Physician associates

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Rob Oldfield

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Just to flag up, there seems to be a worrying move by the powers that be to increase the amount of work done by physician associates. Issues have been coming up on Twitter for the last couple of weeks relating to an EGM of the Royal College of Physicians and today another thread indicating the GMC is headed down the same route.

A couple of links with more details:

General overview:
https://www.pulsetoday.co.uk/news/r...l-colleges-disgraceful-handling-of-pa-debate/

Twitter thread going into a statement from the GMC's medical director (including where he appears to be saying that PAs looking up diagnoses on mobile phones will be just as a good as a fully trained doctor).
threadreaderapp.com

Thread by @doctor_oxford on Thread Reader App

@doctor_oxford: Dear UK public, Yesterday, hot on the heels of widespread concern among doctors at the govt’s project of replacing NHS doctors with doctor substitutes, @gmcuk released a blog about its future intenti...…
threadreaderapp.com threadreaderapp.com
 
This was discussed on GMB on Monday morning, in studio there was parents of a girl who sadly was misdiagnosed by a PA & died.

Not seen or even heard of PA till discussion on tv, mind last time was at gp surgery was seen by Nurse Practitioner & felt very confident with them.
 
nonethewiser said:
This was discussed on GMB on Monday morning, in studio there was parents of a girl who sadly was misdiagnosed by a PA & died.

Not seen or even heard of PA till discussion on tv, mind last time was at gp surgery was seen by Nurse Practitioner & felt very confident with them.
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Yeah, I saw that as well. General consensus seems to be that PAs can certainly be a useful addition to teams, but need to be properly regulated. But GMC, the Royal College of Physicians, and NHS England are all going down the 'not properly regulated' route.
 
There are numerous universities offering Masters courses in Physician Associate Practice which are 2 years duration and require an good undergraduate degree in a health related subject.
Even a well qualified doctor will miss things due to not having time to look at the whole picture when somebody presents with symptoms.
 
Positive development today where the results of voting on various motions at the recent RCP EGM were announced. Those are quoted below. The raw data is, I think, a bit short on the full context of what each motion said but suffice to say that the overwhelming result is basically the RCP membership overwhelmingly disagreeing with the leadership and going with the idea of pausing the roll out of PAs.

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Leadinglights said:
There are numerous universities offering Masters courses in Physician Associate Practice which are 2 years duration and require an good undergraduate degree in a health related subject.
Even a well qualified doctor will miss things due to not having time to look at the whole picture when somebody presents with symptoms.
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And it does seem that the 'good undergraduate degree in a health related subject' isn't definite. Computer systems engineering and homeopathy are both ways in.

web.archive.org

Physician’s Associates qualify for courses with degrees including homeopathy and English literature

Telegraph investigation reveals universities offering the course accept range of first degrees with little scientific content
web.archive.org web.archive.org

(Much as I hate to quote the Telegraph as a definitive source, I can't see how they could mess up on reporting freedom of information requests.)
 
This has been continuing to cause outrage in the medical community. Latest is that PAs are actually performing surgery. These ones are called ‘surgical care practitioners’ but the same shortcuts have been taken with their training.

Link to the report of that happening is here: https://pubmed.ncbi.nlm.nih.gov/386...ients,no conversions or transfusions required.

Response from the Association of Surgeons in Training is here: http://tinyurl.com/ASJSM24

A quote, which is a sample of many, from surgeon Prof Shafi Ahmed PhD FRCS is:

These operations are NOT for the novice and should NOT be performed by anyone other than a trained surgeon or a surgeon in training with appropriate supervision AND only by qualified medical doctors.

We should not play with patients' lives.

This is unsafe and dangerous and needs to be stopped immediately.
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Personally I'm astonished that NHS England is getting away with pushing these schemes. I'd certainly recommend checking the qualifications of anyone involved in your care.
 
I was wrong to single out NHS England for criticism. Turns out it's happening in Scotland as well.

Job advert here https://apply.jobs.scot.nhs.uk/Job/JobDetail?JobId=127492 where the surgical care practitioners will be able to do this:

"The post involves autonomously working in an operating theatre environment – both in procedure rooms and main theatres – to perform surgical procedures independently and to lead the theatre team to deliver safe surgical care for the patient."

Professor Mamas A. Mamas (https://www.keele.ac.uk/medicine/staff/mamasmamas/) summarises:

Non medically qualified individuals that have no formal surgical training / have not passed surgical fellowship exams undertaking advanced breast surgery autonomously, with "remote" consultant supervision.
 
Blog post from Partha Kar here. Overall it's about the current state of the NHS but a lot of it relates to PA type roles.

My highlight is the part where he says "The [NHS] workforce leadership has failed - and not just failed- achieved absolute Grand Master Jedi status on the failure leaderboard."

nhssugardoc.blogspot.com

Making Horlicks...Out of Nothing At All

What an absolute unqualified mess we find ourselves in the NHS- don't we? Let's take a step back and have a look at some factual statements ...
nhssugardoc.blogspot.com nhssugardoc.blogspot.com
 
And a further tweet from Partha Kar earlier today which seems to indicate that DSNs are also under threat from PAs.

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After the death of a woman following an unnecessary procedure incorrectly carried out by a Physician Associate, a coroner has issued a Regulation 28 report. These are designed to prevent future deaths where a problem is identified.

Quote from that report: "There is no national framework as to how Physician Associates should be trained, supervised and deemed competent. This is placing both patients, Physician Associates and their employers at risk."

As I understand it, the NHS has 56 days to respond detailing what they plan to do about PAs.

www.manchestereveningnews.co.uk

Beloved gran died after 'associate' left treatment in for 16 hours too long

'They are are not doctors, and we have seen the tragic consequences of what happens when this is not made clear to patients'
www.manchestereveningnews.co.uk www.manchestereveningnews.co.uk
 
In my recent visits to my GP practice I noticed that the people I have seen are referred to as Mr or Mrs rather than Dr.
I asked today as I had thought that Doctors were only Mr, Mrs or Miss when they were consultants but I was told at the surgery thatthey were clinicians. What does that mean?
 
Leadinglights said:
I suspect it is a way that the practice doesn't have to pay for a actual GP.
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I think it's a bit dafter than that. The NHS Long Term Plan allocated some money to the Additional Roles Reimbursement Scheme (ARRS), so specific money that could not be spent on GPs (or nurses). Which isn't (in my opinion) crazy in itself: GP surgeries can be improved by having physiotherapists, pharmacists, etc.). But it seems to have resulted in quite a few GPs who can't find employment and quite a few places for physician associates (with uncertain value since they need to be supervised by GPs). It all seems a bit of a mess.
 
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