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.

When the university associated with our hospital started PA training it was sold to us consultants as Physician Assistants. Nice and clear. And somehow, mysteriously, it has transmogrified into Physician Associates. Which is clear as mud. I have no problem with a competency based workforce. I have been heavily involved in training up some of our excellent nurse practitioners. But the PA situation is frightening. Especially as some (not for a moment saying all) seem to be happy to be misperceived as actual medical practitioners.

PAd are unregulated and really should not be seeing patients in general practice . I live our nurse practitioners and GPs and would not see a PA

I have worked alongside them within a high dependency unit. They were part of the wider medical team and work with the juniors/regs/consultants.

Those that I knew were incredibly knowledgeable, skillful and professional within their limitations. Some being more approachable and caring then the doctors.

Maybe they are a band aid to fix a bullet hole... Similar concept as a nursing associate I suppose.

But personally I view them as a valuable member of the wider healthcare team.

There is massive concern amongst doctors about PAs.
Not only do they only do a 2 year training course they don't do the rigorous exams that medical students do It's a multiple choice test with a 49% pass mark.

They were originally called physicians assistant and supposed to take basic work off doctors to free them up. Along the way they have been given huge responsibility. Medical students are pushed out if training opportunities in favour of PAs.

The government have given GP surgeries chunks of money that they are not allowed to spend on doctors, only PAs. Doctors are out of work because of it.

A fully qualified doctor is paid £20k less than a PA.

There is a scandal brewing that the GMC have facilitated all this for money.

The BMA (doctors union) have published guidelines that they believe in no circumstances should a PA see undifferentiated (as yet undiagnosed) patients and should never see children.

Interestingly recent guidance (note guidance not rules) from the BMA state that PA’s should not be assessing patients with undifferentiated illness (ie pretty much anyone presenting acutely to general practice)! I’m not saying PA’s don’t have a place, and undoubtedly there will be some very good ones. But as a GP would I employ one? No. It would take half my day to supervise them/take responsibility for any prescriptions etc.

The real major issue here is primary care is under funded. “New” money coming in may allow groups of practices called primary care networks (PCN’s) to employ allied healthcare professionals, but there is NO money to employ new doctors. Increasing staff costs means therefore less doctors, more “other” staff, who the doctors have to supervise therefore allowing them even less time to see the patients themselves.
(for context, the minimum wage rise is going to cost my practice £28,000 in staff pay rises.. giving everyone a rise to a bit above the new NMW as let’s face it no one would work on GP reception for NMW with all the abuse they face when they could be doing something much easier for the same money. This 28k is NOT funded and comes directly from practice money. We thankfully have a member of staff leaving who we will not replace to fund it, otherwise we would be looking at making someone redundant).

I am a long way off retirement but seriously reconsidering my future as a GP with the way things are going.

Seems crazy that PAs can see patients in general practice were there are 1000s of possible problems and real GPs need years of experience to diagnose.

If PAs have specific training in and work in one a specialist area (like nurse-practitioner), I can see the value. But not as generalists.

49% pass mark on a multiple choice exam? We may as well be seen by a donkey.

I'm sure that there are good ones and bad ones, just like doctors, but it annoys me that most of them in the hospital I work in are happy for the patients to think they are doctors! What happened to 'informed consent'.......it should be made clear at the beginning of any interaction that they are NOT doctors. They shouldn't be wearing scrubs like doctors but have their own uniform like HCPs that distinguishes what they are. If a patient calls them doctors I correct it, even in front of the PAs who don't like it. I do think they should be called physician's assistants to make it crystal clear to patients who they are dealing with.

PA saw my 3 year old for a cough and temp for 3 days. Told me it was viral and to ride it out.
Nothing heard on her chest.

2days later getting transferred from urgent care via ambulance because they have pneumonia!

I'm so glad to see this thread.

A few months ago I was trying to get an appointment for my young baby and the receptionist tried to offer me an appointment with a PA. I said I wanted the baby to see a doctor. She spent the next 5 minutes quite rudely insisting that PAs were THE SAME as doctors and had the same qualifications!! I was so angry and couldn't believe what I was hearing.

Apparently she's studying to be a PA so knows all about it. I really should have made a formal complaint because if I was someone who didn't know better, I would've believed the utter crap she was trying to feed me.

I refuse to see a PA after the last one pretended to be a doctor and told me they would not look at the cyst I had growing near my labia. Apparently I needed to go to a sexual health clinic instead despite previously having one looked at by my GP and having antibiotics prescribed by them.

Grr now I'm all worked up at bedtime!

I worked as support staff for a university who offered the then Physician Assistant course. Wonder if it was the same one? It was in London.

