Doctor Parent Help

[mumsneedwine]

Here you go

So the money is there to employ 100,000 PAs (NHS workforce plan) but not increase speciality training posts - which earn £43,000.

Even if the strategy of making all PAs redundant to increase training numbers were possible (unlikely as the funds would be be used within the trusts and practices) then the bottle necks would be just shifted up leaving CCST junior doctors in their 30s with no substantive post. Increasing training numbers does not not mean that there would be sufficient funds to create the equivalent number of consultants and GPs.

sendsummer (or indeed anyone) this is very much back of a fag packet stuff but dividing down the numbers by years in post, it looks (to me - major caveat!) as though approximately one in three get through to Specialty Registrar at the moment and then masses stay at that level thereafter. So very much the opposite of top heavy. Do you think the NHS is currently consultant lite or would you say that the balance is about right? Not everyone who goes through medical school can be cut of consultant cloth in the very nature of things (or even want to tread that path). Or do you see a lot of talent not getting where it ought?

No need to increase PA numbers. They were invented to plug a shortfall of doctors. That we don't have. Increase training places, not decrease them.

And can anyone explain this ? Why bother to train as a doctor ? You can earn more, with no rotational training or expensive exams.

"These rates are only available if covering a Junior Doctor".
So a) anyone can do their job. b) this rate would not be available for a junior doctor doing this cover. Just anyone other than a doctor.

I think the NHS hates doctors #bekind.

This.

No need to increase PA numbers there is no mention in any posts of increasing PAs, You may need to have another read of my PP to grasp one aspect that makes your logic flawed.

pivoinerose yes that ratio is about right, this gives a bit more detail.
https://www.specialty-applications.co.uk/competition-ratios/

There will be others with a far better grasp of current senior doctor gaps however shortages will be dependent on location and speciality. Also IMO there is an inefficient use of doctors' expertise. Time is being increasingly (mis)used away from direct face to face time with the patients, this includes endless forms with additionally poor software and hardware. Finally increasing senior doctors means increasing the infrastructure required for them to see patients and do procedures so again major financial implications.

In case anyone thinks PAs are 'highly trained in the medical model'. Why do we need them at all ? They were introduced to plug gaps in doctor rotas, which don't exist, as we now have unemployed doctors.

We have enough doctors and nurses. They are not providing enough jobs for them. But can afford to employ non doctors/nurses. Why ? No one has managed to explain this logic.

mumsneedwine the Partha Kar article refers to the erosion of training opportunities. Do you have any idea of the scale of this erosion and over what period it's taken place?

The refusal of leave seemingly on a whim and the late distribution of rotas are two things which I've definitely heard over and over again. They lead to a general feeling of lack of control over destiny in the short term which may seem minor but can be absurdly corrosive. I don't know quite why the pay objective has drowned out almost all other legitimate grievances that the junior doctors have, certainly it appears that way in the press and on the tv news.

I don't understand why the BMA and the Royal Colleges have not made any kind of public noise about this (let along the most almighty row, which is what they should have been doing).

Had I not learned about this situation on Reddit I'd have known nothing about it. From what I've read there it has sounded to me as though the Royal Colleges are actually complicit in the use of PAs instead of doctors, though I'd be happy to be told I'm wrong about this.

What on earth is going on? 😳

The BMA is making as big a noise about it all as it possibly can:

a) they have just launched legal action against the GMC over the way they plan on regulating PAs;
b) They also have written a scope of practice for MAPs that they believe is safe for patients, which includes MAPs not seeing undifferentiated patients in the community - ie first and foremost, the current use of PAs, leaving aside cost, is that they are simply not safe;
c) At the launch of that guidance document at BMA house, Emily Chesterton's parents were present.

The BMA keep being accused of only focussing on the money side of things (ie the 35% pay decrease), but you see here a perfect example of a case where they have been focussing primarily on the fact that PAs are simply and straightforwardly a danger to the public as currently used, regardless of how they are paid, and if you are a good example it is just not cutting through.

