Meet the Other Phone. A phone that grows with your child.

Meet the Other Phone.
A phone that grows with your child.

Buy now

Please or to access all these features

AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Physician's Assistants

199 replies

MissMarplesNiece · 19/07/2024 20:57

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?

Physician's Assistants
Physician's Assistants
OP posts:
Thread gallery
5
Pippa246 · 20/07/2024 16:40

x2boys · 19/07/2024 21:46

I think that was one of the reasons why enrolled nurses were phased out originally some were expected to do the same job as registered nurses without the same training or pay .

They never did the same job as RGNs - they did 2 years training as opposed to 3 years and weren’t allowed to administer medications unless they went on and did further training. Eventually they were all upgraded to RGNs after undergoing further training or took early retiring.

ENs are now effectively being reintroduced via the role of the Band 4 Health care support worker role.

I hear a lot of HCSWs saying they do “the same as the RGN” without knowing what the RGN actually does. I supported many on clinical placement who were doing their degree and couldn’t hack it.

Locutus2000 · 20/07/2024 16:58

modgepodge · 20/07/2024 08:31

I’m looking to career change and at first look the PA role looks ideal for me - I have an appropriate degree, I’ve always liked the idea of medicine but don’t want to train for 7 years like doctors, the starting pay is excellent. But I haven’t seriously looked in to it because it all looks a bit too good to be true from the PA perspective (level of pay compared to time spent training) and I just cannot see how 2 years can be enough time to learn all you need to learn when it takes doctors more than 3x that long. I’m currently a teacher and consider it unacceptable that TAs with no teaching degree are expected to cover classes more than occasionally. As far as I can see this is the medical equivalent but with far more serious potential consequences, obviously.

I don’t understand how they are cheaper than doctors - the starting salary is higher than a junior doctor isn’t it?

I think concerns are starting to be raised and I think I saw that one university has cancelled the next cohort of their course. I think sooner or later someone is going to die because of decisions made by a PA and the role will have to change/be phased out (another reason I decided not to go for it, along with not wanting to be the PA who makes a catastrophic wrong decision!) I hope it doesn’t come to this and the role is changes or clarified before anyone gets hurt.

I don’t understand how they are cheaper than doctors - the starting salary is higher than a junior doctor isn’t it?

Junior doctors are paid less initially but have relatively rapid progression. The PA will remain a PA unless they retrain as a proper doctor at medical school or blag a juicy management role.

All non-medically trained staff acting in a medical capacity need to be properly supervised. A GP literally saved my life after over-ruling an over-confident NP who was convinced my acute abdomen was constipation. I was in surgery for twelve hours after crashing while waiting for the x-ray he ordered. If I had gone home as ordered I'd be dead now.

FixTheBone · 20/07/2024 17:16

Doctor101 · 19/07/2024 21:32

PAs are cheaper than doctors and more controllable by management.
They are supposed to be supervised by consultants but in reality the consultants are told to take this on without any additional time for supervising so the PAs just carry on without much supervision. Some PAs are excellent but some are over confident and reluctant to ask for advice from doctors despite very little medical training.
It's not clear who will take responsibility if the PA makes a significant medical error.
Always check if the person you are seeing is actually a qualified doctor ( ask for their GMC number).

Theyre actually more expensive than some doctors they are replacing. Band 7 on AfC starts at £43742.

Junior doctors need to complete 3 years post medical school to reach £43900 to exceed the PA starting salary, by which time the PAs have moved upbthe scale. The actual crossover point is around 5 years post medical school.

mumsneedwine · 20/07/2024 17:42

People have already died because PAs have missed things. It's a disgrace.

x2boys · 20/07/2024 18:44

Pippa246 · 20/07/2024 16:40

They never did the same job as RGNs - they did 2 years training as opposed to 3 years and weren’t allowed to administer medications unless they went on and did further training. Eventually they were all upgraded to RGNs after undergoing further training or took early retiring.

ENs are now effectively being reintroduced via the role of the Band 4 Health care support worker role.

I hear a lot of HCSWs saying they do “the same as the RGN” without knowing what the RGN actually does. I supported many on clinical placement who were doing their degree and couldn’t hack it.

I was an RMN not RGN I know EN ,s were not supposed to have the aame responsibility as a registered nurse and i know their training was only two years rather than three
What I wss told by nurses that converted from EN was that often they were often left alone in charge of a ward on nights etc ,how true this was I don't know as I only saw the tail end of enrolled nurses
Also was it different outside of the NHS ?
Before I started my nurse training in 1993 I worked in a nursing home who employed a few enrolled nurses who seemed to me to be doing the same job as a registered nurse ?

