To think the Physician Associate / Doctor row should focus on patient protection/ care transparency as opposed to a toxic work environment

[Ra1nRa1n]

https://www.bbc.co.uk/news/articles/c2dly5ldrxjo

Was becoming increasingly worried under the Tories how PA numbers were increasing whilst doctor numbers seem to be diminishing and how you often have no idea who you’re dealing with or indeed any choice.

Glad labour are looking at the issue but why is the focus more on a toxic environment as opposed to patient care and protection?

I agree that this needs sorting as a priority.

The issue is poor workforce planning, no one has been taking a long term view on this, trusts just look at the immediate financial picture and don’t consider the impact.

If you have a limited amount of budget, of course it’s preferable to get more experienced staff on the wards, but there is not consideration of through put, of what happens when the next generation retires because no one has been taking in new grads.

Filling all vacancies in a PCN with PAs or ACPs without considering skill mix is also ridiculous. Used well, a wider skill mix could be brilliant, but it needs to be used well.

I saw a PA and he was dressed like a GP, really holding himself out to be more. But I knew something was off as when he was explaining what was wrong with me he really over-explained, like he lacked confidence in what he was saying. And re-call coming out thinking I don't agree and thinking that Doctor had no confidence in what they were saying to me. It turns out wasn't a GP. I asked for a GP the next time and now being fully investigated.

Again, this is up to the PCNs and individual practices to make this happen surely?

If someone needs to see a doctor they absolutely should. If they could have an appointment with a PA / nurse / physio / OT / ACP instead to get their needs met, that’s better for the patients and the doctors because the patients have their needs met more quickly, the GP then has more capacity to see the people that they actually need to see.

Yes but it gets more cloudy when you are diagnosing something new at a GP or a PA handling cases on hospital wards There are big risks re things getting missed and patients have very little transparency or say.

Some funding was given to GP surgeries but ring fenced for PAs. Hardly any surgeries would chose to take on a PA over a GP, but if that's all you can spend that pot of money on then it's better than nothing (debatable). I don't think people are disputing other HCPs don't have value in community healthcare.

I’m repeating myself here but PCNs have enough autonomy (as do trusts) to make this happen.

If there isn’t transparency that’s an issue with the employer, and if any professional introduces themselves as anything other than their profession that’s a conduct issue.

Hounding people on social media, and encouraging others to do the same, ignoring people at work on a professional setting is not the way to go about this and detracts from the actual issue which is transparency and workforce planning.

I agree, a decision needs to be made about it from a patient safety perspective.

I do feel a bit sorry for PAs though if they have spent years and money training for a career which soon could possibly be disbanded or perhaps more realistically severely curtailed. Not sure Labour would ban them immediately but they could stop further training which would make any existing PAs be in a dying career.

And I am repeating myself saying there is a wider issue here as the role itself gives scope to a lack of transparency and say over care. Patients are vulnerable, ignorant re medical staffing and ill in hospital, it’s not our job to hold hospital managers to account and the reality is we can’t- until it’s too late. The role itself and lack of priority as regards training and providing actual doctors carries huge risks .

My lovely ( and highly regarded locally) GP practice is advertising for a GP. Apply!

Yes tittle full name and grade. " Hello I am Dr XY aneasthetic registrar" I drummed it in to the resident Drs, don't say " Hi, I am Alex"

Of course there is a wider issue, I’ve acknowledged that repeatedly and the article you posted acknowledges that at length. The other issue in the article (and one that I also agree with) is that bullying individual PAs is not the way to address this. It is unprofessional and it increases risks to patients.

Mistakes are made by every profession, the way to address that is to improve governance at an organisational and regulatory level but on an individual level, to do what we can about our own individual practice and behaviour. Refusing to speak to someone because of the job they do, is risky and unprofessional, particularly given that one of the key features of the PA role is that they have supervision from a doctor.

I actually applied and got offered a place on one of the first PA cohorts, back when the govt were paying people about 8k a year to do the training and no tuition fees. I declined it as I was concerned about the long term viability of the role, that it could fall out of favour and that there might not be many jobs. And actually locally I’ve never heard of any PAs working at the hospital or in primary care.

I worked as a midwife in the nhs for 15 years and at my interview for the PA course I was the only one with any actual healthcare experience. The others were recent biomed graduates. I remember thinking (and still do) why have the PA role when you can train a nurse on a postgrad course to be an Advanced Nurse Practitioner for cheaper, better regulation, can prescribe and will have more of a useful background and experience 🤷‍♀️. I just couldn’t understand it, it doesn’t make sense. I’ve worked alongside amazing advanced nurse practitioners and would be happy to be treated by one. I wouldn’t want to see a PA.

