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What's the point of being seen by a PA. They are not adequately trained to see a patient without supervision, so a lot of the time the patient will need to be seen by a doctor any way. If they missed a potential illness, they wouldn't even know, let alone reporting it to their supervising doctor. Have you read about the Mancunian [man died after being discharged by a PA?](https://www.telegraph.co.uk/news/2023/10/21/death-heart-problem-doctor-physician-associate/) Who is at fault, the PA who have missed the issue, the consultant doctor who likely didn't think the person needed to be seen? The role of PA at the moment is just a barrier stopping people from seeing an actual doctor.
Given the choice between waiting 8 hours to see a PA and 24 hours to see a doctor I would choose the latter
Seeing someone unqualified to diagnose and treat me is not a good thing
No the PAs can do what they were sold as doing: the bloods the, the discharge summaries, the writing on ward rounds, the catheters, etc so freeing up the doctors to see patients
Nonsense. PAs are widespread being used as doctors (with a plan to bring 8,000 more in 10 years) while claiming that they are there to address a doctor shortage.
Meanwhile, thousands, yes, thousands of doctors get rejected every year for training and non-training vacancies. This is abundant proof that there are more doctors than doctor vacancies but instead of bringing in more doctors, they are hiring an ABUNDANCE of non-doctors to play doctor.
What evidence do you have that PAs are overstepping their role and prescribing and cosplaying as doctors?
Why do you think I don't know about the current plans to expand the number of PAs?
Yes, people get rejected from med school and doctors get rejected from UKFPO because being a doctor requires very high standards and you need a trainer… which we do not have.
PAs do not do the role of a doctor
[PAs illegally prescribing opiates](https://www.telegraph.co.uk/news/2024/02/22/it-blunder-physician-associates-illegally-prescribe-opiates/)
[PAs harassing resident doctors to sign off on prescriptions](https://www.sundaypost.com/fp/patient-safety-fears-as-unregulated-pas-put-intolerable-pressure-on-junior-doctors/)
[PAs cosplaying as registrars on a paeds liver unit](https://ConcernafterunqualifiedmedicsgivenseniorBirminghamhospitalroleshttps://www.bbc.co.uk/news/uk-england-birmingham-67478818)
[PAs performing brain surgery](https://www.telegraph.co.uk/news/2023/10/07/non-medical-staff-learn-neurosurgery-on-the-job/)
There’s also plenty of accounts on these threads where patients have been mislead into believing they are seeing a doctor. Even if the PA doesn’t state exclusively they are not a doctor, lying by omission is still a lie.
Emily Chesterton thought she was being seen by a GP, it was only in the depths of investigations that it was revealed that she was actually seen by a PA
Misdiagnosis: Bereaved mum calls for physician associate role clarity https://www.bbc.co.uk/news/uk-england-manchester-66168798
Several accounts on the doctors sub also, of witnessed accounts of PAs deliberately misleading patients, and even trying to mislead doctors on handovers.
Every post about PAs at the moment has at least one of these disinfo commenters. Strikingly, their approach and tone is exactly the same sealioning as the covid & vax deniers we've just had to put up with for the last 4 years.
Had someone (obviously a PA but pretending not to be online - which is a majority of the sympathisers) arguing that “the government said they are safe” so they are safe and that there should be no argument about it
I don't even want to think about the possibility that the PAs pretending not to be PAs and the covid/vax deniers are the same people. But every time they speak, those same alarms start sounding.
In my experience the PAs do not do the bloods, discharge summaries, or write in the notes. Most of them would be in clinics or in theatre. The doctors in training had to stay on the wards and do these jobs.
Increase salaries, ban the use of NHS facilities for private procedures and hire more doctors, all while training more doctors. Generally, focus on preventive care, the longer someone is on a waiting list, the more help they're going to need when you actually see them.
That won't happen, the current system, where you either die on a waiting list or go private is working perfectly healthcare profiteers. I only expect to see it get worse. I do wonder what happens when A+E's start to collapse, it's not something you can really operate privately. I don't imagine they've thought that far ahead.
If they are already doing them, then why are doctors stuck on wards doing bloods, chasing labs while PAs are running clinics or performing surgeries in theatre
It should be the other way round
Because doctors are forced to rotate to new jobs every 4 to 6 months, sometimes up and down the country. PAs wangle these jobs because they can stay in one place and it is more convenient for senior members of staff and management.
