PAs (Physician Associates) ?!

[fireflylara]

Just want to find out what people thought about this.

Recently went to catch up with a friend of mine who is a lawyer with the GMC (the organisation that inspects doctors) and she had some work colleagues round. They all were talking about physician associates ("PAs") and how they absolutely would not want to see one.

Turns out there's a big push with governments for NHS to use PAs and is funding them as a priority but they are vastly less skilled in terms of their depth and standards of education compared to a doctor as they do a what sounds like a crash course of medicine in 2 years but the courses have no quality accreditation like doctors' university courses do. They spoke about how the GMC is now also inspecting the PAs and will just automatically approve most PA training schemes even though the GMC are aware that quite a few of these have some issues.

I thought I hadn't really met any, but it turns out for some of me and my family's appointments at a GP we were seen by these PAs and we all thought they were doctors. Because I'd seen him before, I assumed I was seeing a doctor but just thought to ask and then he said he was actually a PA. He got very defensive and kept saying he is "medical" and has lots of training but I felt very uncomfortable about the whole thing. Especially as countless times we've said things like "thank you doctor" and it wasn't correct, which really misrepresents everything. I spoke to my friend again and she highlighted to try and request a doctor at the GP even though the surgery don't need to give us one. It worked for my husband when he went for a review of his problem the PA saw and he got a refferal to a specialist after the GP saw him. When I mentioned to my friend that he'll be seen with a rapid 2 week referral, she said that's because its to check for potential cancer. I looked this up and it's true. Very upset about the whole thing and trying to understand what on earth these PAs are doing in healthcare if they don't have the right training? If my husband had seen the GP 3 months ago, this could all have happened much sooner.

Has anybody else come across these PAs and what were they like? My main worry is that I am not especially qualified or educated in this and neither are my family (I work in sales, husband is in IT) and the only reason we got a heads up about this is because of my friend who clearly is very familiar on these matters even though she's not a doctor or nurse. I think she's already proven her point of saying she definitely doesn't want to be seen by one and it looks like all her colleagues were in agreement too - I just didn't register the gravity of it when I met them! Even considering moving GPs to a place where there are no PAs there to avoid seeing one by mistake which is a shame as the older GPs at the surgery are very good and nice and have helped my family a lot over the last 12 years we've been in this area.

[Hoglet70]

I'd never even heard of them until they were going on about them on GMB this week in relation to a young woman who had died after seeing one. Apparently she wasn't given the correct advice.

I have always been happy to see a Nurse Practitioner over the doctor if it means I get an appt but I think they may be better qualified anyway from what you have said here.

[Dotdashdottinghell]

I'm always happy to see a Nurse Prac,but never a PA. They are very unboundaried, are happy for people to think they are doctors.

I think their role in clerking in to hospital is more appropriate than them being in primary care.

[maximist]

I saw a PA a few weeks ago at my surgery and she was brilliant. Took time to listen to all my concerns, made copious notes, then consulted with a GP to confirm a plan of action. I was very impressed - I got to see her in person too, whereas GP appointments are over the phone which I feel much less comfortable with, especially as they won't give you a time, just morning or afternoon.

[fireflylara]

Yes, they're definitely are happy for people to think they're doctors.

I think I'll stick with proper GPs or nurse practitioners going forward for me and my family. Sounds like the safest thing and what's best for everyone.

[Jellycats4life]

There are a lot of angry doctors on Twitter complaining about PAs deceiving patients into believing they are doctors, and providing really poor/dangerous levels of care.

[ChocHotolate]

This is so weird. I am a nurse practitioner and I always start any consultation with a pt by introducing myself with name and job title. A patient cannot give consent if they don't know who they are seeing. I don't understand why PAs seem to be cagey about disclosing their role

[Sohungryallthetime]

We’ve had nothing but good experiences of anything better than with our gp as the PA seem more thorough and our go just thinks he knows best and is dismissive so I’m actually quite impressed. I think with any job you get the good and bad we’ve been lucky to have had a positive experience so far and grateful to have got appts easily .

[fireflylara]

@maximist

I saw a PA a few weeks ago at my surgery and she was brilliant. Took time to listen to all my concerns, made copious notes, then consulted with a GP to confirm a plan of action. I was very impressed - I got to see her in person too, whereas GP appointments are over the phone which I feel much less comfortable with, especially as they won't give you a time, just morning or afternoon.

yes, I thought the same! we had two "PAs" see us at our surgery. all very nice and dilligent and took notes etc. I think its just worrying if they ask the wrong questions or sell our stories to the proper doctor the wrong way, the doctor makes the wrong decision because they're given the wrong information. think I've realised that just because they are nice and professional (apart from hiding their role) it doesn't translate to them being very knowledgeable - they are separate things.

