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?

That is outrageous that she didn’t let you know who she was

So a complete waste of an appointment because the gp had to do it all anyway.

much less traumatic if they’d got rid of the pa and you’d seen a gp directly.

there are new gps who can’t get a job because of this.

This!

Equally I’d rather my child saw a doctor if admitted to paeds for diabetes than a PA.

There are lots of specialist nurses I’d be happy to see for monitoring ongoing conditions. However when I need to see a doctor for diagnosis and help that is who I want to see- not a PA or specialised nurse.

Not if their future is uncertain.

It wouldn't be supervised by a PA. A consultant would be in charge and other doctors would be available. But I think h that PA's should be scrapped.

Yes I would see a physicians associate. I would ask for a second opinion if I wasn’t happy with the consultation, but I would do that irrespective of the persons title- if I needed too. For those in hospital, all patients reviewed by junior staff are discussed with a consultant on a daily basis and that is true whether you are a pa, acp or junior dr. The consultants are also allocated adminstration time to review all aspects of a patients care because they hold overall responsibility. I wouldn’t personally work in a gp practice if I was a PA ( and I wouldn’t as an acp) because I don’t know what the senior support is like there. It is also not an area I have a lot of experience in, having only worked in acute hospital settings for over 20 years. If PAs are being used to replace gps in some settings, rather than to complement them and free up their time for more complex cases, I view that as a failure of the system. Not the individual PAs. I don’t think id have the resilience to be a PA in all honesty.

The GMC plans to give them numbers on 13th December. After which they will be able to order ionising radiation - it is expected that this will result in many unnecessary and expensive scans. Costing the NHS millions.

Doctors are unemployed at the moment. 2,000 GPs are not able to find work with some driving Ubers to pay bills.

We do not need fake under qualified staff who earn more than doctors. We need the doctors we have trained. They are there, ready to work. Someone is making money out of this PA project.

Thing is, there are jobs for doctors. But, they are largely service provision jobs with no training opportunities or chance at progression. Lots of foreign doctors do take these roles because British trained doctors, understandably, would rather be in training posts that eventually lead to being a consultant. Training posts are seriously lacking in the NHS and that’s partly, although no entirely, due to scope creep. It’s also why the plan to increase medical school places is entirely ill thought out until the chronic shortage in training posts is addressed. The bottle neck is post qualification, not pre.

That's what I'm saying she's a specialist in Diabetes, that's what she does day in day out and really knows her stuff
But I'm not sure
I would be as confident seeing a nurse practitioner for an unknown condition..

I would not want to see a PA. I had enough trouble with specialist nurses ignoring symptoms and not having a wide enough picture beyond their specific area of competence (which I'm sure was good). A PA wouldn't even have that.

It feels like everything is designed to try to avoid giving people the care they need and fobbing them off with something cheaper.

I read that they are thinking of paying GP surgeries to keep peopel out of hospital, which all sounds well-intentioned - trying to increase social care etc - but in reality, I can imagine that what will happen is that people who need to be in hospital won't end up there because of targets/payments being missed.

GPs these days seem to be the ones that you have to convince to refer you on and their role is to try not to! I've had far more success being referred by one hospital doctor to another. Everything GP related seems to try to save money, try to get a nurse to do it, try to do a phone appointment, try to get a phone physio or a general group class, try to give you a leaflet instead of a physio, try to use a questionnaire instead of an appointment, etc.

The nurses and pharmacists in effect do seem to prescribe, just the GP has to actually sign the scripts, but it's all based on the word of the others - they don't actually see you themselves, so really it is like they are prescribing.

I thought that Labour promised to look at the ARRS funding that wouldn't let surgeries hire more GPs or nurses, but only the additional roles. Yet there was a meeting between GP groups and Wes Streeting the other day and it didn't sound like this was mentioned yet. I hope it does get discussed very soon. I know there are other issues with getting rid of it - like would have then get rid of the people who have already been hired via it? - but I'm sure it would help somehow, if there are all these unemployed GPs waiting around and no jobs.

I am sorry but the amount of admin time a consultant is allocated is pitiful and they have to do a huge amount of work in their own time to review test results, action findings, answer emails.

I imagine this is variable across trusts, with some better than others.

I've even had a physio do things like refer to other departments, list for surgery, evaluate surgical wounds, etc - with the surgeon agreeing on a review of the notes at some point presumably, but without actually seeing me.

So the idea of other levels of professionals doing the usual work of higher level ones and being overseen very loosely certainly happens. In my case (for the surgery) it worked well as I knew it was suitable and I wanted it. But at the same time, I can see how problems could easily arise that way, as in many cases, the overseeing is really just looking for any glaring mistakes, and the actual decisions are being made by the original clinician who sees you, whatever their actual job.

A PA can have a first degree in English Literature, then do an 18 month course and come out earning 30% more than a qualified doctor. Madness.

A physio has trained to be a physio. A PA has not trained to be a doctor.

Not really

The thing is that we don't assume that all tradesmen, for example, are equally competent or will do a good job, particularly in areas where there are too few of them and they are under time pressures. That's equally true of doctors.

Surely people have stopped giving them any special status over and above other job holders/ professionals. And if you don't 'check' the advice of a doctor, whether a GP or consultant for anything serious, I think that's a big risk. A google of guidelines or advice from reputable web sources, or a second opinion are basic prudence. .

I'm not sure that it's a safe assumption either that an NHS GP will always be superior to the practice nurse or PA. It just depends. For example there's a PA at a local practice who specialises in menopause. Woman of a certain age who goes to conferences, reads extensively and keeps up to speed with the latest guidelines. Also has no reluctance to pass patients on to the menopause clinic if necessary. She compares extremely favourably to the older male GPs at the practice who were disinterested and fairly ignorant on menopause having failed despite complaints to read the up to date guidelines and treatment options.

pressed post too soon:

not really according to good friends of ours. They have medic friends from university who we have got to know over the years and it seems to be the prevailing issue. Not the patients, not their colleagues but the overwhelming amount of admin

I pick a female GP for female issues and I’m sorry they will absolutely be better than a PA. There is no way on earth I want to see a PA for women’s issues that could be serious.

To be honest, I've lost much of the respect I had for the medical profession as a whole ( not individual practitioners unless given reason to do so) due to 1) strikes and 2) the extraordinary stupidity, disregard of scientific evidence in favour of a political agenda and moral cowardice exhibited by various medical organisations/ trade bodies in recent years.

https://www.healthcareers.nhs.uk/explore-roles/medical-associate-professions/roles-medical-associate-professions/physician-associate

@EvelynBeatrice so how else do they get better pay ? Or do you believe £15.53 is an acceptable wage for the person saving your life at 2am ? Government could have stopped the strikes for 1/3 of the cost it's taken to fight them

If I am not mistaken isnt this the unit where Martha Mills died? The inquest found the (consultant lead) care to be lacking, with communication failures and professional arrogance being contributing factors. No PAs implicated.

As a patient and someone who is familiar with medical education, I must say I find the PA debate tiresome in the extreme. Please take posts from anonymous docs on X and Reddit with a pinch of salt. They will never provide vignettes of the countless cock ups docs make everyday (just like every HCP)! Status and protectionism appear to be the primary motivations rather than patient safety. You will also uncover some repellent views towards patients and marginalised demographics.

You won't see the fact that RCGP allows for six exam attempts now - would this be the case for law or accountancy trainees? Failure rates have increased as have extensions to training. GP trainers locally have lamented this drop in quality. You won't see a social media campaign bringing it to light though.

https://www.fparcp.co.uk/about-fpa/who-are-physician-associates