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?

A lot of it now is politically driven, but the main driver historically and underlying now is the shortage of placements and people to train them. When you're running short you can't spare and don't have the facility to have big numbers. Similar concept for health degrees; midwifery for example is highly competitive and even with capped amounts of degree spaces some cohorts have had to chuck people off of the course because there aren't enough placements to go round.

This. Until medical workforce planning is sorted, there's no hope.

At the very top of my post I clearly stated that I felt that PAs should be regulated and work in a very clearly defined way.

Teaching unions did protest at the time against the introduction of TAs covering classes. I was teaching at the time so remember it clearly, although I didn’t really see the bigger picture back then. But obviously they were unsuccessful…

PAs, TAs…it’s all part of a wider neoliberal picture of professional roles becoming casualised, commoditised and public services being run on the cheap.

I’m not sure what is to be done about it, but it seems to be an unstoppable train. Perhaps the train drivers actually have the right idea in vigorously protecting their pay, terms and conditions?

AI is coming for all sectors. The clinician will still be there of course, but I don’t think there will be as many of them and they won’t have the same pay or status…

bmcmededuc.biomedcentral.com/articles/10.1186/s12909-023-04698-z

https://www.independent.co.uk/news/health/gp-appointment-surgeries-nhs-doctors-england-b2606766.html

But GPs have still fallen by 15%. Kind of worrying that GPs now only do half of appointments, it’s unclear who does 10% 🤔and admin staff have risen massively.

They are appealing to the government because they aren't in the BMA so won't strike and can't emigrate as their qualification isn't recognised abroad.

Even if people aren't sympathetic to doctors in general, you would want good medical care for yourself and your family, and be concerned if you felt this was being eroded?

There’s certainly a shortage of doctor positions , nurse positions and midwife positions in some areas. From various Facebook groups I see newly qualified nurses and midwives talking about not being able to get jobs. Some can’t move area due to family. Even for the ones that can Move there might be 40 people going for one job. Hospital near me advertised for 7 midwife positions recently and had over 300 applicants. A whole cohort of Scottish midwifery graduates were told no jobs will be advertised for another year, by which time another cohort will have graduated. Not because there’s no need for them, but hospitals can’t afford to recruit.

i saw stuff about medical graduates not been able to secure their first job. 🤷‍♀️

Yes there is a decline. The year my DD qualified 800 didn't get F1 places! Only in the past few years.

The problem is and always has been the BMA.

Yes, same here. Never had an issue. I'm not saying there never would be one, but as everyone acknowledges doctors make mistakes/provide a poor experience sometimes too. And there are comparatively hardly any PAs around at the moment.

I agree a review isn't a bad thing of course and I agree obviously PAs should not be on doctors rotas etc, but that certainly has never been happening here locally at least (thank goodness).

I'm also unsure how these articles often say PAs have been prescribing though as it's legally impossible for them to do that. Unless they're talking about the tiny amount of an already tiny cohort who already have prescribing rights in their own right from completing a prescribing qualification prior to becoming a PA (i.e if they were already a nurse prescriber or something). If so, the reporting on that isn't clear and is disingenuous as those people could already prescribe anyway. (For the record I agree this could confuse issues and there is an argument to be made that they shouldn't be prescribing in their role as a PA.)

No GPs haven't 'fallen by 15%' whatever that might mean. That isn't what the article says.

GPs per 1,000 patients fell by 15 per cent when accounting for the hours they worked and population growth. That's a different statistic altogether

The number of GPs have increased. Many appointments are now covered by other staff - that may be a good thing, it may not.

If more admin staff tare taking an administrative burden away from clinical staff, that is a good thing. But one thing's for sure, if we are going to deliver an effective health service, proper workforce planning will have to underpin it.

Agree a good ANP are worth their weight in gold.

The best way to fix this is for patients to refuse to see PAs. I do, and it's never been a problem getting someone qualified to see me.

The UKFPO can confirm that this morning all 9,702 eligible applicants for the 2024 Foundation Programme were allocated to a Foundation School, with 75% of those applicants getting their first preference.

This is an improvement on last year when 8655 applicants were placed and 71% got their first preference.

The number of medical students who don't get a place in a foundation programme would also be dependent on the numbers coming out of medical school, it's not just about the number of available posts for them to go into. That's what we keep getting wrong.

If you're talking about 2022, all of the 791 applicants who 'didn't get' into a foundation programme, were placed in programme in the end, but not necessarily their first choice

I used to side with the medics on this but the elitist attitude on X has made the whole argument toxic and they have lost my sympathy right now.

Medicine is changing we can use AI now for a lot of screening/red flag symptoms which can then direct people to a nurse, paramedic, PA or doctor where needed.

As a country we can't afford to have GPs seeing things like minor viral infections unless you massively cut wages to the point people will leave the NHS. I'm happy to see a PA if I just need a script or sick note. Should they be seeing long term undifferentiated conditions or red flag symptoms no, but they do have a role. I would sit them at the same level as an advanced paramedic and make their training match it.

