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?

I understand the need for strikes. I read they’ve made some progress in the past week re pay negotiation. I don’t understand your second point.

Oh and the majority of doctors hate/despise the GMC and up until v recently their own professional organisations. Only when the members have found the time and energy to fight back have they started to listen.

If we have another pandemic we are screwed. The goodwill is not there anymore. They risked their lives, and many lost them, to save people's relatives. And we thank them like this.

Australia has just decided to not have PAs as they would be dangerous.

I absolutely understand that a gp will have more training for anything serious- but I think it's wrong to assume that they will all be 100 per cent on the example I gave - menopause issues. It's horses for courses. Some will be, some won't.
For anything potentially life threatening, lumps etc You really need a specialist -'a consultant- for the issue. The nhs system has the GP as gatekeeper to that.
And again, all consultants are not equal. You may only get some junior member of the consultants team (unless using private medicine when you can choose who to see). Expertise and skill always vary.

Yes, PPs complaining about poor prescribing from PAs should be complaining about the GP/practice who are supposed to review and supervise.

PAs have been around a long time and do need a relevant first degree to start the 2 year training. PAs have been around in the UK for nearly 20 years.
They can be a useful adjunct to GPs, along with nurse practitioners, paramedics and pharmacists to reduce the load on practices, particularly in management of chronic conditions and minor ailments.

I've seen PAs and Nurse Practitioners and tbh, I always thought it made more sense to expand the NP role than introduce PAs but the model as originally set up could help GPs and departments managing chronic patients in much the way that good NPs help.

However the recent BMA PR campaign against them (the tweet upthread is a good example of misrepresentation of the roles) combined with some practices and hospitals using them inappropriately and without the required supervision has undermined the model to the public.

Lots of progress on pay in the 10 days Labour have been in power. They've met the BMA more times than Vicky did in the last 9 months.
Who knew that talking could solve this. They seem to also be talking about doctors conditions as well.

@C8H10N4O2 sorry, rubbish. They do not need a relevant first degree. They don't even need to pass their own, very easy, professional exam PAME to work.

Some do an amazing job, sticking to what they are they for, and assistant to a doctor. But many, especially in GPs, are acting as a doctor. They can't be supervised as there is 1 GP seeing patients. If they need supervision why not just have another GP. Oh yes, ARSE funding, which states you can't employ a doctor but can employ anyone else.

Doctors losing training opportunities and jobs. PAs were supposed to be there to support doctors so they can do more training.

Our gp lists each dr’s specialism and interest. I pick a woman if female and look to see if any relevant expertise. Of course a female gp with an interest in women’s health is going to be a lot more qualified than a PA. All gps will be a lot more qualified to make referrals too. I’ve never had an issue with any of our GPs re referrals. The last time I was referred the hospital commented on what a great job they’d done re tests and how much time they’d saved them .There is no way on earth a PA could have done the same.

And nurse practitioners are highly trained with many years experience. They don't just walk into that role.

A PA can be working in a GP, seeing undifferentiated patients, on day 1.

We have enough doctors, they are crying out for jobs. Why won't the NHS use them so waiting lists can be cut ?

When one of the DC peers trained they were required to have a directly relevant degree for entry to the course. I know there is an apprenticeship model now but most degree apprenticeships are as rigorous as full time degree courses.

I agree with much of the rest of what you say but GP practices are not supervising PAs or are allowing PAs to misrepresent as doctors that is a problem of GP supervision rather than the model (which as you say was there to support and take some of the load).

This has been happening for years but it’s gone under the radar. It’s a way to save money, we are just a number and a statistic at the end of the day.
Check who is treating when you book an app. I have refused treatment from a PA. Make sure you do that too to send a message to the ppl at the top.

@x2boys what do you make of the NA role? We don’t have them in Scotland but the hospital over the border is England and they have them not hearing good things from there about them. There was talk of bringing in band 4 in community in my area to do diabetics and things but I feel it’s a kick in the teeth for the likes of me who has just spent 4 years doing my degree training

I can't seem to reply to individuals as the comments already contain quotes.

But PAs can not prescribe!!! It would be illegal for them to do so. If another healthcare professional prescribes based on the PAs assessment and diagnosis, legally it is still the responsibility of the prescriber to make sure what they are prescribing is correct and appropriate.

Is there already a petition protesting against the use of PAs? I’d likely sign and I’m sure others would too.

