To put that I don’t want to be treated by PAs in my ELCS birth plan?

Has to be a Dr to sign it ... so said Dr is at fault more than the PA for not clarifying allergies.

(All scripts should have allergies documented at the top... so pharmacist is also at fault

I taught them for a year during my education fellowship (when didn't get into training) my gang were fab really knowledgeable and knew their limitations. I def feel there is a role for them but its the lack of regulation that worries me.

Got examined by one when admitted with flu via ooh gp.... she checked for dvts through my jeans and knee high boots, was so breathless it didn't even click what the heck till I'd gone home lol

@Pinkroselondon here's one story. There are many, many more.

www.bbc.co.uk/news/articles/cd1w84dl4pzo

There are many many examples of this. Why bother with 5 years of uni, 2 years foundation and many years training. 18 months will do just as well.

@Neurodiversitydoctor so how do the next consultants learn ? If the PA is doing the routine surgeries the doctors are not, so how do they learn. Consultants should be training their replacements, who should be doctors. Not PAs.

Ok I am not sure how many cesareans you have seen. Seriously delivering the placenta is a non job, couldn't matter less who does it. An elective cesarean is a very routine operation, absolutely something a AHP could be trained up to do. Having a consultant tied up all morning doing v. routine surgery is not a good use of NHS resources.

Also a PA phoned me from my GP practice yesterday, never had that before. She was phoning about my test results. I’m happy with that, but I wouldn’t be happy if she was actively giving me advice or dealing with my health on a serious level. As an example if she has the clinical knowledge and permission to send me for a scan or referral, then great but… I can see how the lack of training they have compared to a GP is 😕 concerning. I would be worried they would miss certain signs or symptoms of something being wrong. It’s a difficult one, assisting the doctor is great, but being a practitioner taking on patients care is quite worrying, especially as general practice is so broad.

I started working in the maternity ward (postnatal/antenatal) mixed in 2017, we had a PA then. No PA in Labour Ward. We have had 3 since then, all very experienced with many qualifications and degrees. I must admit they were such lovely people to work with, the ward wouldn’t have survived without them. Hearing of PA’s helping with c sections is shocking 😮 just like anyone who is not qualified or supposed to be doing that level of care.

I totally agree, I hope this is an isolated incident however, in my London trust this would never happen. Our PA did the following tasks: taking blood, blood gases, TTA’s, giving advice, assisting doctors with tasks, such as paperwork and getting the discharges ready. They were kind of like a doctor's assistant, they never actually went to the Labour Ward, but I can see how different trusts could definitely have different set ups. I would ask, you have the right to ask. You could phone to speak to a Matron who will find out the information for you. Just ask what role the PA plays (if they have one) and what tasks will they usually be involved in during my pregnancy, delivery and aftercare. I am sure a staff member will be happy to have a chat. If more people start asking these questions before going into hospital then they will be more aware of who is treating them, and hopefully feel a bit more comfortable.

Do you know where those stories were in the UK of the PA helping with surgery? I’ll be honest, if anything strange was going on, I would hope another staff member would report it. To ease your mind your midwife should be in theatre with you as well if you have to go in. Unless it’s a big cover up, you could ask him/her if you are concerned as she will hopefully put your mind at rest xx

@therealcookiemonster can I just ask what you'd say to the F2s with no job in August. When PA positions are advertised as being on the SHO rota, so effectively taking a doctors job. How do you think those F2s, with £100,000 debt, feel about not having a job. As a doctor in the UK.

I find this whole PA thing absolutely terrifying.

I do have a life sciences degree, but I chose nearly all genetics modules in my second and third year.. so my knowledge of how the body 'works' is probably not a whole lot deeper than an educated member of the general public.

The idea of me starting a course tomorrow, and being set loose on patients (in the way PAs are currently being used) in 2 years time is questionable. Hand on heart, I would be completely out of my depth.

The idea of someone WITHOUT a science degree, so no deep understanding of anatomy and physiology, treating patients within 2 years is absolutely hideous. There is just no way they are equipped - they won't even know what they don't know.

I feel sorry for them because it's not their fault they're being deployed in this way... but wow. So no OP, I wouldn't blame you for this. I recently advocated for my mum in a similar way - every time we saw someone I asked were they a doctor. If it was something that, IMO, was better dealt with by a doctor (as in not basic blood work, ECG, blood pressure etc) and we were in front of a PA I'd ask for a doctor.