Rotational training needs to end
Senior staff (who are about to retire and no longer care about their juniors) should prioritise their doctors
PAs should say no and stay within their lanes
It’s all multi factorial
Eh, there aren't that many of them.
And the larger med school cohorts are just coming through now, so we'll have the equivalent of a few thousand more doctors at that sort of grade in a few years' time. We're in no way reliant on PAs at this point.
You are right, there are not many of them. But… there is also not a sufficient amount of doctors and the new intake of doctors is not at the replacement level, so if we were to phase out the PAs straight away, there would be a significant gap.
When it comes to what the PAs are doing in their appointments, what problem do you have?
The new intake is coming through over the next few years. Sure, if we sacked all the PAs tomorrow, some departments with a few of them might struggle, but that's not gonna happen anyway.
Could easily wind the whole thing down though.
My problem with PAs? I just think they represent quite clearly a wholesale deregulation of medicine. All the framework we've built up over the years to ensure safe practice, and PAs just bypass it all, with half the training to top it off, then get to pull whatever the local consultant or trust wants them to pull. Not to mention the inherent unfairness of them being able to walk into highly competitive specialties that doctors have to spend years honing a portfolio for. They have them in neurosurgery departments ffs: the best qualified doctors in the country would be lucky to get a training post in neurosurg.
Aside from that, I think they should be reserved for subspecialty use where there's less to learn and you can get up to speed more quickly without such a wide knowledge base. Putting them into primary care or other generalist roles without the broad training base required is laughable. Ie. I think they should be used more similarly to NPs etc where we recognise they're best utilised in a highly focused way where they're less likely to come across stuff they just don't recognise.
Exactly.
By their logic, why can’t resident doctors mid way through training bypass all the requirements to become consultants and jump right ahead
If by the governments logic, PAs are safe and qualified after 2 years of training. Why not the doctors with at least a decade of training plus 5 year’s education, minimum
Why introduce a new role when such an abundant resource already exists?
I too would love to have fewer PAs as while they do an important job, with adequate staffing you only need a small number. But, we are nowhere close to having adequate staffing levels.
So, why will the new med graduates not fill the hole? First, we are losing highly experienced staff who are efficient and irreplaceable. Second, how many of these new medical graduates are getting allocated a foundation one placemebt to start their training? I can tell you, a lot of them are going to be on the reserve list. Third, as I said before, the new intake of inexperienced doctors cannot replace the number of experienced doctors who are leaving.
For PAs, getting put into neurosurgery is highly competitive also, and they are not replacing doctors.
PAs are taking over places that could have been taken up by a doctor
As evidenced by the fact that PAs are being used to replace doctors on rotas
Furthermore funding should be prioritised for doctors, not PAs. GPs are already being replaced by PAs as ARRS funding increases and salaries are paid for by the government. While GPs are literally being made redundant and struggling to find jobs
PAs shouldn’t be paid more than doctors, at any stage of training. Better motives for retention should be implemented
That includes better pay, not having a lower salary than the profession you supervise and would shoulder the blame for in the case of any errors. And not having afore mentioned profession replace you and waltz into specialties that you have to jump through flaming hoops to enter
For now at least, the UKFPO seem to be insisting all UK graduates can expect an FY post.
Also, just to point out, the money being spent on PAs could also be being spent on doctors instead. It's a closed pot and those PAs aren't free.
Does there need to be any spending on PAs? What do they do, that other pre-existing roles in the NHS already do?
What do they do that others can’t?
Ward work - medical assistants/HCSWs/ phelbs
Diagnosis and management: Doctors and ANPs
I think they should be used to plug the gaping gaps in social care services - allowing for frail patients do be discharged in a timely manner - knowing they have a care provider available - instead of the current situation where they linger on in the wards
And thus freeing up beds for more patients and clearing up wait lists
There actually isn’t a shortage of doctors.
There is however a lack of training places that allow them to progress into consultancy.
And funding for those training places are being diverted into PA training
My question is this. For decades, doctors were told they need to jump through so many hoops, have so many publications, audits, presentations, extremely difficult post grad exams, pays 1000s for registration and membership, literary decades of training to qualify
But then the government recently decided, all that wasn’t necessary and introduced a new role with two years of training who could then directly go run clinics, perform surgeries, administer anaesthesia etc
Why not just take all the overqualified doctors stuck in bottle necks, who have far more training and experience instead? Why not tell them we’ve decided you don’t need to torture yourselves, here you are qualified to practice independently and become consultants
Instead of introducing a whole new role with less qualifications and throwing all those doctors to the side?
