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

Not that it's totally relevant to this thread, but those checks are the same as the ones carried out at birth, which can be performed by newly qualified midwives straight out of uni. Yes they're important but they don't need 10+ years of experience.

I've had a number of aesthetics and I've never come across this

I had an ELCS (was breach baby and they wouldn't allow a vaginal delivery) by a junior doctor with only 2 years experience - is this what you mean by a PA?

Anyway they completely messed up, nearly had to have a hysterectomy and left me long term damage.

I am a programme director for GP training. I can assure you it isn’t.

I hate to tell you but GP training is usually:
See one.
Do one.
Teach one.

I agree they are different. But still similar in that they work in middle grade medical roles without medical training which is what is being discussed. Yes regulated but only so far as every nurse is regulated. The GMC are going to regulate PA’s so that’s coming, but NMC have still to update regulation for ANP’s appropriately in my opinion. It leaves ANP’s vulnerable, education is not standardised etc. nor is remit or responsibility adequately acknowledged for individual roles. I would rather have care from ANP in some situations than medic and preferable to PA but would I refuse care which is the statement. Not on NHS no. I don’t think the OP can either. She would need to get care privately and even then it’s not assured that no additional roles would be used

I was told a PA might give the anaesthetic for my operation. Would I let his person anaesthetise my dog ? No, so I cancelled. Costing me ££££ to go private.

I think you have to be aware of how toxic the debate currently is at the moment so you will be seeing the worst stories to make a point/ very rarely will you be hearing the positive stories about care given by PAs. That’s not to say I don’t disagree with some of the concerns raised but it must be pretty terrible to be a PA at the moment.

For what it’s worth I said no to students doing stitches in my birth plan. I ended up with the most lovely student midwife who stayed past the end of the shift to see the birth. She was kind, professional and an amazing support to me. She ended up doing my episiotomy and possibly some stitches under the supervision of the dr. Not something I’d have imagined consenting to pre-birth plan but she was great.

No I wasn’t and I’m sure you aren’t.

But you have no idea how capable she is of listening to a newborn heartbeat and understanding the nuances of the clinical exam. And she didn’t have the minimum ten year training that a GP doing it would have had. I know where I would place my trust.

You can’t know someone’s competence from just watching them as a bystander and the more complex the task the harder it is to judge. So we have to go on their training and the rigour of the exams and assessments they undertake to get into their role.

Six week checks might appear really quite straightforward and about having warm hands and a nice smile. They are actually much more complex, difficult and important and I would not let a PA loose on my newborn to sign them off. You can obviously do otherwise.

Because i am not stupid and you weren’t there. There were also questions she wasn’t sure of so called in the GP when needed.

I’m skeptical about where this information is coming from that unqualified health workers are being used to preform cesarian sections???? 🤯

I'd be more afraid of a nursing associate to be honest. No degree, huge gaps in training and experience, but NHS management is increasingly putting them in charge of wards. We've gone from Matrons/Sisters, to Staff Nurses and now glorified Clinical Support Workers.

There have always been non-doctors in support roles eg operating department practitioners are universal.

www.healthcareers.nhs.uk/explore-roles/allied-health-professionals/roles-allied-health-professions/operating-department-practitioner#

If you needed a section than it is very likely that you would not benefit from excluding them.

Pay privately then. If you go NHS, you get NHS.

ANPs are entirely different to PAs in training, experience and critically in their assessment of their own competence and regulations to practice.

How do you know she was?

She may have been polite and appeared thorough with the exam but you don’t actually know in reality that she was capable of performing what is actually a very important screening exam for abnormalities.

Don't be ridiculous. The patient has a right to choose where they receive treatment and to request a change in the person treating them if they are not happy with the treatment they are receiving. It is literally a protected patient right in the NHS guidelines. Also NHS treatment is not free, we pay for it with our taxes and deserve to be treated with dignity, respect and receive safe care provided by competent people. You can't just got around saying "stop moaning it's free" to everyone who has received sub par and dangerous care.

PA role has existed for more than ten years. Leeds uni started the post grad.
agree though that that’s plenty of time to get a regulatory body.

Junior docs start on less money and worse terms. Not surprised there’s tension.

YABU. If you don’t want NHS treatment then pay privately. We don’t get to pick and choose.

The face of healthcare is changing and there are surgical first assistants that are not doctors. Anaesthetic assistants are relatively new but will probably be coming. They are still overseen By consultant. In most other healthcare systems these roles all exist. Med Twitter is foul just now and highly unprofessional. There is one junior doctor who is particularly stirring up bile and fury and is not entirely accurate in her rhetoric. There does need to be registration of all HCP’s and how that is enforced needs to be clear. That should have been in place before they came to post. That was a mistake. ANP’s are a good model and have been in place in all critical cares adult/paeds/neonates for a large no. Of years now and it’s a care model that has spread through all acute and primary care well. Would I refuse a PA, no. Probably not. If they are the person on shift to provide the care I need then I am not going to refuse that care. If I asked for someone else I don’t know what that would look like. They are not going to bring a consultant in from home for a non clinical reason of my preference. And another provider is not going to offer care for someone not in their service. Any surgery would still be overseen and led by consultant.

Isn't that the same for junior doctors though?

I've been through the system twice in the last couple of years and had two quite extraordinary experiences with junior doctors who clearly didn't have a clue what they were doing.

I'm clinical NHS so have a vague idea myself how it all works.

Why would it be unreasonable for someone with 2 years training, no medical qualification, to be involved in surgical and anaesthetic procedures?

Are you really asking that?!

It can be from nursing too. Nurses were the first to go into PA courses.

Not true. It may have been in the past but there has been an explosion of courses and people accepted with all kinds of degree. Even science might be zoology or nutrition. The course is two years and the exams are multiple choice with a 100% pass rate. That says it all.

@BPquestion I too follow Med Twitter and it's quite worrying that some of those dimwitted insta PAs might be let loose on patients. Anasthestic Associates seem to be the most risky. The training to be an anaesthetist takes at least 15 years, they are the ones keeping you alive in surgery.
I would note the consent form as you suggest.