Physician's Assistants

[MissMarplesNiece]

How would you feel as a parent if you knew your seriously ill child's treatment was being managed by a Physicians Assistant who had just two years training, only 3 weeks of which had been spent in paediatrics?

This isn't the first advert I've seen recruiting PAs into paediatric departments. This is a post at Registrar level so why isn't a qualified medical doctor being recruited for the post?

Why are NHS Trusts playing fast and loose with children's health?

@Doctor101 you are stating incorrect information.
The GMC does not have rights over who prescribes...that is down to the DoH...aka the government.
The GMC is going to regulate this group of health professionals which does go some way in providing standards by which they have to adhere to. And gives patients and the public somewhere to go if things have gone wrong with a PA.
But it is solely the government pushing these people into doctor roles, the government who won't fund GPs but will fund other roles...I hear all the time it's basically money for "anyone but a GP".
Yes it's dangerous and no way should a PA be managing a case load of significantly unwell children...but you cannot blame anyone but the government

Cheap, cheap, cheap!!!

I asked for a doctor's appointment (as opposed to Nurse) recently for my severely disabled husband who has complex medical issues. The nurses are great for a lot of things, but not for this problem. It quickly became apparent that the doctor didn't get the issue and we were sent out while they consulted a colleague. I researched later and sure enough this person was PA. The colleague was presumably a GP. Quite frankly this just isn't good enough. I'm thinking that they are trying to get rid of GPs as a money saving exercise.

I agree, OP, it's outrageous. Not regulated, working sometimes actually on junior doctor rotas and not declaring themselves as noctors, paid more and trained less and whats worse is the horror stories of their lack of clinical knowledge. They shouldn't be anywhere near paediatric wards nor primary care doing triage roles, it's absolute insanity. The tide is turning as we all realise how mad it is though, thankfully.

The day I'm expected to remotely support a physician associate as a senior clinician is the day I will be emigrating

There is one at my surgery who has managed minor ailments of me and my kids extremely well. I think as long as it's well managed it can be an effective role.

It's not just PAs give wrong advice though. My DH was given very poor advice and advised to start medication that was inappropriate by a practice nurse
We could end up avoiding everyone!

I've had really shocking advice from 4 paramedics at my surgery and my mother's.

Depends what for. I was seen by a very competent and upfront about his status Prescribing Paramedic for a musculoskeletal issue and he made a thorough exam and arranged for an ultrasound which confirmed his initial diagnosis. I was quite content with that.
Paramedics are trusted to save lives, they can handle a wonky foot!

I've stood in the reception queue at my GP listening to people recount inappropriate advice given by the paramedic there.

I wouldn't want to see a GP if I'd just had a car accident but neither do I want to see a paramedic for a general practice problem. They aren't the same skills at all.

Theredjellybean I did not say anything about prescribing rights. Other professionals than doctors have can have prescribing rights.
If you want to know if the person who is treating you is a qualified doctor with a medical degree ask for their GMC number.
You can check their qualifications on the GMC website.
For the present anyway only qualified doctors have GMC numbers.

PA's can't prescribe - so this didn't happen!

@Doctor101 I do apologize..it was @Pery ..

I work with both, I think it’s awful that PAs are going to be regulated by the GMC. They should have their own separate regulating body. It’s going to cause even more confusion over the roles, especially as scope creep is already massive in the NHS. It’s not the fault of the PAs who generally are v nice people. But this whole project isn’t good for patients or doctors.

It’s not a registrar level. It’s an NHS band 7, equivalent to a senior nurse.

Just to note, other than doctors, other health professionals need to do a prescribing course to be able to prescribe. There seems to be some confusion on the thread. I imagine a PA who has done a prescribing course can prescribe.

And both my Dd and dh has had shocking advice (Dd on several occasions) from both GPs (inc the senior partner) and doctors in a&e. Dd is only alive in spite of both our GP and the doctors, it was an ANP who saved her life in a&e. I do think it’s possible to be very good at your role without being a doctor.

saying that I don’t agree with the PA role. I applied for the PA course and was accepted on to it and didn’t start as I had serious misgivings about the role. Especially in primary care.

i can see in hospitals if they are staying in the same dept and building up their knowledge and expertise in one area then potentially they could be very knowledgeable. But I agree why not have a doctor do this? Or even an ANP who at least has done three years of nurse training and then further post registration training to get to ANP level.

I don’t believe that PAs are currently allowed to do a prescribing course (because they’re not on a register?).

That’s just their pay scale which to be honest isn’t the point. It’s more about what level of responsibility do they have in the role. Are they doing SHO level work or are they doing registrar level work. From reading the job advert it does seem more registrar level. Unless the advert is badly written. Does managing patients mean making decisions, or does it mean a dr has made the decisions/plan of care and the PA does the day to day management of the plan within strict parameters? But then it also says something about case loading some patients which suggests making the decisions and plans of care?

AI is still very far from this. You are assuming people’s stories are textbook and straightforward.

I agree. I don't have a problem with them having a remit for chronic condition management where they have specialist training and will have garnered a lot of expertise, they are a valuable resource.

However,some years ago my late DH was sent away with mouthwash 2 weeks running having presented with a painless mouth ulcer that wasn't healing. At the 3rd appointment he insisted on seeing his GP, who sent him for an urgent biopsy, which confirmed the squamous cell carcinoma that eventually lead to his death. The GP later told me that he had known what it was as soon as he saw it.

I don't think the short delay in diagnosis affected the outcome in his case, but Nurse Practitioners and now Physician Associates do not have the training is diagnosis that qualified doctors undertake. Saying some doctors are less than great is irrelevant really, because even the worst of them will have done the hard yards, taking many years, to become one and that means something.

There is so much wrong with all this that it is frightening.

My DS saw a nurse practitioner for a suspected fracture. She introduced herself as such, asked if we were comfortable. Did a very expert looking assessment of the ankle, extremely thorough. Ordered an x-ray and then showed us what she was seeing and told us that it would be reviewed by fracture clinic and put him in a boot and crutches. Really didn't need anything further and was extremely efficient and seemed like she did all the fractures initial consultation. Seemed a good idea to me if used in the appropriate setting

Well she did! I presume she goes back to the GP who signs the script. She decided what I needed and said I could pick them up later. It only did not happen because I pointed out the inappropriateness of what she was proposing.
If the GP or hospital doc has to sign all the scripts, they will have to make all the proper checks and look at the history and other meds being taken, they might as well do the consultation themselves!

A nurse practitioner isn't the same as an advanced nurse practitioner (ANP) though. Nurse practitioners tend to deal with chronic condition management, asthma clinics, things like that. ANPs are different and deal with many (but not all) of the same things a GP would manage.

This may have been an advanced nurse practitioner as opposed to a nurse practitioner. Some practice nurses get called nurse practitioners. Even though they should be titled practice nurses. The titles are very confusing.