However I would overhaul the whole system and go back to 2-3years premed system but use it for all professions in healthcare with no limit on numbers universities can offer as it will be a Bsc.

You then reform the whole NHS so staff are say graded 1-30 instead of the current "roles" with medics being separate to agenda for change staff as an elite profession which is by and large the issue here. Notice paramedics and ANPs aren't getting the same abuse.

After the Bsc you do funded clinical training of varying lengths for all the traditional medical professions, broken down into modules so people can advance up the career scale e.g. if you get onto the traditional nurse scale you complete XYZ modules vs the XYZABC on traditional medicine route. You could offer those modules unfunded part time for people to advance over the years (the gap PAs are filling currently) moving up from say a traditional nurse role at band 5 by completing the modules with the relevant experience to advance up to a current F1 complete the next set to move up etc.

Use AI symptoms screening to allocate the patient an appointment with an appropriate staff grade. Whilst allowing trusts to make money on the side with premiums for the nice to haves e.g choice of appointment time, place for a partner to stay, upgrade pillows etc which can be reinvested. I would also take the pay out of individual trust budgets and use a metric to allocate staff numbers to each trust. If they want more it can come from saving or income they generate.

Because toxic environments won’t result in good patient care?

A major point the BBC article fails to cover is the pay - PAs are getting more than a Foundation Year doctor but have far lower levels of competency. They are very poor value for money compared to junior doctors or nurse specialists. It feels like a lot of trusts & GP surgeries are exploiting the lack of regulation to use PAs where they should actually be employing a speciality doctor, consultant or GP (who are more expensive than a PA, but doing a job a PA is not competent to do)

Haven't read whole thread so sorry if this one got answered already
Was it a stealthy Tory policy to get cheap “doctors” on the quiet?
No, it was under the last labour government that PAs started to be employed (2003) obviously their numbers have grown since then.

So in essence, current doctors don't want to have to train the new incoming ones....

Just out of interest OP what do you think the solution is to magic up more doctors without allowing more young people to study medicine?
Because the training issue aside, surely the first step simply HAS to be get more kids into medical school!!!

There is a place for PAs in the health system to deal with issues that don’t require a doctor. My GP practice employs two PAs who do similar jobs to the nurses - changing dressings, taking blood pressure, doing annual checks for repeat prescriptions (that a doctor then prescribes). We’re told if we are seeing a doctor, nurse or PA.

The toxicity on Twitter written by doctors is awful - they are supposed to be professional and highly educated and the bullying that I have read is disgraceful. They should be ashamed of themselves.

The issue is that when these new doctors graduate they need training opportunities at higher levels so they can progress in their careers e.g. to consultant. Otherwise you have loads of F1 and F2s but they can't learn the skills they need to be registrars and consultants who make the clinical decisions.

I suspect there is also a cost saving element to this - F1 and F2s don't cost much but consultants do. PAs are quite well paid compared to equivalent NHS roles but they don't get more expensive in the way doctors do if they are able to progress in their careers.

Many doctors also feel that PAs are taking these development and career progression opportunities from them

PAs don't have the same ability to strike or emigrate, which means that the government can keep a health service going even if doctors are unhappy with pay and conditions.

I work in the NHS as a nurse. To give you some context PAs get paid more than doctors and ECPs but have YEARS less training. An ECP needs to take a professional degree in nursing / paramedic science / etc, work experience and then take another masters (with more work experience) to become an ECP.

PAs can just do the job after a random science related 2 year degree and 1 year experience. They tend to be the type of students who wouldn't be able to get the grades to get into medicine / nursing / parademic sciences and many used to call themselves doctors to patients (something that is banned now thank goodness) which ECPs are not allowed to do.

I think the NHS should rename them to healthcare assistants and lower the salary: we don't need them if we improve the existing ECP pipeline which is safer.

I was so shocked to read that I dug a bit and found this from last year.

https://www.jobs.nhs.uk/candidate/jobadvert/C9409-23-0355

I've had an endoscopy. It was done by a team of people including nurses and a doctor. If anyone feels comfortable with a PA (from the job spec they could also be fresh from their course) performing one on them, single handed, you're braver than I am.

What does this line from the ad actually mean?

• To work unsupervised in the provision of clinical care to patients

The issue I have seen is PAs given priority for training opportunities that medical students need. Also PAs being trained in skills that doctors need to develop into specialist roles.
Many of the NHS waiting lists are driven by shortages of consultants. The next generation of consultants aren't being trained.
In my area some specialisms have been covered by locums for years. Locums cost a fortune.

I don't blame doctors for being demoralised. They have to watch lesser qualified PAs given better working conditions and a lot higher pay.

Why would a GP surgery employ PAs to do the work of nurses when PA salaries are substantially more?
It's because GPs were given ring fenced money for PAs or nothing.
My local GP took the money and employed 2 PAs. They lasted a year and they don't have any now.