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.

@aodirjjd but in your case I suspect the nurse physio had years of orthopaedic experience and had worked in that speciality for years almost learning and picking up knowledge in the job before she ended up in their current role. And it was differentiated work - they expected to figure out what was going on. You had a fracture. Was it ok to plaster or did it need an operation. The consultant made that decision by looking at the xray.

*patients not patents!

This. Perfectly good standard of care by an appropriately qualified HCP.

Specialist nurses, who can prescribe within limits, seems a much better option.

I work in primary care and have concerns about PAs, as do all my GP colleagues. They've been imposed on us and I feel they are devaluing my role as a NP, as well as causing more work for the GPs.

Ours are brilliant and are very explicit in stating to patients they are not doctors. They have a decent knowledge base depending on previous experience - one of ours was a nurse and is very good (he actually saved a life last week recognising a PE). However I know that's not common and I do feel they are a poor substitute for a doctor.

Whilst I do feel we need to move away from the public's perception that you need a GP/doctor to see EVERYTHING, I'm not sure unregulated PAs are the way to go.

HNRTT but have seen PAs being imposed in primary care - were yours imposed or just funding provided for those roles?

Have concerns about the regulation of the roles, or absence thereof.

Agree they probably work better in acute but at the cost of development of medics.

In primary care, it appears proper debriefing by GPs will negate the benefit of the funding.

It's perhaps not so much the shorter duration of study, rather the rigour of the training that medics progress through that is absent. Medics have structured training and supervision in acute before landing in primary care. Dropping PAs into primary care without completing sufficient time in that environment is a concern.

I think it's absolutely terrifying. The fact that there hasnt been a public debate on this is also awful. The fact that our media hasnt made a fuss is also really really bad. Not only does it deskill the medical profession but it's basically the Tories trying to make up for austerity by other means i.e. we dont have enough doctors, oh well we just dont need them.

I honestly cant believe that we havent heard more. That alongside the teaching apprenticeships coming in - is the terrible way in which the government are basically hiding the fact they've driven these professions into the ground.

I wasn’t unhappy with the diagnosis and I’m sure she knew her stuff. Although it would have been nice if I’d seen someone who could/would prescribe me painkillers so I wasn’t in so much agony over the next week that I vomited a few times but who knows. Maybe doctor would have been the same.

my point was that I couldn’t have just refused to see her and demand a doctor if I had been unhappy with the diagnosis. It would have been the same if she’d been a PA in that situation.

my comment was aimed at those proclaiming they’d always insist on a doctor and not a PA. You might be able to pay if it’s non-emergency but a&e might be different story if you are assed as not needing one at triage.

The question to ask is……Would Doctors or MPs allow themselves or their family members to be treated by a PA?

I would debrief my family member about what to say, what to ask, what to expect. If the outcome wasn't what I thought it should be I would be emailing the practice. Of course if it was in hospital then I'd have no idea who they had seen.

The most ridiculous PA visit I have ever seen was a patient who had seen GP, practice specialist nurse, then referred to hospital clinic, had seen hospital specialist nurse and consultant and then referred onto the super specialist hospital having had all the tests needed. Waited months only to be seen by a PA who ordered the same tests with more wait. If id been the referring consultant in the original clinic I'd have been livid!

It seems that these days the only way to get knowledge of scandals like this to public attention is to get a TV series made about it e.g. the recent series about Post Office scandal. At that point it seems to be possible to embarrass the government and other relevant authorities into taking action.

Those involved (who should be those meant to be representing doctors) should try to get a TV company interested in this.

What on earth is the GMC playing at?

I think there are far too many extra, not very useful people who have been added into all processes between patient and GP. It all takes up time and money and often the patient isn't much further forward.
For example, getting a repeat prescription for an extended period for travel or similar has become such a performance. Three weeks of emails, phone consults, receptionist messages, practice pharmacist phone calls, several trips to the surgery/chemist and still ending up with insufficient, wrong meds. Pre-covid it was an email to the surgery, collect meds from pharmacy 48 hours later. IME the more people you introduce into a process, the more potential for error.

Sorry I mis-typed, it's 40%

There has been a flood of funds into GP practices which is ring fencedfor PAs and cannot be used for doctors.
Some practices that previously used locum doctors have replaced them with (free) PAs.

There are doctors who cannot find work and interstingly a qualified doctor is not allowed to work as a PA. So if you are a fully qualified junior doctor on say £30000 you are not allowed to apply for a job as a PA (starting pay £52k).

Training is an issue as well.
PAs and trainee PAs taking up training spots instead of medical students or junior doctors. My niece is a med student. One of the things they have to do is observe and practise skills and get them signed off. They are finding themselves at the back of the queue with PA students getting priority. At the trust where she studies the PA students are allowed to hang around in A&E to observe and practise skills but the med students are not permitted to do the same under threat of being reported .

