To expect to be examined and diagnosed by an actual nurse or doctor?

[Cravela]

Stomach pain came on suddenly and worsened over 24 hrs. Telephone appt with GP who advised hospital and sent me to the surgical assessment unit. So far so good

Staff member arrives in scrubs and takes all my details and then starts examining me. Tells me the plan (CT scan) and that she will give pain killers in the meantime.

Noticed she wasn’t wearing a lanyard/badge so I asked her her name Dr?. She says oh I’m not a doctor, ok so you’re a nurse? (No issues with that always choose to see an advance nurse practitioner when I go to the GP and I have a friend who is a consultant nurse). No she says she’s not a nurse. I was getting quite frustrated at this point because she was clearly avoiding just telling me her job role. So I straight out said can you tell me your job role please. She said she was a “physicians associate”.

I’ve never heard of one before so I googled after she left and literally anyone can be one after a 2 year course. They don’t come under the GMC or the nurses governing body and aren’t able to prescribe medicine or diagnose people??

I asked the nurse in charge if I could see a doctor or a surgical nurse and they came 10 mins later. Doctor was quite apologetic and re-examined me.

AIBU to think if you aren’t a doctor or a nurse you should tell people that before you put your hands on them??

Also who is she?

OP has gallstones 🤔

I think the pushback was also from nurses. As I understand things nurses in the US don't or didn't do a lot of things UK nurses do so PA's were something of a hybrid.

So a nurse in the US did not do sutures, doctors did and then PAs did as well, but it would be unusual to find a nurse in the UK who has never sutured a patient.

They currently regulated by the Healthvand Care Professionals Council

@BabyBin "She" is perfectly obvious and using it as a pronoun linked to the F1 is entirely correct usage in text. I absolutely will not be grateful for sub-optimal care delivered in a less than respectful manner. If, as an HCP, you think that's something to be grateful for and far worse happens, the NHS needs to cease immediately.

We have a home in France and I can assure you the French system is a zillion times better than here and the poor have a safety net to ensure access.

But they get paid more than the doctor who orders their scan and prescribes for them 🤨 and work less hours too

How is this possible?

As others have pointed out they are highly trained and regulated! (I'm not a PA, but I have heard of them.) I'm astonished at your insistence that you see an 'actual nurse'. Our local uni offers the nursing course with a foundation year - entry requirements - no GCSEs necessary and no prior experience needed . .

most years there are newly qualified medics with no job. No point the Gov funding another 1000 med school places if that leads in five years time to 1000 unemployed medicine grads

Why are we seeing so many GPs, nurses, etc coming from abroad then? I don't see the rationale here and it's unlikely that there are so many UK unemployed medicine grads

YANBU OP and I would have asked to see a doctor also in your situation

I'm not confusing GCSEs with A Levels before anyone asks, no A Levels required, no GCSEs either, that's basic numeracy and literacy, I was quite shocked - it seems like an awful lot to condense into a year!

The staff shortage in NHS for many sorts of clinical staff is severe.

The greater creep is that of the HCA and the nurse. The former always wearing a dress that looks like a nurses' uniform and never ever a badge for clarity. There needs to be absolute clarity over who us who in hospitals. It's extraordinary really bearing in mind the hierarchical nature where the consultant is too often still revered with Dr's not far behind, even F1s with the patient bringing up the rear as little more than pond life and spoken to as sh1t.

I am an NHS GP and I would not mind being examined by nurse, FY1, PA, ANP or any other professional when attending the hospital.

No nurses ever had to ‘stand up to me’ because I am not a dick so far up my own arse I need an enema to get back down from it.

Any Dr I seen this attitude with I distanced myself from though; and now my two best friends are nurses so do the maths 😂

I cannot be arsed with any of the politics or hierearchies. Nurses have commented that they have never met a doctor like me because I change my own clinical orange bins and also when I was free as a junior doctor (many years ago mind you when there was free moments) I would help the HCA change the sheets / do tea rounds. I also did not go onto a power trip when I became a SpR. I do not think it is a coincedence I got further in my medical career than them far quicker - maybe NHS karma.

Yanbu op in the sense that the NHS definitely struggles with role creep - these types of professions are often introduced with a relatively limited or specific scope, but then the constant desire to cost cut means more and more activities previously carried out by doctors get transferred to lower paid staff with poorer academic capability. At the end of the day it's a lower paid role for a reason.

I suspect what it will lead to, is that the more basic tasks carried out by junior doctors that will have contributed to their clinical experience, get shifted to PAs, junior doctors get forced to do more stuff currently done by more experienced higher paid doctors, and over time it will lead to fewer senior doctor roles.

