All the doctors I know are leaving. Are we going to be screwed for healthcare in 5 years time ?

[Gigihadr]

Our NHS now has some of the worst health outcomes out of 19 wealthy nations compared in an international study.
But in 2010 the NHS regularly ranked 1st or 2nd in most international studies.

The UK is under-doctored, we have a 3rd fewer doctors per 1000 people than Germany or Spain

Our government response to the doctors we have left has been to erode working conditions and pay, ensure they have record levels of inflation and rocketing student debt

They are moving to better paid, better resourced systems/employers (they are a competitive international commodity) and I can’t blame them for that.

AIBU to think we are utterly screwed? why are we just sitting back and watching this slow motion car crash ?

Sorry, was agreeing with you, but also think we ought to stop qualifying criticism of PAs with "but they're intelligent/competent/I know a nice one" etc. to soften the blow.

PAs say basic ward work (discharge letters, cannulas etc) is boring. The junior doctor rotates every 4 month and has no say on where they work. Consultant does not care about junior doctor as they’ll get a new one in a few months but wants to retain the PA.

PA gets to do procedures with consultant and go to clinic. Junior doctor is on call at 3am on a Sunday looking after sick patient but can’t do that chest drain because they’ve not been taught as the consultant has trained the PA (who works 9-5) to do it instead. PA can be trained in niche area but does not have depth and breadth of knowledge to cope with complications or patients with multiple co-morbidities.

PA wants to be equivalent to reg on the ward but because they’ve not done exams and out of hours shifts etc when a patient acutely deteriorates on the ward they cannot manage it without help from the doctor.

We’re becoming woefully undertrained registrars because associate professions are taking training opportunities and they are able to do this as permanent staff. I’ll be rotating until I’m 40.

Our population has risen by 5 million since 2010 that’s an 8% increase.
has everything else increased by 8% - doctors, train service, schools etcetc

no the opposite

I find physician associates to be a bizarre concept. And legally, they don't have the same standing as a doctor - they should always be "supervised" by a consultant or GP. So why would any doctor want to be stuck supervising/babysitting all decisions made by a PA, knowing that if the PA does something wrong it's the consultant/GP who will get it in the neck as a negligence claim against them. Doctors accept that they are responsible for supervising and training up their next generation of medical students and junior doctors, but that is for the wider purpose of ensuring there will be more well-trained professionals in the future. Supervising a PA, paid much more than a junior doctor, seems a thankless task.

So instead of loling and posting 😂when quoting someone's post, why don't you tell us something about PAs and ANPs?
I've asked about PAs because I now live in another country and don't know what their role is.
Totally unhelpful to LOL at people without contributing.

Lots of ANP bashing on this thread and comparing them to PAs…they are totally and utterly different roles.

ANPs are not being used to ‘replace’ doctors either, they are upskilled and highly trained nurses. I’ll be doing my ANP course in a year or so and it’s not so I can pretend to be a doctor (if I had wanted to be a doctor, I would have applied to medical school!)

Modern nursing and its career development opportunities offers so much more than just playing handmaiden to a doctor, which is what a lot of people seem to think nurses should be limited to.

I’ve never worked with a PA that I’ve thought highly of, though. We had one on a ward I worked on and nobody knew quite what his job role was including him as he couldn’t (or wouldn’t) do anything he was asked to do.

Yes. My parents grew up during World War Two - pre NHS. We're going back there. I'd start researching medicinal plants and folk medicine if I were you. Unless, of course, you're going to be in a position to afford insurance premiums for those shiny new health companies that are about to make our MPs even wealthier.

Can you define what an "upskilled nurse" is and what their role is?

We don’t really have PAs in maternity but I always assumed that the NHS like them as a concept because they can’t leave as not internationally recognised? Really short sighted though if so.

Would have thought you already knew the answer to that seeing as you are the one who posted a load of twaddle about ANPs, yet you don’t actually know what they are or what their role is? Interesting

I'm interested to see what your definition is, as apparently I'm wrong that the ANP role is designed to imitate doctors.

I’m not sure anyone is facing the issue with an NHS type model though. The NHS started when things were quite different.

I’m not sure how it will deal with such an increase with the elderly, with complex health needs.