The OP first post sounds odd...GMC does not inspect doctors . They are the professionals regulatory body.
Cqc inspect and the the decision to have PA come under regulation is positive.and the decision it was to be done by the GMC was made by DoH.
Currently unis can offer the two yr course and no one is quality assuring these courses.
The GMC do not just rubber stamp courses, they quality assure and approve curriculum and decide on the standards required.
This is what happens with medical schools.
So on the good points... regulation will establish standards for PAs and the public will have somewhere to go of they feel a PA has fallen below these standards... including mis representing themselves.
I agree though the insidious dumbing down of our medical workforce is worrying.
I'm a GP and I have only met PAs who clearly believe they are doctors or equivalent to doctors and had no insight into the limits of their competencies.

As per the other thread at my practice they always introduce themselves as PA or ANP. I've had much better advice and treatment from then thznthe Consultant who refused to investigate and listen to me for over a year and guess who had cancer! Also remembered just now that a GP diagnosed me with piles and turned out it was a peri anal abscess.... Just the other day the PA managed to sort out the thyroid medication the Oncologist hadn't bothered to arrange.

My niece is a physician's associate while she waits for a place (Sept) at her preferred medical school. She has a first and an MSc from Reading

She's gained two years valuable experience on a renal ward and cleared some student debt before going on to the exact training as a doctor that she wanted.

It's worked for her.

There is an overall push for the NHS to be staffed by cheaper and by implication less experienced and less appropriately trained clinical staff of which unsupervised PAs are part of. I have been practising now for 30+ years and feel at my clinical prime, I know what I don’t know and have seen most clinical scenarios in my specialty and their outcomes but I’m also at the top of my salary band so relatively expensive. I have had patients who have been told by unsupervised PAs they have conditions which are serious without actual investigations to confirm the diagnosis. AHPs are regulated by HCPC but who regulates PA who have the potential to cause more harm than most AHPs. Unfortunately experienced clinical staff are leaving the NHS in droves as their terms and conditions are being constantly hollowed out only to be replaced by those with much less clinical experience and training. I agree with the lawyers but they unlike most people can probably afford private medical care. Unsupervised PAs are probably symptomatic of where the direction the NHS is heading; to make the NHS treatment so poor and scary that most people are forced to go private to get reasonable safe medical treatment

I looked this up yesterday on the nhs website. There was a page with a young man describing his career path:

https://www.healthcareers.nhs.uk/explore-roles/medical-associate-professions/roles-medical-associate-professions/physician-associate/real-life-story-andy-king

So he didn't want to study medicine so studied zoology as his undergraduate degree instead. Then took a gap year and worked as a medical receptionist before being a diabetic HCA. He then did his 2 year postgrad PA qualification.

I don't know about anyone else, but someone whose main degree is in zoology is not who I'd want let loose on me after only 2 YEARS of actual medical-related study.

Sorry, my use of terminology wasn't great there. As said I'm not from a healthcare background at all and I think most of us non healthcare workers don't properly know the difference between all the NHS bodies such as the GMC, CQC, RCN and all the others. I appreciate my friend works for the GMC and it has a lot to do with doctors - just don't fully the ins and outs of everything as a lawyer and that's another layer of complication I don't understand as I have no legal background eihter. Thanks for clearing things up!

We are talking about roles not individuals. You could say that about any profession. Some will be better than others. However, the point is that the doctors and nurses are appropriately qualified for the scope of their job. The same cannot be said about the PA role in its current form.

It feels like the anger about the use of PAs is directed towards the PAs themselves but they aren't employing themselves. They are being employed to work by other healthcare professionals and managers. If they are being asked to do work outside their skill set then that's on the employers.

One of my dc is a Doctor and I know how hard they have worked and how much training and studying goes into it. (It's never ending!) however PAs aren't some thickos picked up off the street. They receive plenty of training and supervision to do a wide breadth of work.

Noteworthy when asked what he would like to change about his role, it would be to be able to prescribe meds to put the pharmacology unit of his course into practice and it would be less time consuming that waiting for a GP to sign it off. This sums up the huge issue in this - PAs are not doctors and one pharmacology unit in a two year course doesn't give you the skillset to diagnose with the necessary depth of knowledge and holistic view of the symptoms - that's what five or six years of med school and a GP pathway gives you. Where does patient safety figure in this?

I have no doubt there are some excellent PAs. I don't think anyone is saying they are all thickos. However they are not doctors and a key element in any profession is to know what you don't know and some people are better at that than others. The PA role needs to be more clearly defined and regulated so that parameters are set and adhered to as to what is safe for the patient. That should be non-negotiable.