Spacecowboys · 20/07/2024 19:03

x2boys · 20/07/2024 18:44

I was an RMN not RGN I know EN ,s were not supposed to have the aame responsibility as a registered nurse and i know their training was only two years rather than three
What I wss told by nurses that converted from EN was that often they were often left alone in charge of a ward on nights etc ,how true this was I don't know as I only saw the tail end of enrolled nurses
Also was it different outside of the NHS ?
Before I started my nurse training in 1993 I worked in a nursing home who employed a few enrolled nurses who seemed to me to be doing the same job as a registered nurse ?

I caught the end of enrolled nurses too. Two were going through the conversion when I started on my first ward as a newly qualified nurse. One in particular was amazing and I spent my first year in awe, I learnt so much from her. On paper, I was ‘more’ qualified than her, with my degree and university education. In reality, she was head and shoulders above me. The conversion was simply a paper exercise for her. And I suspect it was for others.

Motheranddaughter · 20/07/2024 19:06

I would insist on seeing a doctor

lawnseed · 20/07/2024 19:30

mm81736 · 19/07/2024 22:28

The thing is AI can do a better job than a human doctor now, so all you really need is a person with a good bedside manner and a computer.The decline in the need fir as many doctors has been predicted fir many years

I agree. Recent research has demonstrated that AI made a better job of diagnosing people than a doctor.

Pippa246 · 20/07/2024 19:35

x2boys · 20/07/2024 18:44

I was an RMN not RGN I know EN ,s were not supposed to have the aame responsibility as a registered nurse and i know their training was only two years rather than three
What I wss told by nurses that converted from EN was that often they were often left alone in charge of a ward on nights etc ,how true this was I don't know as I only saw the tail end of enrolled nurses
Also was it different outside of the NHS ?
Before I started my nurse training in 1993 I worked in a nursing home who employed a few enrolled nurses who seemed to me to be doing the same job as a registered nurse ?

never left alone in my experience but I worked in acute hospitals and there were always RGNs on and of course, back in the day students were considered as staff so an EN might have been left with a senior student if the RGN was on their break. Couldn’t say about care homes but legally they’d be able to administer meds if they’d done that training so could potentially work “alone”.

My friend’s mum was a very experienced EN in a paediatric renal unit and had undergone further training and could put the kids on and off dialysis which many of the newly qualified RGNs couldn’t (yet) do so I’m not suggesting ENs were not valuable members of staff.

Pippa246 · 20/07/2024 19:41

lawnseed · 20/07/2024 19:30

I agree. Recent research has demonstrated that AI made a better job of diagnosing people than a doctor.

medicine (and nursing) is an art as well as a science and I’ve no doubt AI could quickly come up with a differential diagnosis but Id be sceptical it could diagnose atypical presentations. We still need to lay our hands and eyes on people to truly care for them. When we moved to automated vital signs monitoring, the number of arrests and peri-arrests increased and hospitals which brought back manual obs saw better patient safety and outcome. A machine can tell you a patients pulse, resps, BP etc, but only by touching the skin and observing the patient can we truly know what their vital signs mean.

lawnseed · 20/07/2024 20:12

Pippa246 · 20/07/2024 19:41

medicine (and nursing) is an art as well as a science and I’ve no doubt AI could quickly come up with a differential diagnosis but Id be sceptical it could diagnose atypical presentations. We still need to lay our hands and eyes on people to truly care for them. When we moved to automated vital signs monitoring, the number of arrests and peri-arrests increased and hospitals which brought back manual obs saw better patient safety and outcome. A machine can tell you a patients pulse, resps, BP etc, but only by touching the skin and observing the patient can we truly know what their vital signs mean.

I agree, but nurses have more patient contact on the whole - or at least they used to - so they could facilitate diagnosis. It comes down to how effective an individual is as well.

noworklifebalance · 20/07/2024 21:43

lawnseed · 20/07/2024 19:30

I agree. Recent research has demonstrated that AI made a better job of diagnosing people than a doctor.

Until the next IT outage

Uricon2 · 20/07/2024 21:56

Pippa246 · 20/07/2024 19:41

medicine (and nursing) is an art as well as a science and I’ve no doubt AI could quickly come up with a differential diagnosis but Id be sceptical it could diagnose atypical presentations. We still need to lay our hands and eyes on people to truly care for them. When we moved to automated vital signs monitoring, the number of arrests and peri-arrests increased and hospitals which brought back manual obs saw better patient safety and outcome. A machine can tell you a patients pulse, resps, BP etc, but only by touching the skin and observing the patient can we truly know what their vital signs mean.