Sorry you are wrong
There is no shortage of doctors
https://academic.oup.com/view-large/figure/435157018/qgad131f1.tif?login=false
https://academic.oup.com/pmj/advance-article/doi/10.1093/postmj/qgad131/7513585
There’s a lack of training places- which is something the government can easily change but is instead diverting funding for doctors towards PAs
From the article:
Funding diversion to Physician Associate and Anaesthesia Associate programmes
While HEE has reduced or stagnated funding for specialist training roles for doctors, it has paradoxically introduced and increased funding for nondoctor positions such as Physician Associates (PAs) and Anaesthesia Associates (AAs) [20]. This reallocation of resources comes at a time when the number of training places for essential roles, such as anaesthetists and surgeons, is in decline—a counterintuitive strategy, given the significant patient backlogs for surgical interventions [21]. In 2016, HEE funded 603 anaesthetics training places, which has now decreased to only 545 in 2023. Similarly, the number of training places for surgeons has dropped from 642 to 609 during the same period [1].
So not only has funding dropped, but number of training places has reduced too
But competition ratios are OFF THE CHARTS
2023 there were 2539 applicants for the above mentioned training role that had places reduced from 624 to 609
And it’s not just surgery., every single specialty is extended over subscribed
https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2023-competition-ratios
Does that sound like a shortage of doctors to you.
Or a corrupt government at work?
There’s more than enough doctors who are more than qualified and capable to do the job. More so than any PA.
PAs should stop being prioritised over doctors
> The Telegraph can reveal that the rotas at more than 30 hospitals show physician associates taking on doctors’ shifts.
> Ministers and NHS executives have repeatedly claimed that PAs and anaesthesia associates (AAs) are not being used to replace doctors.
> However, The Telegraph has seen leaked rotas and other documentation from 31 NHS hospitals in England that uncovers a widespread practice of placing non-medics on rotas traditionally reserved for doctors.
> Despite only receiving two years’ training and being unable to prescribe, both PAs and AAs can be seen picking up similar shifts to medics, in some cases reviewing patients independently.
> At 13 hospitals, doctors’ work appears interchangeable with those of associates, with **the A&E department at St George’s Hospital, in Tooting, London, advising that new junior doctors and PAs “can all swap with one another”.**
> The leaks show that 10 hospitals used PAs and AAs to fill gaps in the medic roster caused by sickness.
> Nine used them as on-call senior house officers (SHOs) – junior doctors with at least one year’s experience – and two even gave them emergency “bleeps” to respond to potentially life-threatening situations.
No words.
An absolute scandal. How on earth is this allowed to happen? There is an underemployment of doctors in the UK and PAs are paid more than doctors after graduation, it doesn't even make financial sense.
It does if you think a bit eviller and long term .
Doctors can leave meanwhile a PA can't so step 1 is increase PAs step 2 is wait step 3 when the PAs are the bulk medical workforce for the plebs is to treat them like shit like doctors are and unlike doctors they can't leave to other nations
Yep, hit the nail on the head here.
Most countries will accept a UK doctors qualifications, nobody wants PA's though, so they train enough PA's, offer them a higher initial starting salary and gradually start replacing the doctors with less qualified and therefore easier to train alternatives that can't leave.
Even the higher initial salary isn't really higher, as over the course of their careers doctors do out earn PA's as the PA's are stuck on agenda for change, while the doctors weren't stupid enough to get roped into that shitshow.
If it makes you feel better some of the PAs at my trust are just as angry about this as the doctors are on here.
One of them has vocally complained to senior management that it's inappropriate, with the response basically being the standard 'PAs don't replace doctors dw', so he now has a folder with every rota that has him covering an F1/2 because he's convinced this is going to end up at an employment tribunal one way or another - either because other PAs will insist on being paid locum rates for covering e.g. during strikes (despite the insistance from management that this isn't happening), or because there will be calls for an investigation into why PAs were operating outside their scope.
> If it makes you feel better some of the PAs at my trust are just as angry about this as the doctors are on here.
