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Physician associates

Bruce Stephens said:
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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The good news is that ARRS is being altered to allow GPs to be hired. (A symptom of grown ups in government trying to sort out the mess.) Registration needed for that site.

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Leadinglights said:
Thank you, I suspect it is a way that the practice doesn't have to pay for a actual GP. Both I have seen have been OK, I have never actually seen my actual doctor, other than when he did the Covid vaccinations.
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The pay issue is certainly one of the reasons they are around. Key question, in my opinion, is whether the person you're seeing is regulated. PAs are not.

I actually had an health issue a couple of weeks ago where I put in information about that condition to my GP website. Result of that was a call back from a GP to discuss and, following that, a face to face with a non GP at surgery. He had a paramedic background but was regulated. (Yes, I did ask, and yes, he was fully aware of the controversy and was fine with me asking. He confirmed that my particular surgery doesn't use PAs)

Main thing for me was that my initial contact had been with GP who'd then passed me on to someone he considered appropriate. It's where you have PAs making decisions beyond their expertise that it gets ugly.
 
I must admit the rolee of PA does concern me, especially as I can see the well used phrase 'lessons will be learnt' after some dreadful error. Sigh.
 
Rob Oldfield said:
Not sure why previous thread is now locked but can be found here..
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I think threads that haven't been touched for a while are automatically locked now. (We used to have people responding to zombie threads where the main participants hadn't visited the forum for years.)
 
Rob Oldfield said:
That makes sense. Thanks for confirming.
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I’ve merged the threads @Rob Oldfield, so it’ll be unlocked now for a while.

All dormant threads (with no activity for an extended period) are now being locked automatically, which has significantly helped reduce spam on the forum 🙂
 
CliffH said:
The BMA is the trade union for medics and so it will always oppose any development that it thinks may lead to a reduction in pay for its members.
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And you'd agree that they should also be opposing unregulated staff carrying out an undefined range of medical procedures?
 
Rob Oldfield said:
And you'd agree that they should also be opposing unregulated staff carrying out an undefined range of medical procedures?
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An alternative might be for them to agree to supervise those staff carefully and thoroughly as junior colleagues, rather than seeing them as competitors.

A parallel is my own profession: Clinical Psychology. Years ago the shortage of Clinical Psychologists in the NHS led to the profession creating the role of Assistant Psychologist: people with a Psychology Degree who work with close supervision from a Clinical Psychologist. The advantage is that many more people can now receive a level of psychological support from the NHS. A downside is that, with the proliferation of cheaper alternatives, the pay structure of qualified Clinical Psychologists in the NHS has become flattened over the years, so that promotion is much more difficult now than it used to be. Sometimes, what's best for NHS patients isn't necessarily what's best for NHS staff.

Another alternative, of course, is to make more use of nurses and recognise that the days of (female) nurses being regarded as (male) doctors' handmaidens is long gone.
 
CliffH said:
I think that all health professionals (whether in the NHS or private) need to be regulated - which includes ensuring that they have appropriate training and ongoing clinical supervision.
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Agree - but this is the UK so we have to be grateful to get seen by anyone with a white coat. Yesterday the practice nurse told me 3.9 mmol/L was out of range and I should eat carbs if I go that low. Also been told I don't need a glucometer if I have a CGM (so how do you check for outliers?). NHS-RIP
 
Jasmin2000 said:
Agree - but this is the UK so we have to be grateful to get seen by anyone with a white coat. Yesterday the practice nurse told me 3.9 mmol/L was out of range and I should eat carbs if I go that low. Also been told I don't need a glucometer if I have a CGM (so how do you check for outliers?). NHS-RIP
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Yes, my daughter in her GP rotation on the first day was told to shadow the practice nurse and she noticed they were reading the urine dip sticks all wrong. When she mentioned it the nurse was totally oblivious to her mistake. This was a few years ago so one hopes the training is much better now.
In any profession you have the excellent, the good, the bad and the incompetent, it is just that in the medical field lives depend on it.
 
CliffH said:
I think that all health professionals (whether in the NHS or private) need to be regulated - which includes ensuring that they have appropriate training and ongoing clinical supervision.
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To me that sounds like very good reason to take action against the GMC as they have completely failed to ensure that is in place for PAs.
 
Jasmin2000 said:
Agree - but this is the UK so we have to be grateful to get seen by anyone with a white coat. Yesterday the practice nurse told me 3.9 mmol/L was out of range and I should eat carbs if I go that low. Also been told I don't need a glucometer if I have a CGM (so how do you check for outliers?). NHS-RIP
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Not wanting to widen the thread into a general 'state of the NHS' one but think important to remember that in 2010 the level of satisfaction with the NHS peaked (at least in recent years). And then the Tories took over. Their plan was always to move to a private model with more money to be made.

www.statista.com

Public satisfaction with the NHS 2000-2023 | Statista

Individuals interviewed in 2010 were the most satisfied with how the NHS is run, with 70 percent saying they are 'very or quite satisfied', this share dropped to 24 percent in 2023, th lowest in the provided time interval.
www.statista.com www.statista.com
 
I think there have been improvements in some aspects, once you actually get an appointment then the wait when you get there is generally much reduced over what it used to be in your would have sat there for what could be more than an hour before being called in but now you are in almost before your appointment time. Well that is what we have found.
 
My wife logged an eConsult with her surgery this morning and after keying in her symptoms was told she needed to see her GP straight away. She rang the surgery (#30 in the queue, but eventually got through) and was given an appointment for this afternoon. When she asked who she'd be seeing she was told it would be a PA, which seems odd bearing in mind what eConsult told her. Anyway, I've sent her a link from an NHS site that lists what PAs can and can't do so that she'll know if they appear to be stepping outside their remit.
 
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Martin.A said:
My wife logged an eConsult with her surgery this morning and after keying in her symptoms was told she needed to see her GP straight away. She rang the surgery (#30 in the queue, but eventually got through) as was given an appointment for this afternoon. When she asked who she'd be seeing she was told it would be a PA, which seems odd bearing in mind what eConsult told her. Anyway, I've sent her a link from an NHS site that lists what PAs can and can't do so that she'll know if they appear to be stepping outside their remit.
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If I understand right, you're saying that she's going to be seeing a PA as first point of contact (unless the eConsult was carried out by a GP?). The BMA are against that - see the bottom of page 5 of https://www.bma.org.uk/media/tkcosjt1/maps-scope-of-practice2024-web.pdf

The powers that be are, I believe, saying that PAs seeing undifferentiated patients is OK with a vague proviso along the lines of 'providing that decent safeguards are in place'. There are no firm guidelines about what those safeguards need to be.
 
My wife saw the PA, who asked lots of questions and took notes that he said he would pass on to her GP with the probability that she would be given a prescription, but without saying what that might be. That seems to me to be in line with how PAs are supposed to operate within GP practices.
 
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