I totally agree. I've been looking after a v poorly DH for years now and the biggest "tells" are things that come from experience, gut instinct and observation. I know when he's at a different stage of rough and hospital is looming.

ETA and I got a D in O level biology and was no loss to the world of medicine!

Pippa246 · 20/07/2024 22:09

Uricon2 · 20/07/2024 21:56

I totally agree. I've been looking after a v poorly DH for years now and the biggest "tells" are things that come from experience, gut instinct and observation. I know when he's at a different stage of rough and hospital is looming.

ETA and I got a D in O level biology and was no loss to the world of medicine!

Edited

I’m sorry to hear about your husband. A good clinician will listen to what the person’s loved ones can report about their condition. It’s important in providing compassionate care. I hate the thought of people thinking AI is better than a doctor!

Uricon2 · 20/07/2024 22:20

Pippa246 · 20/07/2024 22:09

I’m sorry to hear about your husband. A good clinician will listen to what the person’s loved ones can report about their condition. It’s important in providing compassionate care. I hate the thought of people thinking AI is better than a doctor!

Thank you. Nothing will ever convince me that it is!

VaccineSticker · 21/07/2024 20:38

Pippa246 · 20/07/2024 22:09

I’m sorry to hear about your husband. A good clinician will listen to what the person’s loved ones can report about their condition. It’s important in providing compassionate care. I hate the thought of people thinking AI is better than a doctor!

AI will help a doctors make quicker diagnosis therefore more people get seen at a faster rate and docs are less likely to see the same patient again complaining of the same issue that’s been misdiagnosed for previously. .

OtterMouse · 21/07/2024 22:32

This reply has been deleted

This has been deleted by MNHQ for breaking our Talk Guidelines.

5431go · 21/07/2024 23:19

@BeatenbySassafras

Sarah Clarke is that you ?

mm81736 · 21/07/2024 23:25

VaccineSticker · 21/07/2024 20:38

AI will help a doctors make quicker diagnosis therefore more people get seen at a faster rate and docs are less likely to see the same patient again complaining of the same issue that’s been misdiagnosed for previously. .

The point is that it won't be doctors.The AI is doing the heavy lifting ot will be someone with much less training.The number of doctors required will drop significantly.

PippyLongstocking79 · 21/07/2024 23:55

I wish I had your faith in software development teams and algorithms.

FannyCann · 22/07/2024 00:08

Sorry if this has already been posted - haven't read all the thread.
I'm absolutely shocked that King's would do this, with paediatrics in the liver specialty of all things. Have they learnt nothing from the death of Martha Mills - actual consultants didn't manage to care for her properly and pick up on her deterioration. No way should they be having PAs in that unit and giving them so much responsibility.

www.theguardian.com/lifeandstyle/2022/sep/03/13-year-old-daughter-dead-in-five-weeks-hospital-mistakes

VaccineSticker · 22/07/2024 08:26

mm81736 · 21/07/2024 23:25

The point is that it won't be doctors.The AI is doing the heavy lifting ot will be someone with much less training.The number of doctors required will drop significantly.

Eventually most jobs will be taken by AI.
This is the direction we are heading to.
But for the short term, we can’t allow untrained people with little/so called medical training, be in charge of an essential service like health of the people.

FannyCann · 22/07/2024 09:03

A group called Anaesthetists United have a crowd justice fundraising to sue the GMC over this. I think posting links to these crowdfunders is not allowed but it is easy to find on google. Currently at over £70K and there is clearly much support for their case as many pledges are £100 plus, I've seen one for £1000.

Text here:

The General Medical Council was given powers under the Medical Act 1983 to regulate doctors and protect the public from those falsely claiming to be qualified when they are not. But instead, we have watched with dismay as doctors are quietly being replaced by ‘Associates’. Worse still, the GMC appears to be actively encouraging this.
We've listened to empty reassurances from the establishment, as the lines between the two professions have been systematically blurred.
We think patients deserve better; they should be cared for by doctors when necessary, should know who is and is not a doctor, and there should be separate regulation underpinning this.
And we’re ready to take action.