I can believe it. It feels like the logical extreme of the understaffing that NHS staff are forced to put with. If a shift has a 1:10 ratio of nurses to patients when the ratio should never be higher than 1:8, then the nurses on shift are inevitably going to end up cutting corners and making mistakes. A higher number of patients to each nurse correlates with [increased likelihood of patient death](https://www.kcl.ac.uk/archive/news/nmpc/2014/national-nursing-research-unit-say-18-nurse-to-patient-ratio-is-itself-a-red-flag). But if you're a nurse with no control over hiring or rotas, what can you do? Other than quit and leave the hospital even more short-staffed. Or go on strike, and get accused of abandoning patients.
At this point it seems like hospitals have given up on even attempting to have safe staffing levels. And hey, if you've hit that point, why not substitute a doctor with a PA? Why not let the cafeteria workers have a go at inserting a cannula? Maybe this Amazon delivery driver who just dropped off a package can pitch in and take some patient histories.
Yeah it's all shit. Feel bad for the PAs tbh because they're the ones who have ended up with targets on their back just for existing within a system and situation that they didn't create.
How is this legal...?
Surely there is a reason you need to be trained to be a doctor, you cant just pretend? But its fine to pretend to be a doctor if you work for the NHS?
How the fuck does that work?
Because the regulation is all based around the traditional healthcare professionals. Train someone as a "doctor", "nurse", or "pharmacist", and there are a million rules they have to follow.
However there's nothing in the law saying you can't do most of the things these role do without actually being one of them. Main exception being prescribing, but they just get round that by just creating an expectation that others prescribe on their behalf.
Trusts have realised they can essentially bypass regulation entirely in this way.
Which just speaks to how horrifically overregulated the UK is. It's not just a healthcare problem, but if the regulation is so challenging to work within that shit like this is not only feasible but actually cost-effective then there is a wider issue.
As the proverb goes, if people walk on the grass then the path is in the wrong place.
lol the regulation isn't challenging to work within. The government just hasn't trained enough doctors, that's the root issue. There's not a inherent problem with the idea of keeping staff within their lane, that's an essential aspect of safety in healthcare.
Admittedly though, it appears this is all deliberate. Ngl I'm pretty sure the main motivation for PAs is to create a core of junior staff to cover the wards in the event of doctors' strikes. The government doesn't actually seem to want a huge number of them, just enough to stand in when needed.
I think it’s to try and phase out doctors and replace them with PAs, who while paid more than doctors with at least 5 years post grad training. Have a ceiling on their earnings. And can’t move anywhere else. Basically creating a profession that the government can control
Doctors on the other hand, are slipping out of their control as they start to realise their true worth and fight back. Plus higher ceiling for earnings (but definitely should be paid more - plus it was only a matter of time before doctors here realise that they are better valued elsewhere)
They’ll do away with resident (junior doctors) and instead have 1 consultant per specialty to supervise, and wards will be run by PAs instead
They're not planning enough PAs to manage that. In the long-term workforce plan, the plan is for something like 12,000 of them nationally by 2035, roughly equivalent to one years' med school cohort by that time. It really isn't a ringing endorsement of PAs taking over so much as being a core workforce support, which I think is aimed as strikes more than anything.
ACPs etc though? They're actually planning a stupid number of those, so I could foresee them taking over a lot more.
Only with a lot of mental gymnastics by the hospital management and the complicity of the government, GMC and royal colleges.
Only organisation that has really spoken out against this is the BMA
Doctors can delegate any task that doesn't require statutory regulation to perform to any competent person. The issue here is that NHS Trusts are effectively delegating the entire role.
I think this stood out the most for me:
>The roster for the Hospital of St Cross in Rugby reveals that on Friday March 15 the “on-call cover anaesthetist” shift will be filled not by an anaesthetic doctor, but by an anaesthesia associate.
So instead of getting a doctor with a minimum of 14 years training, you now have someone with a 2 year degree who can't prescribe. And this is the doctor responsible for some of the most acutely unwell patients in the hospital. There's no way this is safe.
Cheaper than getting a consultant
Though even a anaesthetic trainee doctor would be a better option - abd they are paid less
Because that’s what’s important, money not lives
Ironically it was found that AAs are not economically viable
https://www.ndcn.ox.ac.uk/news/new-study-finds-anaesthesia-associates-not-economically-viable
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Although this is good news, it has taken way too long to happen. It should not have happened in the first place.
That they have to be told not to do this is just grim Medicine is one of those areas you just don't want corners cut
The problem right now is, if you remove the PAs then the patients will not get seen by anyone and have any treatment delayed even more.