The BMA has also been very much talking about the appalling working conditions for doctors more generally, but the press and the government insist on suggesting it is only about pay.

The BMA also just passed, for example, a resolution regarding the problems of people not being able to manage in their fifth and sixth years solely on the NHS bursary, and highlighting that there have been medical students who have dropped out at that point because they could not afford to continue, but does that get any press?

The BMA has also been very much talking about the appalling working conditions for doctors more generally, but the press and the government insist on suggesting it is only about pay

Exactly.

Hi @Bimkom,

Then the message is definitely not getting through to the public.

What is needed is something like the ITV drama about the Post Office, but sadly those only happen when the disaster has actually occurred :-(

And the Post Office drama was only aired - what 20 years too late! The point about Emily Chesterton's parents being at the launch is precisely because she would like to have been still with us if she had been seen by a doctor.

So we already have at least some disasters known about, and it is still not cutting through

It’s wrong that working conditions should be so appalling, but I’m 62 now and for the whole of my life junior doctors have been enduring very poor working conditions of one sort or another. The public isn’t going to be terribly interested in that, although of course they should because of the impact it has on patient care.

What is different here, and critical, and what the public needs to be brought to understand, is that behind the scenes PAs are now working, essentially, as doctors. They’re in GP surgeries, failing to identify themselves as not being doctors, and they’re in hospitals working qualified doctor shifts. As you know, they are even paid significantly more than junior doctors. Junior doctors can’t get training because it’s being offered to PAs instead. The same thing - even more terrifyingly, imo - is that they are working in anaesthetics.

I realise you all know this, but most members of the public don’t. I’m not from a medical background but I know it because I read quite broadly in reliable places on the internet.

If you don’t already read it then you should start reading the doctors sub-Reddit. There’s a lot of mind-boggling information on there. What I’ve read on there has caused me to worry that the Royal Colleges appear to be complicit in what appears to be the move to ‘use’ PAs as though they are qualified doctors, in hospitals. I don’t understand what their mindset can be.

Yes, that is what I said. We only get to see dramatisations once the disaster has actually happened. I’m very clearly on your ‘side’. Don’t attack me.

It's not PAs who are creating a bottleneck on the training slots.

See this on the RCS website.

"Fully trained professionals,"?

Yes, trained to do an assistant role, but that is not the role they are performing.

Sorry, not meant as an attack, but as a support. Like you, I have no idea how one get's the public's attention.

BTW - I fell over this on Twitter/X - don't know anything more about it than what I have read there - but might be of some interest.
https://x.com/GaryWinslett/status/1807485765355511909
US facing a doctor shortage, so starting next year Tennessee will allow doctors from abroad to practice in-state. Other states are following suit.

And following up on comments etc This particular commentor explicitly thinks it will kill the NHS - suggests that our doctors are top of the list for whom they want to attract - https://x.com/xlucinescad/status/1807606824377430443

Sounds like the bottleneck there is in terms of getting training post medical school (because they seem to need Medicare funding for that - although makes you wonder what they did pre-Medicare, I don't understand the American system).

I think most of our offspring won't want to abandon the NHS unless they have to, but it does sound like there might be options other than Australia.

There is a reason why the USA residency applications have dropped in states like Tennessee - the abortion ban and its effect on training and practice.
However it is always a good idea to take the USMLE exams to keep options open.

@Bimkom
Sorry, not meant as an attack, but as a support. Like you, I have no idea how one get's the public's attention.

Apologies - I misunderstood

Anyone care to speculate on how the Labour government might approach the junior doctor's dispute?

Streeting said the BMA was his first phone call. I think they'll offer a long term solution to FPR (over 5 years) and a promise to look at training posts. It's such an easy early win to stop any more strikes, and actually costs less than strikes continuing.
If he doesn't, he's an idiot. I'm going to hope this lot are better and honest. Some integrity in government will be a welcome change.