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.

Anybody who values their health and health care should refuse to see PAs.

But nurses have a regulator. The PAs arent under the regulatory body yet.

Its not necessarly a bad idea but its been rushed through without safeguards in place.

The thing with specialist nurses is that they have had 3 years nurse training and then many more years gaining experience. And then they are working in a specialist area. And they spend a year on a really difficult course to be able to prescribe. And then the medications they prescribe are generally limited to the specialist area they work in. They have had far more medical experience than a PA before they get these roles and I value specialist nurses highly.

I’d be happy to see a PA or a nurse for something minor like eczema or a tummy upset. There’s not much than can go wrong really, it’s obvious what the problem is and even if they get it wrong it isn’t life threatening.

I would not however be happy to see a PA for something serious like suspected cancer, or symptoms where I wasn’t sure what was causing it and needed an actual diagnosis. I would want to see a proper qualified doctor.

Fortunately there are several doctors at my practice who’ve been there for a long time so I know they’re doctors. I ask for them by name and wait longer to see them. I don’t see the other staff who I’m not familiar with because I don’t know if they’re actually doctors.

I bet the rich with private medical insurance don’t see PAs though. Just us plebs, it doesn’t matter if we die.

And regarding PAs in GP. The government chose to invest in staff in primary care... but not doctors and nurses but other staff like PAs. If GPs wanted additional staff to see patients to meet demand they had to have them. In a practice that was struggling recruiting GPs anyway taking a GP out to supervise a PA wouldn't really end up with more appointments if done properly. Ideally for safety reasons you would go in and reassess every patient again but clearly this isn't possible or helpful. So a GP (or consultant) relies on the story relayed by the PA.

I have a family friend who is a PA. I don’t mean to be harsh, but she isn’t that bright (but studied hard for her exams) and has really poor people and listening skills, yet she’s trained and working as a PA. I am conscious at work she could be a very different person, but if it wasn’t for her, I wouldn’t be as concerned for PAs as I am and really don’t want to see one.

There is absolutely no comparison between a specialist nurse and a PA. It takes years of training and experience to be a specialist nurse and the role is very strictly defined.

But that's the problem. Symptoms of a tummy upset depending on age could be anything from infection, bowel cancer, diverticulitis, coeliac disease, Crohn's disease, and a whole host of other things. If the PA is just in the mindset of "this is an infection" then important diagnoses will be missed.

Yes I spent the whole of last year trying to get an appointment with a GP about some ongoing health issues that were having a severe impact on my life. Kept being given appointments with a PA who was not at all knowledgeable about my particular issues, didn’t have the authority to prescribe what I needed and couldn’t make the relevant referral.

Ultimately, I ended up seeing a private GP who referred me to the correct specialist straight away and I was prescribed the medication I needed within weeks. I feel sad and angry that I had to do this- the NHS is completely broken as far as I’m concerned.

The whole system of PA’s is quite alarming- patients are not made aware that the person they are seeing is not a GP and so many people must be going without treatment they need because of this. The public are being deceived into thinking they are seeing a GP and then denied support and medication when the PA either misses the issue entirely or doesn’t make the necessary referral/prescription.

You are right to be alarmed OP in my opinion

My children are drs and I’ve been hearing about this from them and their friends for several years .

I will be asking each and every time whether I am seeing a dr or a PA - it can be very difficult to tell the difference from what I’ve heard .

Physican assistant is a better term as it is clearer for patients and that was the term originally mooted . Why has it changed ?

I have no problem at all with nurse practitioners- they are specialist in a particular area with years of experience plus patients understand the differing roles of dr and nurse .

Personally I would want see a dr if I have the choice of dr or PA and I don’t care how ‘nice’ the PA is

https://www.healthcareers.nhs.uk/explore-roles/medical-associate-professions/roles-medical-associate-professions/physician-associate

It’s easy to say you’d rather see a GP than PA but you might not have a choice. You ring doctors office for appt you say you need gp they say PA is enough and GP has no appts this week anyway then what can you do except go private?