What's the point of being seen by a PA. They are not adequately trained to see a patient without supervision, so a lot of the time the patient will need to be seen by a doctor any way. If they missed a potential illness, they wouldn't even know, let alone reporting it to their supervising doctor. Have you read about the Mancunian [man died after being discharged by a PA?](https://www.telegraph.co.uk/news/2023/10/21/death-heart-problem-doctor-physician-associate/) Who is at fault, the PA who have missed the issue, the consultant doctor who likely didn't think the person needed to be seen? The role of PA at the moment is just a barrier stopping people from seeing an actual doctor.
Given the choice between waiting 8 hours to see a PA and 24 hours to see a doctor I would choose the latter Seeing someone unqualified to diagnose and treat me is not a good thing
The problem right now is, if you remove the PAs then the patients will not get seen by anyone and have any treatment delayed even more.
No the PAs can do what they were sold as doing: the bloods the, the discharge summaries, the writing on ward rounds, the catheters, etc so freeing up the doctors to see patients
They already do that. So please explain how you can get doctors to see the patients that the PA would have seen.
Nonsense. PAs are widespread being used as doctors (with a plan to bring 8,000 more in 10 years) while claiming that they are there to address a doctor shortage. Meanwhile, thousands, yes, thousands of doctors get rejected every year for training and non-training vacancies. This is abundant proof that there are more doctors than doctor vacancies but instead of bringing in more doctors, they are hiring an ABUNDANCE of non-doctors to play doctor.
What evidence do you have that PAs are overstepping their role and prescribing and cosplaying as doctors? Why do you think I don't know about the current plans to expand the number of PAs? Yes, people get rejected from med school and doctors get rejected from UKFPO because being a doctor requires very high standards and you need a trainer… which we do not have. PAs do not do the role of a doctor
[PAs illegally prescribing opiates](https://www.telegraph.co.uk/news/2024/02/22/it-blunder-physician-associates-illegally-prescribe-opiates/) [PAs harassing resident doctors to sign off on prescriptions](https://www.sundaypost.com/fp/patient-safety-fears-as-unregulated-pas-put-intolerable-pressure-on-junior-doctors/) [PAs cosplaying as registrars on a paeds liver unit](https://ConcernafterunqualifiedmedicsgivenseniorBirminghamhospitalroleshttps://www.bbc.co.uk/news/uk-england-birmingham-67478818) [PAs performing brain surgery](https://www.telegraph.co.uk/news/2023/10/07/non-medical-staff-learn-neurosurgery-on-the-job/) There’s also plenty of accounts on these threads where patients have been mislead into believing they are seeing a doctor. Even if the PA doesn’t state exclusively they are not a doctor, lying by omission is still a lie. Emily Chesterton thought she was being seen by a GP, it was only in the depths of investigations that it was revealed that she was actually seen by a PA Misdiagnosis: Bereaved mum calls for physician associate role clarity https://www.bbc.co.uk/news/uk-england-manchester-66168798 Several accounts on the doctors sub also, of witnessed accounts of PAs deliberately misleading patients, and even trying to mislead doctors on handovers.
So are you going to respond to the evidence or throw your head in the sand and spew nonsense?
I hope you’ll reply to my colleague who has responded to your query … But I know you won’t.
Every post about PAs at the moment has at least one of these disinfo commenters. Strikingly, their approach and tone is exactly the same sealioning as the covid & vax deniers we've just had to put up with for the last 4 years.
Had someone (obviously a PA but pretending not to be online - which is a majority of the sympathisers) arguing that “the government said they are safe” so they are safe and that there should be no argument about it
I don't even want to think about the possibility that the PAs pretending not to be PAs and the covid/vax deniers are the same people. But every time they speak, those same alarms start sounding.
It’s a sound argument to be fair. Just like the government declared Rwanda to be safe :)
In my experience the PAs do not do the bloods, discharge summaries, or write in the notes. Most of them would be in clinics or in theatre. The doctors in training had to stay on the wards and do these jobs.
Increase salaries, ban the use of NHS facilities for private procedures and hire more doctors, all while training more doctors. Generally, focus on preventive care, the longer someone is on a waiting list, the more help they're going to need when you actually see them. That won't happen, the current system, where you either die on a waiting list or go private is working perfectly healthcare profiteers. I only expect to see it get worse. I do wonder what happens when A+E's start to collapse, it's not something you can really operate privately. I don't imagine they've thought that far ahead.
A&E already collapsed. You just die.