Ironically, out of the hundreds if not thousands of students who crossed my path over the years, the most difficult, unpleasant, heartsink student of all was studying to be a PA. I genuinely thought they needed to be kicked off the course. They had issues.

It’s extremely, extremely concerning.

I was reading Dr Rachel Clarke's TwitterX thread earlier about this. The GMC are heavily pushing Physician Associates. Incredibly, the GMC's Medical Director - also the body's Director of Education & Standards - appeared to be suggesting that, basically, doctors don’t need to know so much nowadays because they can look stuff up on smartphones! It’s unbelievable. Quote attached.

What’s behind all these manoeuvres? because it all seems highly dodgy to me.

The job title or how they are referred to in short as PA can be confusing.

I know a lot of PA's working in healthcare - Personal Assistants as in office/secretarial. i.e the doctor's PA is a secretary, not a physician's assistant.

The former was there first and the PA's have that as their job title - that existed long before this physicians assistant role.

A PA to me is a secretary and always will be.

I also saw a PA a few weeks ago when I had an ear infection. She asked plenty of questions, listened to me and looked in my ears.
She prescribed antibiotics but the GP had to authorise before it was sent over to the pharmacy.

I am a GP of 30 plus yrs.
I am in New Zealand and haven’t appeared here yet - but we are watching Uk space.
it’s horrific- the most dangerous place for a PA to be is seeing undifferentiated illness in the community.

You should make a complaint- it's not too late .

I don't see how they save GPS time at all, if they are being properly supervised.

The whole thing is scary. They are less qualified, less regulated, less accountable and seem to be paid more.

My fridnd is gp and she is retiring early as she doesnt want to be accountable for supervising a team of PAs twork from what i understood.

It doesn't bother me so much having them at the GP surgery because I don't find GPs particularly helpful for anything complicated anyway. It's all very...well...general. Non-urgent.

I would be more concerned about seeing one in A&E where timing and urgent diagnosis is essential. I had to take my brother with LD to A&E with a crippling headache (after the GP told me on the phone to take him to A&E) where the PA ordered Covid tests on him FOUR times because they kept coming back negative. She was convinced it was Covid and on discussing it with the consultant continued down the Covid route. Turns out he had meningitis. Diagnosed the next day by a doctor when I brought him back to A&E.

If the NHS insists on using them, they should just be information gathers, imo, and not offer opinions.

I think that physician associate is the wrong title and should be changed back to assistant.
They should not be anywhere near general practice. There are, however, suitable roles in hospital settings. Having said that, I think a better model would be to offer further specialist training to nurses, particularly in the management of chronic diseases, thus freeing up time for consultants to see new patients. 2 years training is not enough to be seeing undiagnosed patients. I have chronic illness and I can ring the nurses for advice any time and don't need to see my GP (apart from the usual muddle with repeat prescriptions).

DS is a junior doctor locus in A&E and there is a lot of bullying of the junior doctors by the PAs, the PAs are paid more and get preferential shifts and if the junior doctors raise any concerns about eg prescribing or requesting scans for the PAs when the doctors hasn't seen the patient they are ostracised. Its very toxic

I don't know how much of a telephone call your brother had with the GP but have you thought that maybe the GP with years of training took a history (90%) of the diagnosis and felt that meningitis was a possible diagnosis that needed to be ruled out urgently. GPs have no access to urgent tests and it would have delayed getting these by coming in to see them. In this case the GP was right to send straight to A&E but then to be assessed by someone with less experience is dangerous and insulting. Yes I agree - be the physicians assistant and do the observations, take the blood etc but not try and fit the symptoms into a diagnosis. Thats dangerous. I'm glad your brother was eventually admitted.

This is very sad and this toxic atmosphere leads to risk of misdiagnosis and mistakes. It's the junior doctor's registration on the line if they don't supervise properly and a patient dies ....not the PAs. I feel really sad for the JDs being put in this position

Yes. That's why we went to A&E. I'm a nurse. I suspected meningitis. I needed to be able to say the GP sent us so A&E wouldn't send us home telling us to contact the GP. I had no intention of taking him to the GP with this.

It was the PA who dismissed meningitis and focused on Covid, which clearly had an impact on her telephone discussion with the consultant who agreed with it being Covid, despite four negative tests, and sent us home to isolate.

There is absolutely nothing wrong with PA and with their training. The issue is that they are being asked to do things they shouldn't and are not being supervised correctly.

Posters are complaining about them in GP settings but it's the GP surgery who are employing them and the GPs who are supervising them.

We already use specialist nurses to do all sorts of things that could be done by doctors but for some reason that's ok but it's not ok for PAs. For example some nurses can prescribe certain drugs. There is no reason PAs can't do similar as long as they are trained properly and supervised.