Should we specifically be asking to be seen by a GP when booking a GP appointment ?

[Gigihadr]

https://hansard.parliament.uk/commons/2023-07-06/debates/D98F2ABE-7B33-4748-B88E-ED7243469131/PhysicianAssociates

poor girl died after being seen by a physician associate and at no point during the appointment at the GP surgery was Emily made aware that the person who had diagnosed her was not a doctor. So sad ☹️

I don't mind seeing nurses or paramedics, at my practice if there is something they aren't sure about they check it with the duty doctor who comes and examines you. If appropriate safeguards are in place then there's no need to always see a GP for every ailment.

So I’m a new registrar. Some of them their base pay is the same as mine, I’ve finished royal college membership exams and been a doctor for 5 years. I get paid more overall as I work more hours than they do (I work more than full time). They’re paid substantially more than the FY1 (new doctor who get £14/hour).

Registrar base pay is the same as band 7, it’s much lower than people think.

ANPs I think also need a defined scope of practice. They’re not doctors. But as a doctor I prefer working with ANPs, most are excellent colleagues and unlike PAs they have extensive period experience of being a nurse/paramedic/physio etc. ANPs also do their own prescribing whereas PAs ask a doctor. It’s very stressful feeling like your registration is on the line prescribing for someone else who can’t prescribe such as a PA.

I’d be ok seeing ANP, they’re good clinicians.

This is really sad, though sadly the outcome may have not been different if she’d seen a gp. My Dd saw a gp and was also sent home twice from a&e when she went with chest pain and breathlessness over a period of a few weeks. Turns out she had PEs. But all the doctors she saw said it was anxiety

Can I ask a very basic and possibly obvious question (as I too hadn't heard of physician associates until reading this tragic and avoidable case) - presumably physician associates absolutely do not have the title Dr? - so if you make an appointment at your GP surgery and your appointment is with Dr Bloggs, then at least you know you are seeing an actual qualified GP?

Ask the ICU doctors you work with how easy it is to get an anaesthetic reg post. The posts are limited by the government. Plenty of people want to train to become consultants but can’t. Google the competition ratios.

But this case, from the description in the debate was clear cut. To not check the valves for a DVT is inexcusable. This was a presentation a medical student would have recognised, this was an entirely preventable death.

*calves not valves! My bad

Yes they’re not doctors. But last person I saw in GP didn’t introduce themselves at all. That’s the issue. And online system didn’t tell me their name. But they won’t have Dr before their name.

@Lemonyfuckit as a doctor at work (hospital based) introduce myself by my first name to patients. I don’t say Dr Surname, maybe I should who knows we all should.

It seems any chest pain/shortness of breath is being put down to anxiety these days. I have a condition which is been over 4 years now and the amount of doctors I saw ( both during hospital admissions and at the GP surgery) who told me it was down to anxiety is absolutely shocking. I do get anxiety but it's never caused me this specific breathing difficulty, which is controlled with steroids now. It's shocking how dismissive they all were, while I sat there as a fat autistic person trying to get them to 'believe' me. It was horrendous. That's at the hands of qualified doctors, god knows what a PA would have made if it. I had to fight my way to medication, they didn't want to listen.

We're quickly getting a two tier system- those with private cover get to see doctors, the plebs get a "practitioner".

In theory, "practitioners" working with doctors make sense. The practice though? It's destroying our health service, and our health. If you want a doctor, you'll have to go private. It's already happened with mental illness- whole teams are staffed by practitioners. If you want to see a psychiatrist, you have to go private.

Seen as it's illegal to impersonate a doctor then yes, it should be made abundantly clear when booking an appointment whether you will be seen by a GP, a PA or a nurse; my surgery are very clear on this when you book and at the start of any appointment. It's tragic as her symptoms were massive red flags, absolutely text book symptoms for this. Whilst GPs aren't perfect and do miss things, the chances of a PA doing so are so much higher, its scary. This is the government's plan though, fill the gaps with lesser qualified and lesser knowledgeable people and hope no one notices. PAs also aren't regulated which is very worrying.

I agree this is a big issue. I have anxiety but when I presented with shortness of breath thankfully my GP said although it could be related to that I want to rule everything else out- I had blood taken, a chest X Ray booked and was prescribed an inhaler to help manage it. They all came back clear and the inhaler didn't really help, getting a grip of my anxiety with new meds and a referral to counselling did help but I'm so thankful they didn't just assume as it would have caused even more stress and this is how serious stuff is missed. Such a shame this isn't standard.

This is quite shocking.

I am an independent prescribing pharmacist. A mock of this very scenario (DVT leading to a PE) was in my prescribing OSCE exam and if you missed it you failed outright (I didn't miss it!!). I am very concerned it was missed on two occasions by a healthcare professional.

I also always introduce myself as a pharmacist and clearly explain my role. To do otherwise is disengenous and does not give the patient an informed choice.

There is so much scope for healthcare professionals other than GPs to contribute to patient care, in some cases a specialist nurse, physio, pharmacist etc may even be more appropriate. But it should always be transparent to the patient and they should have the right to say no.

Do people know a Physician’s Associate is not a doctor? Recently, my friend went to A+E with her relative.

The 1st member of staff said she was “like a doctor” 2nd said he was “better than a doctor” and a 3rd claimed to be “the most senior person there”.

None were doctors.

Dangerous in my opinion.

This is not clear as to who your friend was seen by. It could have been a consultant

Most hospitals make staff wear lanyards with their job description on. Perhaps your friend needs to put a complaint into PALS with this as a suggestion.

I have been reading more into this case and am shocked to learn that at present PAs do not have a regulatory body.

The GMC is looking into it but it won't be in practice until the second half of 2024.

I assume the duty GP takes responsibility for them in the meantime.

YABU

Simply because there isnt any GPs anymore.

The older ones are retiring. The younger ones emigrating.

The only reason, ANP's, paramedics, and physician associates are being employed is because there arent any GPs left. Mainly because if the poor working conditions.

So if you insist only being seen by a GP, then you should be prepared to not be seen, when you're told there isnt any appointments available with a GP.

Or perhaps people shouldn't introduce themselves to sound purposefully like a doctor? It's very misleading.

Complain then and prevent it happening again.

A properly qualified practice nurse would probably have picked this up. From that report the diagnosis was absolutely obvious.
I have had good care from a PA in a specialist hospital, but it was a routine procedure, she did the same procedure all day every day and was competent. No diagnosing involved.
I ran a community based service for years; we were a very experienced, highly qualified team. They got rid of us to save money and employed unqualified, untrained people. Goodness knows how it worked out for the poor patients.

Well that's a sweeping statement and one that insults many excellent hard working GPs 🙄

I'm a (non-doctor but prescribing) HCP too and the switch away from seeing doctors is awful. This is a much more minor example but I needed a repeat prescription of the pill. Very friendly receptionist booked me in for the following week. It was only because I asked if it was a doctor or nurse I was seeing that she said actually it was the HCSW. I asked if I'd get the prescription that day - no I had to go back and collect it two days later! Not only is this totally inconvenient if you work FT, but I then had to move my appointment forward as I'd have run out. Had I not specifically asked who I was seeing I'd have potentially been left with no medication. I mean, I'm sure they'd have rushed it through for me but the point stands that the communication around who you're seeing is terrible.

Totally tragic case being linked to. I'd expect prosecution if I made that level of error.