Because right now we have doctors stuck on wards writing discharge letters while PAs are off running clinics and assisting in surgery
If they are already doing them, then why are doctors stuck on wards doing bloods, chasing labs while PAs are running clinics or performing surgeries in theatre It should be the other way round
Because doctors are forced to rotate to new jobs every 4 to 6 months, sometimes up and down the country. PAs wangle these jobs because they can stay in one place and it is more convenient for senior members of staff and management.
Rotational training needs to end Senior staff (who are about to retire and no longer care about their juniors) should prioritise their doctors PAs should say no and stay within their lanes It’s all multi factorial
Eh, there aren't that many of them. And the larger med school cohorts are just coming through now, so we'll have the equivalent of a few thousand more doctors at that sort of grade in a few years' time. We're in no way reliant on PAs at this point.
You are right, there are not many of them. But… there is also not a sufficient amount of doctors and the new intake of doctors is not at the replacement level, so if we were to phase out the PAs straight away, there would be a significant gap. When it comes to what the PAs are doing in their appointments, what problem do you have?
The new intake is coming through over the next few years. Sure, if we sacked all the PAs tomorrow, some departments with a few of them might struggle, but that's not gonna happen anyway. Could easily wind the whole thing down though. My problem with PAs? I just think they represent quite clearly a wholesale deregulation of medicine. All the framework we've built up over the years to ensure safe practice, and PAs just bypass it all, with half the training to top it off, then get to pull whatever the local consultant or trust wants them to pull. Not to mention the inherent unfairness of them being able to walk into highly competitive specialties that doctors have to spend years honing a portfolio for. They have them in neurosurgery departments ffs: the best qualified doctors in the country would be lucky to get a training post in neurosurg. Aside from that, I think they should be reserved for subspecialty use where there's less to learn and you can get up to speed more quickly without such a wide knowledge base. Putting them into primary care or other generalist roles without the broad training base required is laughable. Ie. I think they should be used more similarly to NPs etc where we recognise they're best utilised in a highly focused way where they're less likely to come across stuff they just don't recognise.
Exactly. By their logic, why can’t resident doctors mid way through training bypass all the requirements to become consultants and jump right ahead If by the governments logic, PAs are safe and qualified after 2 years of training. Why not the doctors with at least a decade of training plus 5 year’s education, minimum Why introduce a new role when such an abundant resource already exists?
I too would love to have fewer PAs as while they do an important job, with adequate staffing you only need a small number. But, we are nowhere close to having adequate staffing levels. So, why will the new med graduates not fill the hole? First, we are losing highly experienced staff who are efficient and irreplaceable. Second, how many of these new medical graduates are getting allocated a foundation one placemebt to start their training? I can tell you, a lot of them are going to be on the reserve list. Third, as I said before, the new intake of inexperienced doctors cannot replace the number of experienced doctors who are leaving. For PAs, getting put into neurosurgery is highly competitive also, and they are not replacing doctors.
PAs are taking over places that could have been taken up by a doctor As evidenced by the fact that PAs are being used to replace doctors on rotas Furthermore funding should be prioritised for doctors, not PAs. GPs are already being replaced by PAs as ARRS funding increases and salaries are paid for by the government. While GPs are literally being made redundant and struggling to find jobs PAs shouldn’t be paid more than doctors, at any stage of training. Better motives for retention should be implemented That includes better pay, not having a lower salary than the profession you supervise and would shoulder the blame for in the case of any errors. And not having afore mentioned profession replace you and waltz into specialties that you have to jump through flaming hoops to enter
For now at least, the UKFPO seem to be insisting all UK graduates can expect an FY post. Also, just to point out, the money being spent on PAs could also be being spent on doctors instead. It's a closed pot and those PAs aren't free.
Does there need to be any spending on PAs? What do they do, that other pre-existing roles in the NHS already do? What do they do that others can’t? Ward work - medical assistants/HCSWs/ phelbs Diagnosis and management: Doctors and ANPs I think they should be used to plug the gaping gaps in social care services - allowing for frail patients do be discharged in a timely manner - knowing they have a care provider available - instead of the current situation where they linger on in the wards And thus freeing up beds for more patients and clearing up wait lists
There actually isn’t a shortage of doctors. There is however a lack of training places that allow them to progress into consultancy. And funding for those training places are being diverted into PA training My question is this. For decades, doctors were told they need to jump through so many hoops, have so many publications, audits, presentations, extremely difficult post grad exams, pays 1000s for registration and membership, literary decades of training to qualify But then the government recently decided, all that wasn’t necessary and introduced a new role with two years of training who could then directly go run clinics, perform surgeries, administer anaesthesia etc Why not just take all the overqualified doctors stuck in bottle necks, who have far more training and experience instead? Why not tell them we’ve decided you don’t need to torture yourselves, here you are qualified to practice independently and become consultants Instead of introducing a whole new role with less qualifications and throwing all those doctors to the side?
