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?

If you go to a GP surgery or A&E you will see 1000s of people who are there for very minor ailments or who don't really need to be seen by a fully qualified MD. They just need a blood pressure check or similar.
So there's a place for doing some shorter training on certain areas. For example, I'd love to see PAs with training on nutrition. Which is really not well covered in MD training. Or menopause ! We all know that's extremely poorly covered in MD training. So having someone who spent more than a half day on a topic could be really helpful, but they shouldn't stray outside their lane and should have proper supervision

There's loads of GP positions here www.bmj.com/careers/jobs/gp/

Working people so hard is happening across the NHS it's so rubbish. Results in people off with stress and offering worse care.

My GP practice refuses to hire them. I feel truly blessed over how my surgery is run when I hear the horror stories elsewhere

But then why not invest in employing more Dieticians? More HCAs? More admin support? Nurses tend to be the ones who specialise in women's health- more funding for further training for them? There are just no scenarios where someone starting on a band 7 with the training PAs have is more valuable or useful than other existing professions. Its also risky because without the same breath of knowledge as a doctor or an experienced HCP a PA won't necessarily be able to diagnose and judge whether something is serious or not.

Well there does need to be a root and branch review on what is needed and how best to supply in terms of professions.

Medicine and nursing are not growing at the rates needed. I wholeheartedly agree about dieticians etc but somehow that seems also to be a challenge. I'm not sure what the answer is. I'm not sure PAs are the answer either but I also am sure that the current furore over PA who are a very small cohort is distracting from a full review of how to provide healthcare in a modern age.

There are doctors who cannot secure jobs, cannot secure training posts; there are nurses who are unable to find band 5 jobs because there aren't enough for graduating cohorts despite being constantly told how short we are of these HCPs and why PAs are needed to fill some gaps. I'd rather they were disbanded and these wages paid for established HCP roles personally.

Fair enough I'm not sufficiently sighted on the stats of these to comment

In a different jurisdiction. Here we have a PhD level qualification that is for experienced senior nurses and paramedics to become senior medical practitioner, sorry cant remember the exact title.

I am surprised something like this isn't adopted in UK. My understanding is your paramedics and nurses are well trained, add in experience, and assessments, government financial support and surely you would have a better qualified person taking medical decisions?

"...They want us to be subservient.” from the chief of their representative body is telling.

Sorry, they should be subservient to those who have had a much, much more extensive and rigorous training. I think a huge issue is that their existence is limiting the chance for junior doctors to gain the experience they need to fully train and I don't blame them for their resentment.

Part of the problem apart from the favourable pay and conditions is that you are taking people who are comparatively well educated and putting them in a role where they are not going to progress. I foresee further issues down the line when it dawns on PAs that they have nowhere to go career wise, especially if their role is regulated back to what it should always have been, ie doing very basic work as assistants to doctors (not associates) around note taking, chasing discharges etc. They will be overqualified and experienced for that and not qualified enough to do the work of a real doctor and never will be.

I don't see a role for them at all in general practice that isn't going to take an inordinate amount of time to supervise.

There’s a whole profession for diet and nutrition. Also for menopause. Why would you think a PA doing a 2 year course would know more than someone doing 5+2+3 at a minimum as a GP? Why would you take medication advice (for HRT) from someone who is not a prescriber? Why would a doctor sign off someone else’s decision (prescription) and take on the legal responsibility?

I do have concerns about PAs and patient safety. They could indeed be very useful as part of a healthcare team but should certainly be regulated and their role tightly defined.

However, I don’t have much sympathy for doctors who are complaining on the basis that their training and professional status is being undermined. The medical profession was nowhere to be seen when exactly the same thing happened to teachers (who are also graduate public sector professionals), namely the opening up of their professional domain to teaching assistants. Yes, some teaching assistants have HLTA qualifications but many are entirely unqualified or qualified to Level 2 at best. It used to be a legal requirement for a qualified teacher to be in class at all times (hence most primary schools had a qualified cover teacher on the payroll part-time or on a supply arrangement), now it’s left to the discretion of the HT and those jobs for teachers have largely disappeared. TA cover is fine for an afternoon, but not so fine for regular or long term ‘teaching’. There are umpteen Mumsnet threads where parents have expressed concerns about this happening in their child’s class.

But on a different note, surely AI is coming for much of the diagnostic and evaluation aspects of medical care anyway?

Social and technological change is coming and I think few jobs are entirely safe.

Yes, absolutely. It’s the behaviour of some of their senior spokespeople (and self-appointed TwiX etc. warriors that is most concerning. Physician associacy (??) is not a profession. If it was they could define their uniqueness and sell that, rather than demanding recognition. Recognition for what, exactly?

There isn't a decline in number of doctors. You've said this several times, but it's not true.

You have no sympathy with doctors because they didn’t have a stance on the erosion of the teaching profession, and consequently the standard of education, by the introduction of TAs?

An extraordinary race-to-the-bottom position. Surely the similarities of the effect on the two professions and on the public would make you more sympathetic?

It’s not a race to the bottom. I, for one, do want teachers and not TAs, dentists and not dental hygienists, doctors and not PAs, pilots and not cabin crew. All others have a role, of course.

What a weird view. I'm a teacher and not even teachers really bothered to advocate for our profession, why would we expect others to? Also on the same note as you mention it- imagine if HLTA had a starting wage and better contractual terms than qualified teachers, wouldn't you be even more angry?

The NHS can't even join up their current outdated IT systems, I don't think AI is much to worry about yet. We will be replaced as teachers long before doctors.

If I’m honest the only PAs I’ve had experiences with have given me incredible care and if they have had doubt they have sought a second opinion. I have been way happier with their care (2 of them at separate practices) than 70% of the GPs I’ve ever had to see.

Because most GPs spend virtually zero time doing menopause in training and there's 100s of women who report very poor GP experience.
I'm not saying PAs should prescribe and I'm not saying that they are the answer by any means. What i am saying is that the current set up is not working and we do need to find different ways to solve our modern healthcare needs. PA may or may not have a role but there's not actually that many of them and we should be focusing on the problems in health provision as a whole

To some extent doctors brought this on themselves by voting against increasing the number of places available to study medicine, years ago.
They worried that if there were more doctors readily available they wouldn't be able to demand high pay/ top jobs
https://www.bmj.com/content/337/bmj.a748
Imagine if in 2008 more medical school spaces had been created, now 16 years on we'd have lots more locally trained doctors.
Instead, govt ended up increasing physician associates to plug the gap.

Because even back then there were training bottlenecks. There's no point accepting x more students if there aren't placements and aren't jobs/training posts both when they graduate and when they finish F2 year. There are lots of doctors who either didn't get a training place and/or can't get a job ie as a GP even though there's a shortage.

https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis

BMA says otherwise

I didn't really get what all the fuss was about until that rural community-serving travelling endoscopy clinic was found to be staffed by a PA only, endoscopy is supposed to be supervised, but the NHS management were delighted to trumpet he worked alone bringing a much needed service yadda yadda. Awful.

Who decides how many training places there are

Firstly, that article refers to GP numbers only, you said doctors.

Secondly even in the article to linked to it says 'Numbers of fully qualified GPs have recently started to increase though – there has been an increase of 663 fully qualified FTE GPs in the last 12 months'

Lastly, here are the stats on numbers of doctors:

https://www.statista.com/statistics/679968/number-of-doctors-nhs-hchs-workforce-england/

https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/key-facts-figures-nhs