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.

I wouldn't see one asI have a complex medical history. It's bad enough explaining things sometimes never mind to someone who doesn't have the training a GP does.

Unfortunately many PAs aren’t adequately supervised or supervised at all by doctors which is where the concern is. NHS trusts and GP surgeries are using them to fill in for doctors roles because they are much cheaper than doctors

Out of interest what additional courses does a prescribing nurse do before they can prescribe?

It is the subterfuge that annoys me. I spoke to one on the phone, not knowing she was not a doctor to begin with, but it did not take me long to work it out as I knew what she said was wrong. When I asked her whether she was a doctor, she fessed up.

I've done a non-medical prescribers course as a registered nurse- the V300. A Masters level academic year long course. More info here as an example. https://www.shu.ac.uk/study-here/options/health-and-social-care/short-courses-and-modules/nonmedical-prescribing-v300--level-7

This is off the back of years of practice, as well as diplomas, degrees and certificated accredited courses.

I saw one who introduced himself as "one of the physicians".
I knew what he was but didn't argue as I was feeling very unwell.

"Then consulted with a GP", this is the issue, fully trained doctors need to sign off on them. I’ve listened to many a rant from a family member who is a hospital doctor about this. The ultimate responsibility is passed on to the 'real' doctor.

Different profile entirely. All the ANP's I know have had years of nursing experience before ANP training. You don't send newly qualified nurses off to be ANPs. They tend to a huge asset to the health service - experienced, very knowledgeable in their field, passionate about being nurses and very clear on where their role stops and other roles start. No issue at all with them prescribing.

The trouble is that we don’t know what we don’t know.

A PA will have done a science related degree at undergraduate level - this might not be health related but could be something like zoology, then a 2 year PA course which might be a lot of distance learning and surprisingly little face to face clinical learning.

A GP trainee will have a medical degree as well as several post graduate years of work in medicine behind them.

PAs are supervised by GPs but if hey don’t understand the relevance of what patients tell them and what they pick up on examination they’re not going to present that I forgo the supervising GP. This leave the GP in a very vulnerable situation too.

The recent cases in the press only go to show how dangerous this cost cutting move is.

Agreed, a big part of a medical degree and F1/F2 is understanding the human body holistically - studying all the systems and how they work together and how they can go wrong and how a symptom somewhere can often be caused by something else going on elsewhere. Diagnosis is complex even for qualified doctors. A holistic perspective is hugely important and it is common sense that someone without this depth and breadth of training is likely to misdiagnose and incorrectly medicate. In a nutshell, beyond very rudimentary ailments, any level of supervision by a doctor, short of being in the consulting room with the PA is insufficient for diagnosis and prescribing.

I saw a PA for a bad neck etc that I’ve mentioned on here. The advice in here was to also give me a low dose anti d which he hasn’t done; he’s given me naproxen though. I’m tempted to go to a GP now reading this.

Right but looking at that uni website you don’t need years and years experience. You just need to be a qualified nurse or a physiotherapist or a bunch of other roles (none of which have higher entry grades to study than PA) and it’s a 30 credit course which is one day a week study for 6 months plus two weeks supervised work (90 hours). So not really a full year masters as a full masters is 120 credits.

I’m not doubting you’ve got qualifications coming out of your ears and I’m sure nearly all prescribing nurses are smashing at their jobs but it’s still not really making sense to me why we trust nurses to be conpentent without a 5 year medical degree but not PA’s.

Today I’ve learned you could do train as a physiotherapist and go onto prescribe medication which is slightly disconcerting as I presume they wouldn’t even study pharmacology as part of their undergrads.

@AquaCrow

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.

Nobody except a doctor has had enough training to work as a doctor. That's the issue here. PAs are working as doctors, but they're in no way qualified to do so. Also, some of them seem to be deliberately creating the impression that they are actually doctors. It's outrageous, and really very frightening to see that this is the way our medical care in this country is going.

@aodirjjd

Right but looking at that uni website you don’t need years and years experience. You just need to be a qualified nurse or a physiotherapist or a bunch of other roles (none of which have higher entry grades to study than PA) and it’s a 30 credit course which is one day a week study for 6 months plus two weeks supervised work (90 hours). So not really a full year masters as a full masters is 120 credits.

You're absolutely right. I never said it was a Masters, just at Masters level i.e. level 7. You also need to be at least a year post reg and have experience in the area you will be prescribing in with appropriate support and supervision. It's quite an expensive course, relatively speaking, so many employers won't fund it unless they're sure it's in their interest and to their benefit!