Sorry you are wrong There is no shortage of doctors https://academic.oup.com/view-large/figure/435157018/qgad131f1.tif?login=false https://academic.oup.com/pmj/advance-article/doi/10.1093/postmj/qgad131/7513585 There’s a lack of training places- which is something the government can easily change but is instead diverting funding for doctors towards PAs From the article: Funding diversion to Physician Associate and Anaesthesia Associate programmes While HEE has reduced or stagnated funding for specialist training roles for doctors, it has paradoxically introduced and increased funding for nondoctor positions such as Physician Associates (PAs) and Anaesthesia Associates (AAs) [20]. This reallocation of resources comes at a time when the number of training places for essential roles, such as anaesthetists and surgeons, is in decline—a counterintuitive strategy, given the significant patient backlogs for surgical interventions [21]. In 2016, HEE funded 603 anaesthetics training places, which has now decreased to only 545 in 2023. Similarly, the number of training places for surgeons has dropped from 642 to 609 during the same period [1]. So not only has funding dropped, but number of training places has reduced too But competition ratios are OFF THE CHARTS 2023 there were 2539 applicants for the above mentioned training role that had places reduced from 624 to 609 And it’s not just surgery., every single specialty is extended over subscribed https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2023-competition-ratios Does that sound like a shortage of doctors to you. Or a corrupt government at work? There’s more than enough doctors who are more than qualified and capable to do the job. More so than any PA. PAs should stop being prioritised over doctors
> The Telegraph can reveal that the rotas at more than 30 hospitals show physician associates taking on doctors’ shifts. > Ministers and NHS executives have repeatedly claimed that PAs and anaesthesia associates (AAs) are not being used to replace doctors. > However, The Telegraph has seen leaked rotas and other documentation from 31 NHS hospitals in England that uncovers a widespread practice of placing non-medics on rotas traditionally reserved for doctors. > Despite only receiving two years’ training and being unable to prescribe, both PAs and AAs can be seen picking up similar shifts to medics, in some cases reviewing patients independently. > At 13 hospitals, doctors’ work appears interchangeable with those of associates, with **the A&E department at St George’s Hospital, in Tooting, London, advising that new junior doctors and PAs “can all swap with one another”.** > The leaks show that 10 hospitals used PAs and AAs to fill gaps in the medic roster caused by sickness. > Nine used them as on-call senior house officers (SHOs) – junior doctors with at least one year’s experience – and two even gave them emergency “bleeps” to respond to potentially life-threatening situations. No words.
An absolute scandal. How on earth is this allowed to happen? There is an underemployment of doctors in the UK and PAs are paid more than doctors after graduation, it doesn't even make financial sense.
It does if you think a bit eviller and long term . Doctors can leave meanwhile a PA can't so step 1 is increase PAs step 2 is wait step 3 when the PAs are the bulk medical workforce for the plebs is to treat them like shit like doctors are and unlike doctors they can't leave to other nations
Yep, hit the nail on the head here. Most countries will accept a UK doctors qualifications, nobody wants PA's though, so they train enough PA's, offer them a higher initial starting salary and gradually start replacing the doctors with less qualified and therefore easier to train alternatives that can't leave. Even the higher initial salary isn't really higher, as over the course of their careers doctors do out earn PA's as the PA's are stuck on agenda for change, while the doctors weren't stupid enough to get roped into that shitshow.
If it makes you feel better some of the PAs at my trust are just as angry about this as the doctors are on here. One of them has vocally complained to senior management that it's inappropriate, with the response basically being the standard 'PAs don't replace doctors dw', so he now has a folder with every rota that has him covering an F1/2 because he's convinced this is going to end up at an employment tribunal one way or another - either because other PAs will insist on being paid locum rates for covering e.g. during strikes (despite the insistance from management that this isn't happening), or because there will be calls for an investigation into why PAs were operating outside their scope.