What are Physician/Anaesthesia Associates?
Physician Associates and Anaesthesia Associates are a new profession. They are not doctors, they do not have the same training as doctors, but are being permitted to take on many of the roles doctors have traditionally fulfilled. The press have reported on troubling cases. And the General Medical Council, the body legally responsible for doctors’ regulation, has now been given the responsibility of regulating Physician/Anaesthesia Associates too.
(To make it more confusing, an “Associate Specialist” is an experienced doctor.)

So how have they blurred the distinction between Doctors and Associates
Parliament originally made it clear that Associates were to be kept entirely separate from doctors. There should never have been any ambiguity as to who or what a health worker is. But instead, the GMC has made the situation vague and indistinct.
The biggest worry is that the GMC have steadfastly refused to say what an Associate can, or cannot, do to support patients. The precise term for this is their ‘scope of practice’. The GMC have even refused to hold a consultation on it, despite a statutory requirement for them to do so.
So it is left entirely down to market forces to determine scope. This favours using Physician/Anaesthesia Associates as doctor replacements. There is no good reason for this ambiguity: in comparison, the General Dental Council has strict rules on the difference between dentists, hygienists, technicians and the other professions that they regulate.
Worse still, the GMC has confusingly started to use the term ‘Medical Professionals’ to encompass both doctors and Associates. It has even issued guidance on ‘Good Medical Practice’ for both doctors and Associates to share.
We believe the GMC is simply ignoring the law on professional regulation.
You can read our legal case in more detail here.

What are we trying to achieve?

  • Clear and enforceable guidance from the GMC on the ‘privileges of members’ admitted to Associate practice, defining what they can and cannot do (their Scope of Practice) and clear rules on levels of supervision. This can be delegated to the appropriately-empowered Medical College/Faculty.
  • The current ‘Good Medical Practice’ guidance replaced by two separate sets of guidance for the two separate professions, and
  • An end to the use of the ambiguous term ‘Medical Professionals’ used to describe two separate groups misleadingly.

What have we done so far?
On 26th March we wrote to the GMC setting out our case. In their reply they answered some of our points but completely failed to address others. We feel that the only route left open to us is a legal one, and we have had expressions of interest from some top lawyers in the field.

How much money do we need?
We have been quoted the sum of £15,000 to cover the initial costs of a brief and opinion.
We are working with John Halford of Bindmans LLP, a public law solicitor with experience in the regulatory framework on protected titles, and Tom de la Mare KC of Blackstones. Both of these are highly regarded and respected in their expertise; we need to work with the best.
It is quite possible that a strongly-worded representations from top lawyers will be sufficiently forceful to push the GMC into accepting our proposals. But if not, then the next step is court action. We don’t yet know how much that will cost, although we do know that the GMC has a reputation for spending large sums of public money on defending themselves.

Who are we?
Anaesthetists United are a group of Anaesthetists of all grades.
Anaesthetists have a reputation for getting things done. We are the group that convened the Extraordinary General Meeting of the Royal College of Anaesthetists, which led to a sea change in the way the medical profession, and the public, have looked at the whole issue of Associates. You can read more about us as a group, and details of our core members, here.

The GMC was set up so that the public could tell who was and was not a doctor. That aim is now being undermined. We urge doctors and patients to come together and fund a legal challenge to restore faith and ensure that patient safety is never compromised.

Thank you.

Why is the NHS hiring fake doctors?

'Physician associates' are increasingly a risk

https://unherd.com/2024/02/why-is-the-nhs-hiring-fake-doctors/

FannyCann · 22/07/2024 09:06

In their update they are calling for case histories so if you have direct experience with PAs you can send them in.

"Legal case update and request for patient case histories
We held a very productive meeting yesterday with our full legal team at Blackstones. We discussed many of our concerns about the way in which the GMC has introduced regulation for Anaesthesia Associates and Physician Associates. Our lawyers shared our concerns and are preparing to write formally to the GMC on our behalf, hopefully next week. There is, however, a great deal of work still to do in preparing the case.

Our lawyers are especially interested in hearing from patients who have been directly affected by some of these issues and who are prepared to share their experiences. In particular, instances where patients were unaware that they were being treated by an Associate, rather than a doctor, and instances where there may have been inadequate levels of supervision. If you, or someone you know, are able to supply us with relevant personal information or case histories then please contact us by email at [email protected] "

They also refer to a case being brought by the BMA about this, which I do not know the details of.

"We are closely following the BMA’s own legal case and are fully supportive of their action. We are not duplicating what they are doing; the focus and aim of our own case is different, and is concentrated on the true meaning and aims of ‘regulation’ and ensuring doctors and associates understand their respective roles with patient safety in mind."