Physicians Associates

[DevilsKitchen]

I’ve just been prescribed something by a PA that is not recommended in pregnancy due to the risk of deafness and cleft palate.

I am only by virtue of being an inherently distrusting person that I am not now taking this. I mentioned I was pregnant and the PA said “oh yeah I’m pretty sure it’s fine” which to me is not good enough so I checked with the pharmacist who told me categorically no and go and ask for something else.

My colleague also had a bad experience with a PA when her daughter was prescribed something inappropriate for her specific condition.

And it’s no wonder is it? It’s two years training at masters level which is obviously nowhere near enough. It was a nice idea to try and reduce the waiting list and I don’t even think it’s their fault because they are doing their best but AIBU to say it’s time this experiment was ended?

I would like to say my surgery has dealt with it really well and I am now booked in to see an actual GP.

Not so long ago my GP surgery tried to make me have a hospital prescription that came with no instructions decided by the pharmacy( amount and frequency). I held firm and said I wanted a doctor to decide how much and how often . A doctor messaged me with the info saying I’d absolutely done exactly the right thing and it should be my GP deciding on the dosage not a random pharmacist. Same system tried to palm me off with a medical practitioner when I wanted a GP appointment for something I was concerned could be linked to something quite serious I’m under the hospital
for. They weren’t honest and I looked her up on the site and realised. Again held firm and got a GP appointment which we have a right to do.

Happy to see pharmacists and nurses for things that are relevant for them but I’m not dumb and when I know I need to speak to a GP a GP is who I expect to speak to.

We can and should reject staff who aren’t GPs if we don’t feel they or their advice are relevant.

On the other hand when DH was seen by a PA she stated straight away what she was and was open about having to check with a doctor.

"Some" PAs are better than GPs as some actually listen to you rather than fob you off.

My DH saw a succession of GPs over a couple of years for a number of apparently unrelated conditions, after literally never setting foot in the surgery for about 20 years. Each GP just fobbed him off. It was only when a PA actually listened to him and took a few minutes to read his notes/history properly that he was referred for a specific blood test, which led to his diagnosis of cancer!

When we had the diagnosis of the exact name/type of the cancer, we Googled it and his conditions were literally text book as to his cancer. We still fail to see how several different GPs completely missed the glaringly obvious!

I voted Yabu because if you are in the UK , PA's can NOT prescribe. Someone else has prescribed the medication for you.

It’s not like PAs have been caught illegally prescribing independently though is it?

if the prescription request did go to the GP, and the GP signed it off without seeing the patient or checking the history the yes, it’s a GP problem.

However, GPs have been forced to work this model. It increases their own work load. The level of supervision PAs need to be safe is too much. It would take GPs away from seeing their own patients. And it appears that the GP is merely a liability sponge. GP surgeries are strapped for cash. To force them to employ PAs the govt have funding called ARRS which stipulates that this money cannot be used to employ actual GPs. The other stipulation in this contract is that PAs employed must see undifferentiated patients (to stop GPs from getting them to do routine stuff like chronic illness reviews etc.

it would appear the recommendations of the Leng review have been ignored by many.

The GMC hold a list of PAs. That’s about it. And for the last two years it’s been voluntary. It’s a whole load of wishy washy bollocks.
No one is listening to doctors and their concerns (Leng review recommendations are being ignored). Maybe it’s time for patients to make a stand.

The argument that ‘Drs make mistakes too’ is null and void. GPS for example have 5 yrs med school, 2 yr Foundation doctor, then several years GP training. PA have 2 year course. If an experienced GP can make the occasional mistake, why do people think that a PA with 1/5th of the training of a GP is going to be anywhere near as safe and make fewer mistakes.

patient safety should be at the front of this conversation but as usual the feelings and ambitions of a certain cohort yet again take priority.

The GMC hold a list of PAs. That’s about it. And for the last two years it’s been voluntary. It’s a whole load of wishy washy bollocks.
No one is listening to doctors and their concerns (Leng review recommendations are being ignored). Maybe it’s time for patients to make a stand.

The argument that ‘Drs make mistakes too’ is null and void. GPS for example have 5 yrs med school, 2 yr Foundation doctor, then several years GP training. PA have 2 year course. If an experienced GP can make the occasional mistake, why do people think that a PA with 1/5th of the training of a GP is going to be anywhere near as safe and make fewer mistakes.

patient safety should be at the front of this conversation but as usual the feelings and ambitions of a certain cohort yet again take priority.

You’re so so lucky you checked. This is absolutely unforgivable- who is the GP who signed this off? I’d make a formal complaint to their trust and bar the PA and their comments about them being „pretty sure“ it’s fine.