I think for many, the issue is PAs are unregistered - currently they don't have a PIN/registration number, aren't accountable for their own practice, don't have a code of conduct and don't have a regulatory body. That's the concern as much as potential lack of knowledge and training.

I've had a very poor experience that significantly delayed my care. I'd already had an endometriosis diagnosis but had a worsening of my condition. I was told that the appointment would be with a PA and I checked if they were able to make referrals and was told they could, so I accepted the appointment. I simply needed a referral back to gynaecology.

However, they wouldn't do it and insisted that I had a full panel of STI tests (despite me saying this was extremely unlikely given I'd been with my partner for several years and was quite sure he was faithful). And the fact that I had a diagnosis already! Woman in committed relationship with endometriosis reports pelvic pain, hmmmm must be an STI...

Then, because the sexual health services were all closed or closing it took me months and months to actually get an appointment. Panel comes back clean. What a surprise. So then I go back, make sure I get a GP this time and the GP barely even listens to what I'm saying because it's so clear from the first couple of things that I just need a referral!

Of course,in hindsight I should have just ignored the STI test demand and made another appointment to see someone else much earlier. I thought that they would think I was being obstructive or something...

If a doctor has to OK the PA decision then they will need to be sure that they safely can or their insurance and registration will be in jeopardy. And it does not save time.

I've had a very poor experience that significantly delayed my care.
Same here. I saw a PA after stomch problems, weight loss and vomiting blood. He said he didn't want to refer me for endoscopy because "they are not very nice" and I should come back in a couple of weeks if no better. I made sure to see a GP next time who referred me on a 2ww.
Luckily it was not cancer.

Do you all know that GMC staff get free private health care. Just think about that. The organisation whose sole purpose is to ensure that doctors are practising safely, mostly in the NHS, do not use the NHS themselves!

The only comparison is what they are paid - a newly qualified PA, who might have a law degree and a 2 year generalist MSc with a 100% pass rate, is paid the same as an experienced Nurse specialist who has a 3 year nursing degree, at least 3 years of post qualification experience and a more demanding, specialist, qualification focused on their specialty.

This is a helpful video which captures most of the issues.

For those saying PAs are not thick, most will not be, but some on Tictoc are terrifying. There have been leaks of WhatsApp chats of PAs discussing diagnoses on which my first year medic son could see that several suggestions were inappropriate, and some downright dangerous!

It is also worth knowing that there are now many (hundreds if not thousands) unemployed GPs who can't get work because the general GP funding has been cut back so much that practices have to take the free staff offered by ARRS. Some GPs have been made redundant so that practices can use free staff, one is now an Uber driver because he can't get work. There is also a huge problem with the number of training posts available to doctors who have completed their foundation years, but like a big game of musical chairs they can't get a training post because there are not enough, and it is getting worse. So there ARE enough doctors coming through, but some are not getting jobs and others are choosing to leave because they can earn twice as much whilst working 30% fewer hours and being treated with respect in a system which is not at breaking point.

There are now senior doctors, such as Rachel Clarke (who wrote Breathless) mobilising to try to get things sorted, but the people who SHOULD be saving the NHS as we know it appear to be deliberately destroying it.

I think they're a liability.

They do two years of training and are then fully qualified. Compare that to a doctor who does 5 years of medical training, then 2 years of foundation training, then either 3 years of GP training or 6-8+ years of specialty training to be a consultant. So a minimum of 10 years to be a GP of 13 to be a consultant, but often more with extra years of additional training added in.

Someone with two years of training cannot do the same job as doctor who trains for many many years. They don't have the depth and breadth of knowledge that doctors have. They may become more able to work in whatever specialty they're in the longer they do it but given the fundamental lack of a wider medical knowledge, they will always miss things that a doctor won't.

I am a GP and made this video to help increase public awareness around the PA situation in the NHS:

Thanks @SophieNewton for this excellent video and for speaking up.

It is healthcare on the cheap from this govt.

worryingly, there has been huge scope creep from the PAs and they are being used as substitute doctors. They replace doctors on rotas, hold emergency bleeps etc.

I don’t know why there isn’t more attention in the national media about this frightening issue.

there is obfuscation around their role. They wear stethoscopes and scrubs and look like doctors. A national uniform would help. I tell my family members to ask to see a doctor.

there is a role for them, but not in general practice seeing undiagnosed patients at the front door. Also not in A&E where they also see undiagnosed patients. A newly qualified doctor is not permitted to work in the emergency dept as they are deemed too inexperienced- yet a PA with a 2 year course (vs 5 year medical degree) is allowed to??

agree with your thoughts re 2 tier medical system.

Haha, I just posted that in the thread before you did! Great video.

Oh great, thanks! 🙌🏻