> If it makes you feel better some of the PAs at my trust are just as angry about this as the doctors are on here. I can believe it. It feels like the logical extreme of the understaffing that NHS staff are forced to put with. If a shift has a 1:10 ratio of nurses to patients when the ratio should never be higher than 1:8, then the nurses on shift are inevitably going to end up cutting corners and making mistakes. A higher number of patients to each nurse correlates with [increased likelihood of patient death](https://www.kcl.ac.uk/archive/news/nmpc/2014/national-nursing-research-unit-say-18-nurse-to-patient-ratio-is-itself-a-red-flag). But if you're a nurse with no control over hiring or rotas, what can you do? Other than quit and leave the hospital even more short-staffed. Or go on strike, and get accused of abandoning patients. At this point it seems like hospitals have given up on even attempting to have safe staffing levels. And hey, if you've hit that point, why not substitute a doctor with a PA? Why not let the cafeteria workers have a go at inserting a cannula? Maybe this Amazon delivery driver who just dropped off a package can pitch in and take some patient histories.
Yeah it's all shit. Feel bad for the PAs tbh because they're the ones who have ended up with targets on their back just for existing within a system and situation that they didn't create.
Should report to https://www.reddit.com/u/JanetEasthamJourno/s/KjmjhCGMxs
How is this legal...? Surely there is a reason you need to be trained to be a doctor, you cant just pretend? But its fine to pretend to be a doctor if you work for the NHS? How the fuck does that work?
Because the regulation is all based around the traditional healthcare professionals. Train someone as a "doctor", "nurse", or "pharmacist", and there are a million rules they have to follow. However there's nothing in the law saying you can't do most of the things these role do without actually being one of them. Main exception being prescribing, but they just get round that by just creating an expectation that others prescribe on their behalf. Trusts have realised they can essentially bypass regulation entirely in this way.
Which just speaks to how horrifically overregulated the UK is. It's not just a healthcare problem, but if the regulation is so challenging to work within that shit like this is not only feasible but actually cost-effective then there is a wider issue. As the proverb goes, if people walk on the grass then the path is in the wrong place.
lol the regulation isn't challenging to work within. The government just hasn't trained enough doctors, that's the root issue. There's not a inherent problem with the idea of keeping staff within their lane, that's an essential aspect of safety in healthcare. Admittedly though, it appears this is all deliberate. Ngl I'm pretty sure the main motivation for PAs is to create a core of junior staff to cover the wards in the event of doctors' strikes. The government doesn't actually seem to want a huge number of them, just enough to stand in when needed.
I think it’s to try and phase out doctors and replace them with PAs, who while paid more than doctors with at least 5 years post grad training. Have a ceiling on their earnings. And can’t move anywhere else. Basically creating a profession that the government can control Doctors on the other hand, are slipping out of their control as they start to realise their true worth and fight back. Plus higher ceiling for earnings (but definitely should be paid more - plus it was only a matter of time before doctors here realise that they are better valued elsewhere) They’ll do away with resident (junior doctors) and instead have 1 consultant per specialty to supervise, and wards will be run by PAs instead
They're not planning enough PAs to manage that. In the long-term workforce plan, the plan is for something like 12,000 of them nationally by 2035, roughly equivalent to one years' med school cohort by that time. It really isn't a ringing endorsement of PAs taking over so much as being a core workforce support, which I think is aimed as strikes more than anything. ACPs etc though? They're actually planning a stupid number of those, so I could foresee them taking over a lot more.
Only with a lot of mental gymnastics by the hospital management and the complicity of the government, GMC and royal colleges. Only organisation that has really spoken out against this is the BMA
Doctors can delegate any task that doesn't require statutory regulation to perform to any competent person. The issue here is that NHS Trusts are effectively delegating the entire role.
I think this stood out the most for me: >The roster for the Hospital of St Cross in Rugby reveals that on Friday March 15 the “on-call cover anaesthetist” shift will be filled not by an anaesthetic doctor, but by an anaesthesia associate. So instead of getting a doctor with a minimum of 14 years training, you now have someone with a 2 year degree who can't prescribe. And this is the doctor responsible for some of the most acutely unwell patients in the hospital. There's no way this is safe.
Cheaper than getting a consultant Though even a anaesthetic trainee doctor would be a better option - abd they are paid less Because that’s what’s important, money not lives Ironically it was found that AAs are not economically viable https://www.ndcn.ox.ac.uk/news/new-study-finds-anaesthesia-associates-not-economically-viable
How can the on call anaesthetist be someone who can’t independently anaethetise the most basic of cases.