ThIs is a link to the actual review. It sounds patient focussed to me. https://www.gov.uk/government/publications/independent-review-of-physician-and-anaesthesia-associates-terms-of-reference/leng-review-independent-review-of-physician-associate-and-anaesthesia-associate-professions-terms-of-reference#:~:text=terms%2Dof%2Dreference-,Summary,contribution%20to%20multidisciplinary%20healthcare%20teams.

Alleged “bullying” seems to be the priority not wider transparency or patient voice. We’ll be in an even worse situation if doctors can’t voice concerns or highlight mistakes.

Maybe doctors not speaking to PAs is doctors preferring to deal with other doctors in order to save time and have higher safety.

Same for clinicians, really. We may introduce ourselves by our fist name but it is always followed by our professional title and the service we work for. "Hi, I am Max, a physiotherapist with XYZ service". I have never worked with anyone who just introduced themselves by their first name and left it at that, including a few PAs I worked with and any staff I saw at my GP practice.

Thankyou but transparency doesn’t seem to be in the areas of focus. Efficiency is mentioned which going by recent events across the NHS just means less access to qualified staff.

I think this is the point that we fundamentally disagree on, a) I don’t think the bullying is anyone’s priority over the wider issues b) even if that was the reason for a doctor not speaking to a PA (which is huge speculation on your part), that doesn’t justify ignoring and refusing to speak to people. It potentially puts people at risk and if that’s a persons priority, they should be very concerned about that.

I agree that there is a role for PAs working alongside doctors, supporting their workload, but I am not convinced they are necessarily trained for the job some of them are doing e.g. seeing undifferentiated patients and replacing doctors in hospital rotas. This is the issue.

Whether you like it or not, doctors are more qualified than PAs, and can do more than PAs. This is just a fact, and the existence of some poor doctors and some brilliant PAs does not negate that.

And you say that doctors are different from, not better than PAs, which is curious. Clearly being a doctor doesn’t make a person a better human being than a PA, but it does make them better qualified to triage, examine, investigate, diagnose and treat patients, and also allows them to undertake tasks such as prescribing which PAs explicitly cannot (although it seems, sometimes do). What tasks can PAs do that doctors can’t?

This is not elitist or “professional protectionism” (a phrase I’ve heard in the discussion of the consultation around pharmacy supervision, which is a whole other pile of nonsense for another thread). It’s just reality. We actually do need experts.

Fair point, well made.

@Tutorpuzzle I agree, I would never see a PA. I did see one who diagnosed me with atrial fibrillation, but didn't tell me. She did put it on my medical record and I only found out when a doctor running a new drug study, that I signed up for, queried it. I was told that any life or travel insurance would have been invalidated whilst that was on my record. I reported her to the practice manager. She was a temp so I hope they don't use her again.

They used to be in different uniforms, but then they were deemed demeaning, so every fucker wears scrubs now. No idea if one is dealing with the cleaner or consultant

OP, I find your original argument strange. In your subsequent posts you explain clearly all kinds of different reasons why the PA model is flawed. Is it that you think the patient safety angle is the strongest argument so the most effective way of getting action on the issue? Because I actually think your subsequent posts, building a case through the many different harmful mechanisms at play (much like the linked article) does a more effective job.

Losing doctors because we aren't valuing their skills hurts us all in the long run and I think people see that. That's a strong part of the argument too.

What I find amazing is that so many people have had contact with PAs and have experiences of poor PA behaviour when there are only around 3,500 PAs in England compared to 390,000 doctors.
Yes NHS E is trying to train up more but they've said 10,000. This isn't a hostile takeover.
They should be regulated. I can't understand why they are not. They should not be allowed to do certain things and should be confided to very specific roles. But is it all around a terrible thing. No in my opinion.

I suppose it's more what's the point of them? What gap are they trying to fill? If it's to free up time on the wards and in the community for doctors and HCPs- why are they being paid more? Why does it require a postgraduate degree to fulfil this supporting function when some trusts have band 4s doing this? You only have to look to the US for insight into the clear motivations.

A third is generous! Having been a GP in a training practice for over 30 years the GP training is pretty intense. PAs have 2 years. GP trainees have, by the time they are trained, 10 years+

Good luck to your husband. I retired last year. The changes over the years are immense. GPs are far far busier now. I used to go home for lunch 30 years ago. By 2023 I ate it at my desk.