I'm glad you've got an excellent PA though! Shame you can't see your GPs face-to-face - we can at our practice and it works well. Telephone appointments at my GP mean you are seen sooner (actually these are done by non-GPs funnily enough here) but also means you then get a priority face to face booking if it needs a GP to sort it. Or we can wait a few days and be seen by the GP later in the week. Think I'm quite happy with that.

just felt a little deceived because the only reason I found out this one was a PA was because I just happened to ask quite gently saying "can I just check if you're a doctor?" just because I know sometimes the GP has young doctors with them who later work in other surgeries or set up their own. Even after what I'd heard from my friend working at the GMC, I wouldn't dare challenge somebody on their qualifications and the such (I think it's quite a compromising position you're in as a patient when you're very much dependent on their healthcare).

[Bearpawk]

I saw a PA who fast tracked me to a cancer diagnosis after getting nowhere with a gp. They were clear about their job title. don't think we should tar them all with the same brush.
Lots of gp's I've seen don't have any experience or knowledge of specific non common conditions anyway and it's so hard to get referred to a specialist, I'm not sure the PA system is much worse tbh

[fireflylara]

@Bearpawk

I saw a PA who fast tracked me to a cancer diagnosis after getting nowhere with a gp. They were clear about their job title. don't think we should tar them all with the same brush.
Lots of gp's I've seen don't have any experience or knowledge of specific non common conditions anyway and it's so hard to get referred to a specialist, I'm not sure the PA system is much worse tbh

glad to hear good experiences elsewhere - especially if not getting luck with the main GP!
But does seem odd that if people are worried about GP lack of knowledge on things, surely a PA has even less knowledge given their lesser training and experience? They might be similar as you suggest, but don't think so.

Think everyone in the NHS works so hard no matter who they are. You can tell they're always so busy and so many of us need to see them for appointments they're always in demand.

[MumMumMumMumMumMumMum]

My 4 yr old had a GP appointment which turned out to be a PA and she was bloody awful I'm sorry to say. DD has severe eczema, now under the care of the hospital, and during one of the worst flare ups all the PA could offer was 'have you tried to bribe her to stop scratching, maybe say you'll take her to the park'.... At 3am when screaming her head off in pain and has itched so much she has open sores bleeding through her pjs...yeah don't think that will work 🙄🙄🙄

[ColleenDonaghy]

There have been a number of concerning threads on here about PAs. As someone with zero medical training beyond watching Grey's Anatomy, I find it very worrying.

[fireflylara]

@ColleenDonaghy

There have been a number of concerning threads on here about PAs. As someone with zero medical training beyond watching Grey's Anatomy, I find it very worrying.

Hadn't realised about the other threads (new here). But this my worry also. I think lots of those in the know clearly seem be very wary of PAs due to their training. Lots here seem to say how nice they are too, but I think its important to separate niceness from having the necessary knowledge. I find this worrying too.

Still can't believe the worry about them from actual GMC people who are the ones inspecting them! I think that is very telling more than anything else - especially as they're lawyers of all people - so far more knowledgeable and responsible than I am.

[chocolatenutcase]

I am a GP and have concerns about PAs working in GP. A newly qualified GP will have had at least 10 years of training through uni and specialist GP training. They should have had thorough grounding in consultation skills alongside robust teaching (it is regulated) in clinical presentations. A PA will have had 2 years training. The issue is not knowing what you don't know and this is where the problem lies. PAs will know less than a GP but won't know what they don't know. They can't prescribe and in theory need full supervision from a GP. I teach my trainees that 90% of a diagnosis comes from the history given by the patient. The supervising GP is relying on the inexperienced PA asking all the right questions. The risk all taken on by the GP not the PA.
Pas often spend more time with patients because they have more time. But in the time they see 1 patient a GP could have seen 2 and in addition the supervising GP has to have fewer patients in their own surgery so they can supervise (CQC requirements) reducing availability for patients to see a GP.
Presentations in GP are undifferentiated so that cough could be anything from viral to bacterial, asthma, copd, heart failure, lung cancer, reflux, rhinitis all of which have nuanced presentation along with the cough. That's where the skill of a generalist comes in. I agree there are excellent PAs and poor GPs but the near miss rates for PAs are significantly higher.

[chocolatenutcase]

And the other unfair aspect of this is that PAs in hospital start on significantly higher wage than foundation doctors, generally work 9-5 and often require the foundation doctor who is earning less than them, to supervise them and write their prescriptions, all while working punishing shift rotas. I've read somewhere about PA development and progress to consultant level. It's all over Twitter. When PAs were introduced in USA they were never intended to replace doctors but to assist them. Physicians assistants.

[fireflylara]

@chocolatenutcase

And the other unfair aspect of this is that PAs in hospital start on significantly higher wage than foundation doctors, generally work 9-5 and often require the foundation doctor who is earning less than them, to supervise them and write their prescriptions, all while working punishing shift rotas. I've read somewhere about PA development and progress to consultant level. It's all over Twitter. When PAs were introduced in USA they were never intended to replace doctors but to assist them. Physicians assistants.

