Physician Associates and SystmConnect in GP surgeries

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I’ve read of mounting concern re the use of Physican Associates on here by doctors and by doctors in the media.The message seemed to be always check and ask for a doctor. I think that is far harder to do in reality particularly in GP surgeries that have switched to SystmConnect. Our surgery has switched to this and apparently all requests for appointments have to go through an online form which a doctor then triages. Apparently trawling though all forms and patient notes. Obviously we have to take in good faith that it is a doctor which always does this. You are then directed to the right personal- nurse, pharmacy, PA or a GP. You have no choice. Great in theory if it stops the Monday morning 8.30 bun fight for appointments and patients having appointments for sniffles however you may not see a GP for a new condition, something hidden or something that might be connected to previous medical history. You actually have no ability to insist on a GP if you don’t feel something is right or is more serious than it looks and a PA with a lot less expertise could well miss something serious. If the practice is employing less GPs and more PAs surely the likelihood of seeing a GP will decrease and could leave something undetected for longer and increase risk.

We’ve been given very little info by our practice re staffing, triaging or rights re actually seeing a GP.

Happy to be reassured but AIBU to be concerned about this?

Swap surgeries for one that doesn't do this, the money goes with the patients.

The actual GPs there are very good, 1 in particular who we don’t mind waiting a couple of weeks for. I’d actually rather wait to see a GP at times than to see a PA or similar sooner.

If you end up with a GP, insist that their supervising GP also comes in to see you. They have to be available for this

PAs are fine for all sorts of minor things and can see you much more quickly than a GP. Same for physios and so on - you don’t always need to see a GP.
if you personally feel that only a GP can solve your problem, then go into the surgery and tell them that

Aware you don’t need a GP for everything but there are some things than can be serious if left and a lesser qualified PA or nurse doesn’t pick up on. You now can’t tell them a GP is needed. The reception doesn’t deal with appointments and just says it’s all done online now. Hence my concern.

Agree on many of your points, there is a review going on, you can write to Healthwatch with your concerns

That’s great. I really worry for more vulnerable patients. Is there a link or any advice on how to actually insist on a GP?

Perhaps you could write it on the form, if it's something you want to see a GP for?

We have a similar form and there's a box for what you'd like the surgery to do. I'd specify that I want to see a GP in there.

I’d actually rather wait to see a GP at times than to see a PA or similar sooner.

You prerogative but as AHP, I would much rather see a person who is qualified to deal with my specific issue and in a lot of cases it isn't "The Doctor". I work with doctors, they are great at diagnosing. That's about it. A good surgery will have an MDT and a good doctor will lean on their colleagues for their expertise in treating a condition - pharmacists for medication, nurses for management of diabetes. MH, etc. physios for pain and mobility problems, occupational therapists for activities of daily living, social prescribers for social isolation and benefits etc. Not sure what the role on an PA would be, I worked with one and it was an OK experience but I was not massively impressed or seen a role for them apart from cost-saving. But refusing to see anyone BUT a GP is very very short-sighted.

We use Patchs and there is a space to state what you want the surgery to do. I write “face to face appointment with a GP partner” and always get that. We do have PA’s but I’ve never seen one.

Where things like physio, repeated meds or sniffles, minor ailments , bloods etc are concerned of course I have no issue with being directed to other staff however there are all sorts of things a GP knows best and it’s their expertise I’d want. There is now no way of that happening if something is triaged to a PA and something seemingly routine actually isn’t. The elderly and vulnerable less tech savvy or able to be proactive are at risk of experiencing more serious things getting missed.

Also our GPs are amazing and do a lot more than diagnosing. Diagnosing isn’t always a 5 minute on the spot process.

No box as far as I can see for that on SC.

Well, yes and no. Again, as an AHP, I see a lot of patients who are referred to me for a particular condition. I have 75 minutes with them for an initial appointment. In these 75 minutes I can collect an incredible volume of information and, having experience working in a variety of settings I may not be able to diagnose a specific condition but I am certainly very much able to pick up on small details and symptoms that don't fit what the patient has been referred to me for. More often than not, I may also have an idea of a general body system which may be out of whack and recommend to a GP to check the symptoms or complete a referral to a particular specialist. In some instances, things are missed for a while because either the patient themselves didn't think the symptom was a big deal and didn't mention it to the GP or they didn't get a chance to speak about it in their generous 10 minute GP appointment.
I have a very different clinical training from a PA so not in a position to comment about their skills but I am excellent at patient history-taking and have enough clinical experience to figure out that something isn't right and needs further looking into by a medic. I imagine any nurse, physio and OT with years of clinical work under their belt is able to do the same.

I'd probably stick it in anywhere in that case.

A committed and careful PA will treat you effectively within the limits of their expertise. They will pass anything concerning up the line. In some areas nurse practitioners are doing GP's jobs and are paid the same. Sadly GPs miss stuff all the time and no matter who you see, they are likely to treat you for what is most common not the sinister and unlikely possibility, until you've returned many times.

Doctors diagnose, manage and treat it's literally their job.