Are physician associates safe to see instead of GP?

[ourchildrenareourfuture]

The news articles are really scary seeing people getting misdiagnosed or being given prescriptions they shouldn't have been prescribed, and being made to think they're seeing a doctor when they're not.

Has anyone else had any issues with physician associates, or PAs, when they've wanted to see a doctor? Have you had a delay in getting a diagnosis for something, or misdiagnosed?

It;s like the old SEN role which 20 or so years ago we were told wasn't good enough. Now it's basically been brought back.

Absolutely is, glad I’m not the only one who can remember way back then 🤣

100% re Enrolled Nurses. I learned so much from knowledgeable, capable, experienced EN's as a student and newly qualified Staff Nurse. They were such a stable, core part of the team.

There's confusion on this post, no wonder the public are uncertain as to who they are seeing etc.

Nursing Associates are band 4 and not qualified nurses
ANP or NP are band 6 or 7 upwards

There's a big difference in training and scope of practice there.

The one NA I've met displayed a lot of the traits being talked about re PA and did not make it clear they were not a Registered Nurse.

I appreciate the career progression points and see the merits there, but also think there is a degree of cost cutting involved.

Yes. I feel sorry for all the ones who were told they weren’t good enough. Some upgraded to RN but others left. We were told nursing was to be a graduate only profession.

Nursing Associates are band 4 and not qualified nurses

I know they’re not technically nurses. But someone up thread said they manage their own patient workload, plan care and administer medicines. I’m genuinely asking what can nurses do which NAs can’t? On a bog standard band 5 nurse role? I’m not talking about specialist roles, or icu training or anp role. NA role sounds to me (not a nurse) what I’d expect a nurse to do

They can’t administer IV medication in our trust. They also wouldn’t be able to undertake a nurse prescribing qualification, whereas qualified nurses can.

I’m not in the uk. The biggest difference with our system is likely that we have ready access to specialists.

when my GP retired, her recommended replacement was a nurse practitioner. It has been fine. I see her for minor illnesses, managing chronic conditions, and signposting to the correct specialist for anything serious. That is exactly the role my GP filled.

the lowest level urgent cares are also staffed by nurse practitioners and physician assistants. If we have something like a serious ear infection or strep throat, they can totally handle that. If I’m not pretty sure what we are dealing with, then I go to the next level up urgent care where they have actual doctors on staff. I know I might still see an assistant of some sort to start, but if my case is they will swap me or at least consult.

And there in lies the issue. They are a cheaper alternative with less training/education.

Ooh do tell! What are the chilling stories?!

I have a complex medical history including cancer.
I had gastric symptoms for the first time ever and made an urgent appointment after loss of weight, pain and vomiting blood.
The PA introduced himself as "one of the physicians".
Now this is not a measure of his performance but his bedside manner - he was dressed casually and visibly chewing gum, looked bored.
He looked something up on his screen and asked me some questions. He said he wouldn't send me for an endoscopy because "they are not very pleasant" (this is to a patient who has had every test going including chemotherapy so an unpleasant test is really not a concern of mine).
Gave me PPIs and said come back if no better in a couple of weeks.
I made sure my next appointment was a GP. She was visibly annoyed when I told her what the PA had said and referred me on a 2ww for endoscopy.
Fortunately it was nothing sinister.

I am very happy to see a nurse practitioner as the ones at my practice are very experienced and thorough but I never want to see a PA again.

Not GP/Associate but in hospital a Trust Grade Doctor (could tell at the time he had no idea what he was talking about - thought my issue was muscular despite me having a high d dimer test). Sent me home with costochondritis after I had waited for over 18hrs to get a CT a specialist had recommended 4hrs before I saw him. A week later and I was blue-lighted back and a pulmonary embolism was found when a higher grade doctor finally sent me for the CT I was meant to have the week before. It appears they never find out about these problems and therefore I have very little faith in the system at all, as this doctor will clearly never learn from his mistakes.

Ok, so same as a NQ band 5. In my trust IVs is a post qualification workbook/course.

My eyebrows flew off the top of my head reading that! 😤

I saw a PA and got wrong advice and had to pay privately to see a consultant to get the right advice.

My left leg had swelled up and my leg and arm had gone numb with numbness extending into my chest. (I'm mid 40s)

The PA said I should rest and elevate my leg.

I went to see a consultant privately and he scanned my leg with an ultrasound scanner. He said I had a varicose vein from my knee to my groin, meaning that the little flaps that are meant to help the blood go up against gravity had collapsed. He said I ought to have surgery immediately to correct it, but could put it off if I wear compression tights at all times.

He says I am at risk of deep vein thrombosis if I don't wear the compression tights and I must come back for surgery sometime.

So no, I don't think PAs have enough training for the job, lovely though they are.