Did not realise this.
Also didn't know they can't prescribe. Looking back it always was odd that they would tell us the prescription would be ready for us in reception in 30 minutes. I just thought that it was a doctor's different way of working because all the other times when I saw other doctors, we got the prescription there and then or were told it was sent to the pharmacy. But it makes more sense now that they would need to speak to somebody in that 30 minutes to prescribe our medicines. And it turns out its not just a doctor with a different way of working, but rather they are a PA.

[fireflylara]

@chocolatenutcase

I am a GP and have concerns about PAs working in GP. A newly qualified GP will have had at least 10 years of training through uni and specialist GP training. They should have had thorough grounding in consultation skills alongside robust teaching (it is regulated) in clinical presentations. A PA will have had 2 years training. The issue is not knowing what you don't know and this is where the problem lies. PAs will know less than a GP but won't know what they don't know. They can't prescribe and in theory need full supervision from a GP. I teach my trainees that 90% of a diagnosis comes from the history given by the patient. The supervising GP is relying on the inexperienced PA asking all the right questions. The risk all taken on by the GP not the PA.
Pas often spend more time with patients because they have more time. But in the time they see 1 patient a GP could have seen 2 and in addition the supervising GP has to have fewer patients in their own surgery so they can supervise (CQC requirements) reducing availability for patients to see a GP.
Presentations in GP are undifferentiated so that cough could be anything from viral to bacterial, asthma, copd, heart failure, lung cancer, reflux, rhinitis all of which have nuanced presentation along with the cough. That's where the skill of a generalist comes in. I agree there are excellent PAs and poor GPs but the near miss rates for PAs are significantly higher.

Thank you for sharing this and articulating things so well. It's definite echo with what friend and colleagues who work for GMC were saying (!!) too. Seems strange to have the set up that we do but I guess it is what it is and we all just will need to be a bit more careful now going forward as members of the public.

[Covidwoes]

I saw one recently in A&E and she was awful. Refused to treat me because my bloods were normal, and just wouldn't look outside the box. Turned out I did have an infection after all. She just wasn't listening to me, because I didn't fit the rigid pathway she was clearly following. She also didn't tell me she was a PA, so I spent the whole time thinking she was a qualified doctor! She wasn't!

[cattygorically]

They should be called physician assistants and to not identify themselves clearly as NOT doctors is dishonest.

They're extremely poorly trained and take training opportunities from doctors at that.

Nurse pracs are totally different and much more regulated

[VivaVivaa]

Recently went to catch up with a friend of mine who is a lawyer with the GMC…They all were talking about physician associates ("PAs") and how they absolutely would not want to see one

This is absolutely damning if true. The official line of the GMC is they support the role out of PAs and eventually plan to regulate them. Its not exactly a concordant message if one of their own lawyers wouldn’t want to see one, despite arguing they are overall a good thing for healthcare…

[AnguaResurgam]

I think it is absolutely vital - and core to a relationship of trust between HCP and patient - that you know who you are dealing with - whether that's GP, nurse practitioner, consultant, registrar, junior doctor, physio, allied health professional, anything

So PAs absolutely must identify themselves as such

[WhamFantastic]

Hospital consultant here.

The PA roll out is a disaster.
Very well explained by the GP PP.

It is medicine on the cheap. Except they get paid more than my doctors in training. But are cheap to produce.

What we actually need is assistants to do the admin and clerical work. Not the current model where PAs take training from doctors and push the doctors to doing THEIR admin eg prescribing or requesting scans.
It's bonkers.

I don't know the details but i understand that the government has made money available to GPs to employ PAs but they can't use the money for another doctor. So essentially PAs are enforced on GP practices.

There is a shortage of qualified GPs and specialists but this is a ridiculous and unsafe solution.

[WhamFantastic]

Oh and the GMC regulating them with further muddy the waters.
There is another healthcare professional regulator that physios, OTs, paramedics etc are regulated by. Why are PAs being regulated by the doctors regulatory body? More confusion and deception.

[Ineffable23]

To my understanding, associate roles are generally regulated by their "parent" body - i.e. paramedic associates by the paramedics body etc.

In terms of PAs working outside their knowledge/capacity - this is an issue that should be resolved through regulation, not through refusing to regulate. Once they are regulated if they are not performing you can report them to the GMC and they will be able to take appropriate action, just as the relevant regulator can with any other healthcare professionals.

The PAs I have come across have been both knowledgeable and helpful and aware of their limitations.

[Trolltrotters]

I get that somewhere in the NHS, there could be a role for them. I'm not sure what, but I don't think consulting in general practice is it.

In my practice last week, there was a grid explaining to patients which HCP could do what. PAs could neither prescribe nor refer (according to the poster I saw). I only ever consult if I feel I might need a referral to speciality or if i need a prescription. I'd be fairly pissed off if I saw a clinician who couldn't do either and surely that defeats the purpose of the role if I then had to take another appointment to see someone qualified