definitely can’t prescribe etc.
and their background can be something science related like Biomedical science

nurse practitioners aren’t a cheaper option to doctors, we’re highly skilled and trained in our own right 😊

Oh god. This is scary. So these people have less training than a nurse?! Having read about these I’m now worried as I had to take an elderly person to minor injuries earlier this week who was in a great deal of pain after a fall. I assume they had seen a nurse who thought they hadn’t broken anything but to me their pain level suggested that the injury is more serious than just bruising. They’ve been sent away with codine and told that the hospital will examine their X-rays and call them if they think they need to go in!

@Oneblindmouse that’s a great article. My DNs were saying the aim is for a 5:1 ratio of doctors:PA in 10 years’ time. Terrifying.