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 ☹️

Dh saw who he thought was a dr in A and E but was in fact a trainee ANP, even though he was seriously ill. Apparently not uncommon.

Or these so called 'professionals' could be more accountable? They know what they're doing when they say what they say.

I don't understand the role of physician associate or how they are trained. I think in that scenario, I would prefer to see a nurse. That being said, I'm not sure if that outcome would have been different.

That's the purpose of a complaints process, to hold them accountable

My GP service now has telephone appointments with a physio or pharmacist. If you want to see a GP instead you have to wait one month.
I am happy with talking to other clinicians mostly, but think some things really need a face-to-face appointment and others are complex and need a doctor to diagnose or refer to a hospital specialist.
Some people here have suggested that GPs look after long term conditions but nurses, and now pharmacists, mostly look after people with asthma or diabetes etc.

I don't know much about physicians associates as we don't seem to have them in my area, however I would certainly be happy seeing a advanced practitioner instead of a GP.

Over the years I've seen some shocking mistakes by GPs who unlike PA can't claim a lack of medical education or relevant experience.

Examples that spring to mind.
Severe Congestive heart failure diagnosed and treated as chest infection.
Pregnancy diagnosed as menopause resulting in stillbirth.
Patient with SVT misdiagnosed as having pulsed VT then told by GP to sit and wait for ambulance in an empty waiting room (I guess it could have been worse and been the other way round).

All doctors and HCPs make mistakes GPs are no exception and neither are PA, tarnishing them all with the same brush is unfair and not going to help the collapsing health system and backlog of patients.

I'm a midwife and I'd have spotted the signs of a dvt. But we are always on alert for those signs as it is such a big killer of pregnant women and new mums. Any mention of SOB or calve pain and they are being reviewed by a reg.

Not quite the same, but I've recently had an issue with a nurse practitioner when I believe I should have seen a GP at the start. I have got an appointment for urgent "2 week wait cancer referral" biopsies next week for lymph nodes which I'm concerned about, but I had to request a second opinion from a GP to actually get the referral.

I'd seen a nurse practitioner the first time I presented to the surgery and he told me that despite the fact my lymph nodes had been raised for 3 months (with no apparently cause) and despite the fact I'd also developed drenching night sweats with excruciatingly itchy legs (with no cause), he had no real concern.

He thought the breathlessness I've developed was anxiety so told me to "breathe slowly" when I'm breathless and that the lymph nodes were probably from an infection I didn't realise I'd had. I asked if that was the case, why hadn't the gone down after a few weeks and he said "you just have overactive lymph nodes". I asked if he could say this for sure without at least a scan and he told me to book a blood test but didn't think a scan was necessary. He had no explanation for the night sweats but said the weather had been warm recently. I did point out the weather is warm every year in the summer but I'd never had night sweats before, which he didn't respond to. He briefly felt my neck but I know he didn't feel my lymph nodes as he didn't press on the raised ones, despite me trying to show them where they were.

Unhappy with this, I phoned up and asked for a second opinion from a GP and got an appointment the following week. The GP didn't understand the nurse practitioner's lack of concern, brought someone in to do blood tests there and then and referred me for urgent biopsies. The GP said I was right in seeking a second opinion.

While a nurse practitioner is someone who is qualified in their own right and does have extensive medical knowledge, I still think the nurse practitioner should have known the criteria for an urgent referral and I still don't understand why he was so unconcerned. If I'd taken his advice I would not be awaiting a biopsy and, if it does turn out I have something nasty, I would be much further behind in the process of sorting it. I only asked for a second opinion because my DP really insisted that I should, but the nurse was so confidence in his assurance that I was absolutely fine I really felt no need to, I'm so glad I did though.

This is horrific. I'm a nurse and a prescriber. I can't seem to get my head round the fact that the physician associate managed to prescribe a drug. How??
You need to have a different registration status for this and a prescription pad is issued to you by the local authority.

Therefore for the prescription to be issued, if you are not a prescriber, you would need to ask a prescriber to prescribe the drug and therefore they should join the consultation. Someone in that surgery knows something. Someone else ie a GP or nurse has prescribed that drug

Having been through the Scottish NHS over the years have never come across any. Have seen a few nurse practitioners who gave been handy for stuff like UTIs.

PAs are a scary concept depending on the field and their remit (shudder).

To be honest having read this as a prescribing AHP with a defined scope of practice that includes looking after patients with breathing issue this worries me. Any patient turning up in my clinics like that would have been referred directly to services to assess for dvt/ pe. It's drummed into all medical and AHP staff as red flag symptom as PP said. Most advanced practice nurses/ physio/ pharmacist have year and I mean years of clinical experience at senior levels first and work in very defined scope. The rules are always er on the side of caution and if an doubts find a consultant in my case. Hope the ressurs a few of you. Oh we also earn less then physian assistants just like some doctors.

I'd be interested to see the retention rates for PA who have come from a non clinical background. It must be ridiculously stressful for them. It's bad enough in the NHS as it is without that kind of pressure.

I think advanced practitioners are more appropriate. But also have concerns about the speed at which some of them are being pushed through. 3 year undergraduate degree, 2 years post registration experience then a full time masters, meaning that they are practicing at the level of a mid grade doctor after 6 years. I think the 2 year post registration experience should be extended particularly for the full time masters.

I think this would also make it more palatable to the doctor's that have concerns/are vocally anti AP.

I can’t believe they are still allowed to work.

And more palatable to the patients. There are enough accidents with doctors who have gone the course or who haven't had a breadth of experience.

I expect it'll be uncovered as to what happened in this regard. I find it scary that they are still working as a locum especially as the surgery seems to highlight other issues they had. I suppose that's what happens when not regulated.

I am a hospital consultant and I have had experience of working with both JD and PA. NHS England has deliberately cut the number of JD posts to save money over the last 15 years. As a result, there are more vacancies than applicants for consultant jobs now. PAs work hard, well most of them and try to do their best. Medicine is not an easy subject. You not only need theoretical knowledge, you also need practical, hands on experience. It is next to impossible to see everything during your training, whether you train for 2 years or 10 years.

PA jobs have been created and left for consultants to deal with. We have enough on our plate already; add the job of training future doctors and now this. Medical science is built on basic sciences like anatomy, physiology, biochemistry. Further knowledge is built on diseased body(pathology) and manipulating it externally(pharmacology). You cannot build your knowledge if you dont start from the base camp. PA training is not easy because of their half knowledge of human physiology and pathology, and as bible says, "Little knowledge is dangerous".

And why should a consultant take responsibility for a PA's duties and responsibilities? Bring in a regulator(like NMC for nurses), make them accountable and responsible, give them the prescription rights. But the pt should have the ultimate say in whom do they want to see and not reception deciding which way to bat the patient.
When I was a trainee, would I have liked if my consultant had ignored me and trained a PA instead? Of course not! Why do PAs think that Consultants will favour them?
Most difficult tasks any JD learns is when they are put out of their comfort zone during out of hour on calls. PAs dont do on calls !! How they can be equal to JD is beyond me !!