Physician Associate - have you come across this yet?

[ConversingWithStrangers]

On Wednesday I had an appointment at the doctors due to finding a lump on my breast. However, once in the consulting room the woman I was being seen by explained that she was a Physician Associate.

I haven't come across this before and I'm curious about what people in health care think about this. (I'm in education and wondering if it's the same kind of move as HLTAs in teaching or PCSOs in policing etc.). Curious especially about how nurses feel about it, as that seems to be the area of biggest crossover.

(I was very happy with her consultation btw. She checked my breasts and referred me to the breast clinic. Only thing that felt a bit off/unexpected was that she used the word "arseholes" at one point).

As a nurse I’m not happy that you’ve got someone on a lower wage doing doctor jobs. It’s like the HCA’s doing, what was, midwives/nurses tasks. It it’s how they reduce costs in the NHS, while they waste money in other areas.
As an aside, I’ve been seen by a paramedic at the GP surgery, another cost cutting exercise. But he had to go and ask the GP anyway, so no saving there.

Lots of threads on here about it .
Imo it makes sense to use PAs where you'd be referred on to a specialist for the next stage anyway (ie cancer pathway)
Lots of GP appointment actually don't require a GP and I suppose they can't afford enough of them.

Incidentally in 2021 I was dismissed by a GP who was very sure of himself but then made another appointment, was referred on the 2 wk pathway by a PA and got my cancer diagnosis. I think if anything they're going to be more cautious than GPs

They've been around for ages.
She shouldn't have used that language.

Above all else these things need to be up front. I had a phone consultation with a PA and only knew what she was when I realised she was giving bad advice (an unsuitable drug) - and then I asked.

Throwing half-trained people into the mix is not the solution - proper training of lots of doctors with proper support to work within the NHS and make their own decisions is what is needed. I'm not holding my breath.

There is a lot of pushback against PA's from doctors. They are often being used inappropriately and unsafely, and with no transparency to patients who are expecting to see someone with 6+ years medical training.

i’m kind of hoping they will find a place- I know PSCO’s were/are mocked but having worked with a couple they are an amazing resource. They aren’t “police lite”, it’s a different job and has developed into an invaluable asset.

i have heard that PA’s used correctly can be fab- getting a thorough history, taking the time to listen, then referral on to the correct pathway. Takes all the appt’s off GP’s and NP’s that simply need an oh yes, you need a referral to x dept”

history taking is a skill and most appointments don’t allow the time. if PA’s are doing that and feeding back it will save so much time and money, get quicker diagnoses, and most of all patients will feel heard, so it may get some of the repeat offenders dealt with.

i am happy to see whoever initially, our surgery I’ve not seen a GP, only NP’s. They take the history and refer on /prescribe as necessary, which tbh most of the time is all that’s needed.

Lots of threads on here about it

I've been completely oblivious :( I don't really have much engagement with the healthcare system.

Whatever their place may be it's not general practice. You want somebody with more than two years training on top of a science degree to pick up things that are really truly wrong and react. People are not coming into a GP's surgery in a filtered way. PAs simply don't have the breadth of knowledge of a doctor or, for that matter, a nurse. They were originally meant to up doctors by doing paperwork - not to be out there in the healthcare trenches diagnosing and triaging with two years of training. PAs can't prescribe or order x-rays themselves which is I suppose some kind of blessing.

I have mixed opinions. I work in primary care with GPs, nurses, PAs, NAs, HCAs, GPAs, pharmacists, physios and MH nurses.

I firmly believe that not everything we deal with needs a GP and there are many things we’re presented with that can be dealt with effectively and efficiently by a non GP role. However I fear that there is a dumbing down trickle effect of skills, knowledge and experience. Managers are trying to insert lesser qualified professionals to deal with things that IME are best done by more qualified personnel.

As a very experienced prescribing nurse practitioner I am pushing back hard against the drive to move a lot of my work to Nursing Associates and HCAs. It’s the fault of non clinical managers seeing so much of what we do as a box ticking exercise and not quality heath care.

I think if anything they're going to be more cautious than GPs

Unfortunately there are plenty of stories where that has not been the case, and the PA has not known what they don’t know, and make reckless decisions as a result.

This one apparently hadn’t heard of DVTs/PEs, with fatal results.

am struggling to think of a context in which the word 'arseholes' would be appropriate in a consultation about a breast lump! If that's the sort of language they think is appropriate in front of a patient I'd imagine they won't be around for long!

It seems to me that it's just another way of fobbing us off.