You would not be unreasonable, but actually very wise, to do the same!

@mumsneedwine I am obviously very sorry that you had such a terrible experience. the competition ratios signify many different factors - I mean you used cardiothoracics as an example, it's one of the most over subscribed specialties as obv more people are interested any than are either suitable or needed. sure we could do with a slight increase in the number of training contracts, but that won't reduce the competition ratio, so it's a bit misleading.

there are definitely not enough training contracts being given out, however even if we increase the number of specialty training contracts tomorrow, I won't solve the problem. on average it takes 3-4 years of specialty training for doctors to be providing that service with minimal supervision. longer for more complex specialties
the bigger issue here is that healthcare is growing in complexity every day and the demands on it growing at a rate that is very difficult and expensive to cater for. PAs can be an effective way of providing accessible care with the emphasis of can be.

I am a specialty trainee in Anaesthesia and intensive care. I have worked with multiple PAs doing very specialist tasks in the last ten years over several trusts eg. providing regional blocks for orthopaedic surgery, acting as support on very busy intensive care units and as assistants to surgeons. except for one case, they have all been exemplary.

Just one speciality.

@therealcookiemonster I was almost killed by a PA. Prescribed me pencilin, no idea who signed the prescription as I thought I was seeing a doctor (he claimed to be a physician). It was only because I happen to know our local pharmacist as a friend that I didn't take it. I'm allergic and would be dead. And I didn't spot the name as wasn't one I'd seen before.

GP was v apologetic. PA couldn't give a shiny shit when challenged.

@therealcookiemonster ratios to get into training this year up to 25:1. All over 4:1, which even taking into account multiple applications means many F2s looking at unemployment in August. Many many doctors stuck in bottlenecks of trying as no jobs. We DO have enough doctors but there are not tonight jobs.

@mumsneedwine btw have you worked much with PAs yourself?

we really absolutely do not have enough doctors. it's a struggle every single day to have enough staff around to provide a safe service. we are often having to pay consultants to do junior doctor jobs and there are only so many hours that existing staff can or will do.

PAs can be a very helpful addition. however the government is trying to use them to cover up the chronic and worsening lack of medical staff is a massive mistake. they also need to be regulated and their scope limited. I have worked with multiple, very competent PAs who do highly specialised tasks and are invaluable members of the team. I have also worked with a couple who needed improvement or were in over their heads.

@Destiny123 😊

I'm a reg (trainee) myself

@therealcookiemonster why are they doing surgery or anaesthesia at all ? We have doctors who need training but can't now get it as PAs doing it. How do you gain skills if don't get to do the basic stuff.

We have enough doctors to cover all of this !

@Destiny123 please don't train them at the expense of the doctors. Many are worried they won't be allowed in theatre if a PA is being trained instead. If they don't get practice they won't be able to get better.
Consultants were trained by their consultants, please please pay it forward to the next generation. That's all they ask.

PAs as assistants was a good idea, although doctors assistants exist. No one seems to be able to say what they bring to the team, except they don't rotate, which doctors would quite like not to have to do too.

Medical, not lethal, but that's what a few PAs have been. But the doctor has been the one hauled in front of the GMC, for not supervising closely enough. Makes no sense.

@Calamitousness PAs out earn doctors until ST6. And lots of doctors don't get there now after 8/9 years post graduation.

They are not supervised, that's the issue. They seem to want to play doctor but not do the work. If everything they does is supervised what's the point of them - a doctor could just do it themselves.

Again, we have enough doctors, but not enough jobs for the ones who are already qualified. But hey, let's take on more lethal students. 1,000 of them still waiting to find out where they are doing F1. Starting in July.

PA’s are not more expensive than doctors. Yes they earn more than junior roles but their rate doesn’t increase with experience. I agree with being non prescribers it devalues their role. I much prefer ANP’s for more experience, can prescribe, order imaging etc. PA’s are good for tasks I think, but yes everyone training wants to compete for procedures. It’s a tricky one. We definitely haven’t got the model right yet.

Think that's optimistic (I'm a obs anaesthetist) and I've seen PA students on 2 labour wards

But yeah not seen any qualified ones yet. But sure it's a matter of time

PAs doing Anaesthesia or surgery only do elective cases and are always supervised.

they won't be involved in ELCS.