Aaaalrightythen that sounds horrific. However a staff grade Dr is a qualified, experienced Dr, so although you have had terrible a experience, the role isn't unsafe.

A physician associate is a non-clinician with a science background who has had two years training. Such individuals are frequently being used within GP practices and are working far beyond a safe level of practice.

Re nurses band 5 is the lowest qualified band, and nursing associates are band 4, so more senior than an HCA but below qualified in the hierarchy. NA will monitor care under the guidance of registered staff but won't make decisions based on those results.

NA can't be in charge of a ward and don't assess needs or plan care. They always work in teams with qualified staff.

Not quite band 4: nursing associates cannot ever do IV drugs unless they do an 18 month university course to become a registered nurse.
This role can be amazing and useful but honestly it is another way to get cheaper medics. The quality of NA that qualifies varies greatly and it can be confusing for patients and relatives to know who is who.
I think eventually the NA will replace RN's, NA's work while training so right from the start they are counted in clinical numbers, they qualify in 2 years and it seems more attractive as no debt and a job upon qualifying.

There is really no proper replacement for Drs and RN's just a cheap government looking to cut corners.
Research has proven time and again that mortality is greatly reduced when qualified nurses care for patients as opposed to alternatives.
I imagine it would be similar for Drs vs PA.

This is indicative of public, front facing, statutory roles all over the country. This kind of practice goes in and out of fashion as different governments come and go as other posters have suggested about nursing.
I know it's not off topic slightly but just to share....
There are 100s of schools where the majority of teaching staffing are made up of alternatively qualified or unqualified staff. How many of you know your childrens teachers qualifications?
Did you know that the new Working Together published recently proposes that proposes that non social workers and non children's social worker practitioners are the holders Child In Need cases? (already common practice in some areas). Imagine the horror when another child dies at the hands if their parents and it comes out they were on a Child in Need plan but allocated to an unqualified worker. The solution to this is to ensure they are closely supervised by

It's a catch 22, lots of alternatively qualified people have a wealth of knowledge and experience who bring great value to their roles but them being misused and miss sold is the consequence of continuing budget cuts and public services constantly being expected to do less with more.

Trust grade Dr isn't a grade so not sure if sho or Reg - but if sent you home probably Reg. But that's a Dr anyway - buy Uni Soto ignore the consultant advice for CT

Unusual

Dd had her pulmonary embolism missed twice in a&e (by doctors) and once by the GP. Given incorrect diagnosis of anxiety and costochronditis was also mentioned. She also (less seriously) had coeliac disease missed several times over 8 years by various doctors. MN diagnosed her with that in the end. Same situation for her Ehler Danlos syndrome. So I do agree anyone no matter how qualified can get stuff wrong……but we should be looking at improving training not letting people with less training loose on the public.

It’s the pretence they are doctors and not correcting people or introducing themselves as such. They are told on their training to do this and that they are equal or above doctors

Yes, but telling me he qualified and missed something that even the GP receptionist piked up on, doesn't make me feel any safer! The fact he will never know how his rush to get me gone before he clocked off shift (he did keep going on about how I was the last of the day) is depressing.

I wouldn't voluntarily see a PA, no.

The NHS model is often said to be about funding, but imo it's not. The NHS model is about seeing the most highly-trained generalist - a GP - first. And they do the thinking and, yes, the gatekeeping. The latter has a bad reputation but it is what made the NHS exceptionally good value in the past.

Of course GPs make mistakes. All health professionals do. But far more often, they hold the uncertainty that goes with a caseload that could be absolutely anything, all day long and quite often, far into the night and at weekends. I could walk into a GP's office with a question about my fungal toenail and end up starting medication for something life threatening, because I'm seeing an incredibly highly trained professional. They hold that possibility.

The constant desire on the part of governments to fiddle with the 'best trained first' model is heartbreaking. I actually don't even think they mean to destroy the system, they just think it looks easy, a GP saying 'hmm... thats probably nothing to worry about but come back and see me quickly if it hasn't gone in a month' and NOBODY TALKS about the amount of experience, thought and training it takes to do that safely because it doesn't LOOK exciting.

PAs should, if they know how little they know, refer to specialists and for tests more often than GPs. (Evidence shows that they do, though probably not as often as they should). That's going to cost us as taxpayers more. But they can't move to Australia on six figures, and the people they see will have 'got an appointment' and may complain less to their MP, until of course they're misdiagnosed.

I'm interested to see that there is a role called Doctor's Assistant which sounds brilliant - the GP says 'right, I'm prescribing this drug and referring to that service' and the DA gets on with all the paperwork and chasing while the GP or consultant sees the next patient. That is what PAs should be doing imo.

I'm a nurse and advanced clinical practitioner- i wouldn't see a PA.