Im sorry if that sounds disrespectful to PAs, it is not intended as a criticism of them as individuals, more of the whole system that has made it almost impossible to see an actual doctor.

Im a nurse, I've never come across one.

Actually they are not qualified / allowed to prescribe. What will actually happen is that they go and speak to a doctor who takes time to hear your story second hand and then writes the prescription if they agree. If not you are asked to come and see the doctor. It’s not effective to be seen by someone who can’t prescribe .
Ot they write a referral to secondary care missing out key details so that it get bounced back for more information .

I have no problem with PAs being used for work that classically ward based, foundation doctors would do. So taking bloods, putting in cannulas, writing discharge summaries, updating families etc. Great use of them.

I think anything beyond this shouldn’t be allowed. I think PAs seeing undifferentiated patients in GP practices has the potential to be dangerous.

I think they are a cheaper option to doctors and that’s why they are being pushed so much. I’ve worked with some lovely PAs and it’s absolutely not a criticism of them personally or professionally. But the role is scarily undefined and unregulated at the moment.

A GP will have done 5-6 years at medical school and 2 years foundation training and 3 years GP vocational training scheme .
A PA has trained for 2 years. You simply do not get the same training, exposure and broad clinical experience in 2 years which is needed to develop effective communication history taking skills and knowledge.
PAs are a cut price solution that does not deliver value for money or good care for patients .

Apart from some of the latest gmc/mpts rulings that have basically said that as a supervising clinician, unless you repeat/confirm everything the PA has done, you're liable for any mistakes... So it saves no time at all.

PAs are paid more per hour and have better working conditions than junior doctors. The average starting salary for a PA is the same as the basic salary for a junior doctor in their third year after qualifying 🙄

I was surprised, pleasantly, at how much they are on (band 7).

They were originally meant to up doctors by doing paperwork - not to be out there in the healthcare trenches diagnosing and triaging with two years of training.

Very similar to TAs - initially meant to relieve teachers of non-specialist work but eventually used as teachers on the cheap.

I have no problem with PAs being used for work that classically ward based, foundation doctors would do. So taking bloods, putting in cannulas, writing discharge summaries, updating families etc. Great use of them.

Forgive my ignorance, but is this not what nurses do?

It's a shame the NHS cannot be redesigned from scratch. Is there anyone writing on this theme? (Edit - from a left wing / socialist perspective).

@DustyLee123 in your example it would be more like an HCA with less training and experience, being paid more than you as a nurse. PAs on 2 years training are paid more than a junior doctor after 7 years of training.

PAs don't even save money, the jobs they are actually useful for don't merit Band 7 pay and there are 1000s of GPs out of work as the NHS is currently funding PAs in preference.

Forgive my ignorance, but is this not what nurses do?

Depends. Some nurses can cannulate and bleed, some can’t. Most won’t write discharge summaries. Nurses will update families but often a ‘medical’ update is required as well.

Foundation doctors can and will review patients on their own, request tests and prescribe. This should be in a controlled manner, ie if there is any issues there will be a senior on hand to help. There is a lot of concern about PAs undertaking these more ‘complex’ tasks amongst medics.

PA role worries me. I’m
an ANP in paediatric intensive care. I have 30 years experience and a myriad of extra qualifications plus a masters/prescibing qualification. BUT I am well aware of my limitations in comparison to my medical colleagues and work alongside them rather than in place of them. I am very restricted (rightly) in what I am allowed to do and we are heavily regulated in our profession. PAs seem frightening ly unrestricted and do not have the experience to know what they do not know

We had one on the ward I worked on. He would prance about the place, speaking to nurses like shit and demanding we carry out XYZ but didn’t actually have the power to request any of the things he wanted, so we would have to approach a real doctor to place the order (prescribing, ordering scans etc). They gave him his own caseload of patients that he couldn’t actually do anything for, so it was an utterly pointless role.

I will only see a GP or NP when I attend my surgery, I have declined to see any PAs because they usually don’t have the breadth or depth of knowledge or experience required, and care might be delayed as they need to ask someone else to action anything that might be required. It’s a cheap role that isn’t actually cost-effective as it creates more work for everyone else.

We have two at our surgery. I saw one last year for unresponsive hypertension. She must have gone out of the room to check something with a doctor 4 or 5 times, while I was glad she did check it made her role a bit pointless.
I also saw a Paramedic for some bloods a while back, turned out he wasn't keen on blood (maybe why he was not a frontline Paramedic) but his friend, HCA Chloe did bloods for him. Unfortunately Chloe had popped to the CO-OP, think she may have been doing a big shop as I ended up with an hour long appointment.