I think a PA can have a role at a clinic or gp for example. I would have no concerns seeing a PA for persistent thrush or cystitis that the chemist couldn't clear up. Or for a referral to the hospital for sterilisation or for yet another ENT (as it's our existing issues). A Gp doesn't NEED to really have any input into that sort of stuff. But actually medical care, no.

Honestly I find the physician associate thing terrifying.

I do have a biomedical degree and KNOW that I wouldn't be up to scratch within 2 years. I had lots of medic friends at uni and IMO it is just not possible to condense medicine into that short of a time period - even for someone like me.

The fact people who don't even have this foundation knowledge in the first place are eligible is mind boggling. Some of them will be completely out of their depth and patients will suffer.

Thing is though, what if that recurrent thrush or cystitis was actually a symptom of something more serious? What if that referral would be better placed somewhere else due to case specific information?

I definitely think PAs have a role in hospitals although I think their role needs much more definition and with limitation of scope creep.

I really worry about PAs seeing patients in primary care for the above reasons. It can be extremely difficult to pick out the complex from the simple and, even GPs sometimes get it wrong.

I'm not a nurse anymore ,but it sounds similar to the enrolled nurse role that was phased out in the early 90,s when I started my nurse training, I just about remember them
They could do drug rounds, injections etc but I dont hink they could be fully in charge of a ward ?
A friend of mine did the course and I font think she ever had a substantive post as a nursing associate, as she quickly went on ti complete her training as a registered nurse.

yes; but in my example, I was showing that sometimes, physios, say, do things that the surgeon would normally do, and are only very loosely overseen - so the idea of role creep is not unique to PAs, and happens more than people realise, which is quite scary in many situations. I think once there are roles like PAs that need official sign offs for prescribing or decisions, where the doctor doesn't ever see the patient, then it starts to spread and become accepted and people don't really ever know who is treating them or making the decisions, because who knows how much overseeing really goes on. I'm sure the doctors or surgeons don't have time to review every case in detail, so they trust what the other clinician is teling them unless something seems glaringly wrong. This still leaves so much scope for mistakes or just missed opportunities, and I find it worrying.

A persistent cystitis is normally something that needs referral to urology as it can be a sign of sth serious.

We are talking about people’s lives here not stacking a shelf at a super market.

You may be right but I was basing my comment on this
Esseentially the GMC saying they support prescribing by PAs and AAs and are contributing to discussions with Government.

I think this is what worries people.
There is a way to do medicine if you already have a degree but it's recognised that even a relevant degree has very little overlap and the graduate entry medice degree is over four years with the first year being exceptionally intensive. I know a peer of DC who did a neuroscience degree and then went into medicine. He found the first degree no help at all.
PA courses accept degrees such as homeopathy and zoology.

I had a pa involved in my care at one point but he was never responsible for my care I had 2 other consultants who where always in the room with him. The only thing I remember him doing was things like urine samples and he was my point of contact if I needed things or had questions ect. I don't think they would ever be solely responsible for a seriously sick patient, even drs aren't solely responsible for seriously sick patients hospitals are more of a teamwork type of job

Physios are autonomous practitioners. We work closely with our colleagues, including our medical colleagues, as part of multidisciplinary team working. We aren’t “loosely overseen” by our medical colleagues.

Depending on the team we work in, the clinical supervision structure may include people from other professions but we are overseen by our professional body and practice guidance.

It’s important to not conflate physician’s assistant roles with other professions who have their own governance.

@Pery strangely enough I studied neuroscience for a period as well. I transferred to biological science in the end.

First year was very anatomy and physiology focused (so relevant), but then after that I was mostly interested in genetics - so 90% of my second and third year in depth knowledge is genetics.

I could tell you precisely how genetic diseases arise, but in terms of the pathophysiology of an organism as complex as a human? I'm lost. I look like a good candidate on paper, I consider myself a relatively intelligent person, but I could NOT pick that up to a decent standard within 2 years. Patients under my care would be at risk.

There's a reason GEM is 4 years. This fast track into PA (in the way they are currently being used in some trusts) is so dangerous!

In addition to my post above, this 2 minute brief from the chartered society of physios may be helpful when untangling concerns about PA , etc from professions such as physio and roles within those professions such as first contact practitioners: https://x.com/ashjamesphysio/status/1813510826827084047?s=46&t=pqk_ZCKFaaVkqk8Dp2SFIg