I’m afraid I would have to go private -
this is my concern
They are building a two tier system

I've been to see a PA once and it was terrible.
I had a cerebral spinal fluid leak (it hadn't been diagnosed yet) and she told me I just drank too much caffeine and refused to believe it could be anything else.
She took my blood pressure and it was really high and she said "no wonder you feel rubbish, your blood pressure is low".
I said "forgive me but isn't that reading stage 2 hypertension?" She went bright red and said "oh, that's low for your age group".
I replied "no it isn't, that's actually very high".
She sat there in silence for a moment and then said the appointment was over.

I saw a GP a few days later and told her what happened. She put me on blood pressure tablets and I was in hospital for a week with the CSF leak.
The PA no longer works there.

Why on earth are PAs paid more than junior doctors? I assumed the point of this was to save money?

Or is it that PAs are much cheaper to train, so the government are saving money in the long term?

It’s outrageous. If I was a junior doctor I’d be seeking work abroad as fast as I could. What an insult to their 5-6 years of gruelling study.

I think this about some doctors and nurses too lol. If you've ever worked in a hospital, you'll meet some...professionals who will absolutely terrify you and make you wonder "How the hell did they ever qualify..."

@fireflylara why do we think that GMC will ok any old rubbish training scheme for PA’s but we trust them to regulate doctors and nurses? Surely GMC getting involved will improve things?

Why are PAs being paid more than doctors who have trained for 5 or 6 years?

It’s outrageous!!

No wonder doctors are striking. They’re already poorly paid and the. On top of that they’re doing the prescribing and supervising for people who have barely had any training.

Apparently there are PAs who work in anaesthetics. Imagine being anaesthetised by someone with 2 year’s training!

@aodirjjd

actually I’ve just noticed there are PAs for anaesthesia! So maybe I wouldn’t have the choice
How terrifying

@BringBackSunshine
Cross post !

I agree! This was absolutely my experience- I spent an entire year trying going back and forth trying to get an appointment with a GP instead of a PA. Because our surgery only allows patients to book appointments via the app (which doesn’t tell the patient anything about who they are booking the appointment with and gives no choice) I would end up repeatedly wasting my time having appointments with PA’s who couldn’t help me.

This is what forced me to go private in the end which is something I was trying to avoid as we are already struggling financially. I feel for everyone who just don’t have that as an option at all and have to live with debilitating symptoms because they can’t get the help they need. It’s no wonder that we have so many people unable to work in the UK because of health issues.

They should be introducing themselves as. a PA, or wearing a badge that clearly shows their role or both. They should be well aware that patients will assume they are doctors and mitigate that by pointing out that they are not Totally inappropriate. A PA in my mind is to help doctors with the administrative side of medicine, not masquerading as being qualified in medicine when they are clearly not.
Typical everything done on the cheap by this government.

That’s AWFUL and a classic sign of what will be happening all over the place with PAs unaware of the limits of their limited knowledge. Terrifying.

They are building a 2 tier system. The direction of travel for GP at least is to bring GPs all under the regulation of the hospital with PAs paramedics etc providing initial consultation. A GP would supervise a large number of them remotely at one time.

If you want continuity of GP care then you'll need to go private.

GPs are against it but feel powerless and it won't surprise me that there will be an explosion in private GPs much like we see for dentists.

And I don't think voting labour will help. Wes wants to get rid of the GP partnership model. I'd hazzard a guess that those patents who can only get to see a PA are registered with a conglomerate type GP practice, run by a huge organisation rather than a small GP practice run by the GP partners.

I saw a physio nurse when I went to A&E with a badly broken limb. It was the weekend and a orthopaedic surgeon checked my X-ray on Monday to confirm yes it was broken and no action required apart from what had already been planned . I doubt making a fuss then who have got me in to see a doctor.

What’s most concerning is how this very dangerous system has been widely introduced by stealth! PA’s masquerade as GP’s so many patents are completely oblivious. I have seen nothing at all in the media about this, no street protests and I know very few people who are even aware that it’s happening.

It’s deeply worrying that the only way people can get reasonable quality healthcare in the UK today is if they can afford to pay privately. Effectively, this is the dismantling of the NHS right here and now.