Paramedics can prescribe - do you think they carry doctors around on ambulances to prescribe all the drugs they give? some nurses can also prescribe as can some podiatrists

Correct but it demonstrates how the system is dangerous. Drs are seeing their own patients while also having a lesser qualified, non doctor sticking something under their nose saying “can you prescribe xyz”.

Details get lost in the chain of poor communication. Maybe the PA didn’t tell the doctor that the OP was pregnant 🤷‍♀️. The doctor doesn’t have time to look at OPs notes, or go take a history themselves (and the model is that they shouldn’t need to take a history). If a doctor had seen the OP they’d have had that information. If I was a doctor I wouldn’t want to prescribe without seeing the patient and taking my own history.

The history is only as good as the questions asked and that can rely on the questions asked. I remember as a HCP doing a history with a patient before surgery and asking them if they were normally fit and well/any issues. Patient said they were normally fit and well. I went and told the anaesthetist we were good to go. Anaesthetist went to speak to the patient and came back and said they had a brain tumour and the surgery couldn’t go ahead as planned. I later asked the patient why they hadn’t told me and she said it doesn’t cause her any problems so in her mind she was fit and well. 😁. I learnt a lesson that day.

It might be helpful if the OP were to return to the thread to clarify some of the points raised …

Paramedics cannot prescribe routinely they administer medication under a legal framework called patient group directives or PGDs that enables the administration of certain drugs in certain situations, this is not the same as prescribing.

Hence there are prescribing paramedics, as you’ve said - same as there are prescribing nurses

only qualified staff can give under PGD - there’s no patient specific prescription in this though

Some paramedics have done an extra course to allow them to prescribe yes thats correct however the context of your other post "do you think all paramedics carry a Dr around in an ambulance to prescribe drugs" is misleading as road paramedics will not be prescribers however will give medication under PGDs.

If it makes you feel any better OP my consultant obstetrician who I was seeing daily (was an inpatient for 6 weeks) prescribed me antibiotics that were not at all suitable for my unborn baby, who had major health issues. This type of AB is contraindicated for the issues my baby had. I flagged this up with a midwife who said this was correct and she sent word to him.

My DB is a dentist and in his first year post graduation he worked one day per week in an oral surgery ward. The nurses would tell him that a patient had increased blood pressure or heart rate or whatever other sudden ailments and it was up to them to prescribe medication. He was terrified and left that job as he knew very little about any medication that wasn't directly related to oral health. All the responsibility was on the dentists, most of whom were new graduates.

They are currently not regulated which is why it says “how will they be regulated” in the link. There’s currently a big argument because doctors are angry gmc would regulate as they are NOT doctors and they feel the regulation should come from elsewhere.

Yes, the GMC was set up to regulate Doctors thereby putting a stop to non doctors representing themselves as Doctors. This is why Drs are annoyed. Now PAs have a GMC number, which some are using alongside the phrase ‘GMC regulated ‘ to legitimise their many aesthetics practices or to fool the public in to thinking they are doctors. It’s a mess

Yes, the GMC was set up to regulate Doctors thereby putting a stop to non doctors representing themselves as Doctors. This is why Drs are annoyed. Now PAs have a GMC number, which some are using alongside the phrase ‘GMC regulated ‘ to legitimise their many aesthetics practices or to fool the public in to thinking they are doctors. It’s a mess

Yes they are regulated by the GMC as of 13 December 2024. They were given two years grace for them to join the register though.

Any HCP can make a mistake. My mum has been prescribed medication more than once by a GP which she shouldn't have been prescribed due to either her list of chronic health conditions or existing medications. She has also been taken off medication before she needed for life by a GP (that one she ended up in the hospital ICU). She has had pharmacists dispensing the wrong medication. We had to keep an eye on every medication change for her (when she let us, as she wanted to show she could be independent too!)

The issue is not unique to PAs.

My one experience of a PA was dreadful, looked symptoms up on the internet and totally missed what was actually wrong. I now insist on seeing a GP.

Of course anyone can make a mistake. That isn't an argument to allow unqualified people to attempt to diagnose and treat patients.

Yes, exactly and if someone with years of training and experience can make a mistake then someone with 2 years training and a tenuously-related undergraduate degree is much more likely to.

If I don’t have any training in health at all I would make mistakes all day, probably resulting in the deaths... But that is ok because everyone makes mistakes!

They can't prescribe but they do in practice. Some surgeries are staffed mainly by PAs and other none doctors such as nurse practitioner or ACP. Overseen by a GP who is ultimately responsible.
I had a PA miss a red flag which was picked up when I went back and saw a GP.
I'm equally concerned about nurse practitioners or nurse specialists making decisions on complex patients.