Lots of mis-information and poor attitudes on this thread, particularly from my NHS colleagues I’m sorry to say. It’s entirely depressing to read.

PA’s have a managed voluntary register and are overseen by the Royal College of Physicians pending professional registration, which may come under the GMC. There is a competency framework document outlining their scope of practice. They receive two years of intense clinics training on the background of a bioscience degree so they are not at all untrained, or “wannabe doctors”.

As with any new role in the NHS there is massive resistance to change and concerns regarding role creep and overlap, which is to be expected and depends on the service and department in question.

PA’s are an absolute godsend in primary care which is facing its biggest crisis since the NHS was formed. I work and have worked with countless skilled and competent PA’s who have become invaluable in their area of work. As with any role there will be those who aren’t, but again this shouldn’t be to the detriment of the entire profession.

Give PA’s a chance and stop being so snobbish about traditional hierarchical healthcare roles. The NHS is changing and we need to adapt or die.

And @Pyewhacket - brushing off PA’s as tea-makers and store cupboard checkers …. you sound like an absolute joy to work with. What a revolting attitude towards any member of the MDT.

I'm a part time HCA, leaving to start uni in September (not nursing!) I don't wear the same uniform as a nurse and I don't know any HCA that would, I always wear my name/ID badge, tell patients my job title (I tend to say healthcare assistant rather than haach-see-aaaaay) and work well within the scope of my training and role. No patient has ever had a problem seeing me to be fair. The NHS is on its knees, patients are honestly happy to have a friendly face, someone kind, who chats to them about the weather for a few minutes and who doesn't hurt them taking blood.

In my experience it's often other staff members who are deeply insecure about their own role or lives outside of work who make snarky comments about being 'just an HCA'. That's almost understandable if you're a rocket scientist, brain surgeon, splitting the atom or sequencing the human genome. Coming from a nurse though, I tend to just smile in sympathy.

Sorry that comment was directed at @RosesAndHellebores

Totally agree. Bring the PAs in. So much snobbery and hierarchy.

People coming from abroad is the reason post-graduation doctors don't get jobs, because the system ranks everyone the same and doesn't prioritise UK graduates. Every year more jobs have to be created in dire corners of the UK just to have somewhere to send the rest of the UK doctors.

Imagine spending 5-6 years and £80k in loans working your arse off only to be told that you haven't got a job, having to sit around and wait for someone to create a vacancy, because the government won't prioritise its own graduates.

The absence of doctors is deliberate. There are heart and brain surgeons who will likely never become consultants because there aren't enough posts. But the NHS could easily create more consultant and registrar posts. Instead it hires from abroad and creates pseudo-doctors on the cheap.

I work with many fantastic IMGs. But our own newly qualified doctors and doctors in further training should come first, as they do in most other countries.

Well I phoned my dentist the other week because of a concern and the receptionist was able to reassure me but she said that she will check with the dentist and call back if he said otherwise.

Although 'just' a receptionist, it is a specialised dental implant place so will have had many years of answering the question I asked. I trusted her judgement and didn't demand to see the dentist.

Which country does this happen in???

hmmm
8209 FY1 places allocated, 791 newly qualified doctors were placed on wait list for FY1 places. But "everyone on the reserve list will be allocated their foundation school in April, moving into their Foundation Year 1 posts from August 2022".

How many unemployed UK-trained doctors are there who have at least 5 years experience?

@lljkk that's very interesting information. How does FY1 allocation work. I ask because our local hospital is dire - parts still require improvement after successive inspections. The FY1 I dealt with was so hopeless I couldn't help wondering if allocation was a bit like secondary school entry where the top students have choices re the best schools and those at the bottom if the pile get sent to poorly performing ones. It would certainly explain why even A&E services for not very complex things were so much better when we lived between St George's and Chelsea & Westminster, with Kingston (excellent hospital on the whole) as easy to get to.

Allocation works on rank system
score out of 100
the higher the score the more likely you are to get your first choice
most people want cities to stay close to friends from uni so higher score required for london, manchester, glasgow, edinburgh etc - some do not care what their score is as long as its high enough to want to go ‘home’ or closer to partners etc to

then you get your pick of rotation dependent on how high your score is

classically with my uni / peer group - everyone wanted London so the score shot up. I ‘got a london score’ but chose not to go to such a competitive place so had my pick of rotations in another area.

same cycle begins again for registrar / training numbers

Agreed, snobbery and ignorance.

A lot of the PA'S I work with, already have backgrounds in nursing/physio or OT.
It's awful that she didn't introduce herself properly though and appalling that she wasn't wearing a lanyard. Our Trust sends staff home if they've forgotten their lanyard, as our name badges are also smart cards that (literally) open doors and give access to the computer network.