I saw recent maps/calculations that suggested Germany and Spain and especially Italy had worse aging populations.

So while aging is one issue there must be many more - underinvestment going back decades and probably many more.

The more my older family members have to do with the NHS more critical they become - glaring inefficiencies and increasingly brunt out uncaring staff - but I don't think they want private costs at their point in life with their fixed incomes and limited savings.

I think it will be an uphill battle to improve things and problems will probably outlast next government.

An ANP will have had significant post-graduate training in their field of practice including a Masters, most ANPs are non-medical prescribers (the clue is in the name, non-medical), are experts in their field (nursing, not medicine) and are usually the clinical lead (of the nursing team) for their area. An ANP is a specialist nurse, not an ‘imitation doctor’. HTH

What does an expert nurse do? Can you give examples of some things they're specialists in?

Because prescribing is something that doctors do, not nurses.

PAs have masters degrees, but you seem to think it's inappropriate for them to be managing patients in spite of that?

I’ve worked with and also been treated by some amazing ANPs. Their knowledge was amazing. If I had a sick newborn needing resus and an ANNP was with me I was much happier than if it was an SHO or even some registrars.

There are ANPs for every possible area of nursing you can think of. Palliative ANP, emergency care ANP, sexual health ANP, the list is endless.

Shit, I’ll tell our ANP she mustn’t use her prescribing qualification anymore because you said she can’t as she’s not a doctor 🥴 of course nurse prescribers can prescribe 😂

Also I never said that, I said I have never worked with one I have thought highly of. You have a very vivid imagination, though, good job. ⭐️

Eh? Screwed in 5 years time? Em where have you been for the last few years already, OP!

YABU to have only just realised!🙄

You may be right about Italy, Spain etc but I wonder how much we feel it more due to cultural differences wrt looking after family

They can prescribe within their narrow scope, but they cannot prescribe in the same way a doctor can and nor should they. They were introduced to address a shortfall of staff who could carry out certain tasks rather than actually being a core part of nursing- as with other roles it's been expanded upwards. It's another role which whilst many do work within their scope of practice is poorly defined in many areas and even the NMC doesn't record someone's ANP status which leads to issues. Broadly the NHS plan for the future is to keep pushing these roles to reduce costs rather than to continue to invest in doctors, patients will not benefit.

You may be right about Italy, Spain etc but I wonder how much we feel it more due to cultural differences wrt looking after family

It's possible.

We are nowhere near our parents due to work and housing costs and I think UK has high numbers for working mothers - I've heard male conservative politicians opine that families need to do more for their older frail family members but as parenthood is push back to older ages and more end up with work child rising and elder care all at once.

Yes, that’s why I’ve quite clearly outlined that an ANP is a specialist nurse within their field of practice. A respiratory ANP would have no business prescribing for a gynae patient, for example.

However, if faced with a scenario where I needed care and the two staff on duty (heaven forbid) were an ANP whose specialist area of practice covered the issue I presented with or an FY2 who has been rotating around every 4 months and had only come across the condition once or twice, I would hope to see the specialist regardless of their job role.

People seem to really resent that nurses are progressing past making beds and handing out pills.

If people bear in mind that alternatives to state funded health treatment would cost average families about £20k a year for insurance for very basic services, they may be more careful about how they use the NHS and reconsider how much they're prepared to pay for healthcare. That combined with a political preference to kill off the NHS by prolonged resource starvation will probably mean we will have to pay for treatment in future, or do without. If you think things are bad now, unless we acknowledge and address both pay and patient funding, it will inevitably result in an exodus of staff along with reduced services through AI/robots and narrowly trained care staff. You can't expect a doctor to do a difficult and highly trained job for half what they would be paid elsewhere, because you wouldn't be stupid enough to so that yourself.

I was just thinking about this today after I
finally managed to get a GP appointment.
For interest I thought I’d check the Practice website. 2 more GPs seem to have left recently. Both younger. My Surgery used to have 5 GPs who had been there for years. Now I don’t know any of them, and there are many locums.

Yes and it is a major reason why I’m emigrating. Not just that as there is so much about this country that is broken I’m not sure it can be fixed and I’m sick of paying a fucking fortune in tax and quite frankly not getting back what we put in.