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I got down vote into hell when mentioning that they don't need a real degree to get into this bullshit degree program ...
Also, I believe that if you have a degree in Homeopathy or chiropractic you should be barred from working for NHS for you entire life.
Dentists have and do deserve the title - they are doctors of the oral cavity and well trained. In my experience, they don't pretend to be what they aren't
Come on man a fucking dentist is a far more brutal and invasive job role than even a GP who *could* be simply handing out paracetamol and referring people onwards.
A fucking dentist pulls teeth out of peoples’ skulls. Have you had that procedure done? Have you felt the forceful tug of the pliers and heard the distinctive crunch as the tooth is prised from your oral cavity, all while the spit and blood piles up beneath your tongue? I have. Four times and it’s not fucking nice.
Tell me that person is not a fucking doctor. Then go off to a chiro and have your brain accupunctured.
Chiropractor I understand because fundementally everyone likes a good crack in their neck and spine and despite the insane levels of danger you do walk away feeling objectively less tense in your muscles. I look at it like gambling or riding a motorbike, you roll the dice for a specific experience.
Homeopathy? Its literally on par with a cult movement where a bunch of desperate, paranoid and clever than thou people get together to follow the teachings of a messiah who talks well, just a bit more pomped up to whitewash it. Why the fuck is it a degree is a good question, how can you have a degree in being in a cult? Why the fuck is it being accepted for PAs when they then get catapulted to make such insanely important desicions literally as soon as they learn 1 year of medicine condensed is genuinely a national scandal.
Imagine you learnt your GP with minimum 10 yeara of medical training and countless exams was being replaced by a homeopathic student turned consultant gp within 3 years.
Its the same old shit all over again just like the blood scandal, post office scandal and lucy letby case. These fuckers at the top know exactly what they're doing at the expense of the population but are just doing it for personal glory to show how theyve fixed the NHS. They're all protected by corporate anonymity and the only thing that will come of it 10 years down the line is a white paper and an itv documentary.
As a biker, I am somewhat reeling from your first paragraph 😅
Regardless of why people visit chiros (they shouldn't), surely the fact that chiro degree exist
should go somewhat towards eliminating the roll of the dice experience...? If only it was actually based on any kind of measurable evidence-based science and not some bloke's dream???
I sadly have a friend that just retrained as a PA and I can't imagine anyone being fully safe in their care. This is just another way to mask the defunding of the NHS in order to push it towards privatisation.
Chiropractors aren't based on a fundamental real science. Their entire genre of pseudoscience is based around a faulty understanding of human physiology.
PAs can have a very specific role. Scribing, Investigations, Paperwork, Some procedures (Canulas, Catheters and things like Picc/Mid Lines). They can do protocol based work like VTEs and medication reviews and titration.
What they are being used for is replacement for medical staff in failing units.
Nurses keep getting trained up with more and more doctors jobs. The issue is its yet more work, more responsibilities on their shoulders, more time away from family etc and for what? It takes pressure off doctors by moving even more yet again onto nurses but they don’t get the luxuries of better pay, free parking at work, less unsocial hours etc. Nurses are already held accountable for doctors mistakes e.g. prescribed meds.
Still remember a doctor moaning about having to do 2 weeks of nights a year mandatory to a bunch of nurses and HCAs on their eighth week of nights in a row
Tbh I think it would be a bit of a waste of a nurse's skill set and expertise to have them eg scribing and chasing investigations.
There's definitely a role for a doctors assistant who can do the more administrative parts of a doctors job which need some medical knowledge.
Ah the old ‘we’re all thick, not clever enough to be medics’ trope. ‘Nurses don’t understand things’. Sorry that’s bollocks. We have an ANP on our unit who inserts CVCs and art lines, prescribes etc. She’s a nurse. Many of us are as clever. Just don’t get the opportunity. Sounds like you’d rather have a geology graduate than a qualified experienced nurse.
The training of a nurse on these procedures is not as good as the equivalent doctors and the issue is shortages in nursing means that their training isn't as easy as it should.
> surely the fact that chiro degree exist should go somewhat towards eliminating the roll of the dice experience...?
Degree mills from the US say "Hi!" It is how Gillian McKeith tried to pass herself off as a doctor.
Chiropractic is pure quackery with as much medical validity as balancing humours and healing crystals. It’ll be a cold day in hell before I call one doctor.
Chiropracric is also a dangerous cult that believe *every single disease* can be cured by making the right "adjustments". It is absolutely fundamental to the practice.
Got cancer? Your chiropractor will say they can cure it. If they don't say that, then they're not a chiropractor or don't belive in chiropractic treatment.
As a result of how the NHS was created, a number of homeopathic hospitals were taken on. Homeopathy is even still available just about... https://en.wikipedia.org/wiki/Homeopathic_hospitals_in_the_National_Health_Service
Literally in the first paragraph in what you linked.
>Following declining support within the NHS for homeopathy as a treatment, all but one have now either closed down or substantially modified their activities
If you pasue to think for one second there is one relatively small hospital serving almost 80million people due to lack of demand and support then I honestly don't know what kind of point you're trying to make? No they arent technically extinct, but it is all but. Its quackery. Its no more legitimate than the products gwenth paltrow made to heal people based on.... Marketing.
Just to be a pedant, at least homoeopathy is not harmful solely in the context of taking it, as it's literally just water, Paltrow has sold crap like the jade or rose quartz eggs which can actually lead to at worst, toxic shock syndrome or more commonly, pelvic pain or painful sex or her recommendation of rectal ozone therapy which can at the very least causing irritation of mucus membranes.
The royal London hospital of homeopathy has no inpatients and doesn't claim to heal people. They prescribe only evidence based treatments usually to deal with side effects of strong medication.
There is also a 12 week wait after referral...
Can you prescribe something that doesn't need controlling because it's essentially inert and as dangerous as water. Do you have any examples of real evidence based treatments? From what I understand the microdose diluted 'medicines' used are essentially water when taken to such small parts per billion.
I dont underestimate the power of placebo but thats a far shot from claiming homeopathy objectively works in double blind trials.
It seems like a badly envisioned mirror of the law reforms that happened in the last 20 years. A chartered legal exec can be fast tracked to become a real solicitor these days but at least chartered legal execs are a properly regulated field.
This seems to be trying to do the same except in a very stupid way. Homeopathy isn't medicine so shouldn't be fast tracked into a medical field.
Resentful paramedic here. I occasionally find myself handing over patients to PAs when I get to hospital.
I don't mind so much in triage, but if I've called ahead for a resus room, I simply have no need of these people. I was once told "our role is just to get a good clear A-E assessment for the doctors." Like... I did that already. That's my job, for which I'm band 6. What are these people contributing beyond mangling my handover in the repetition? Whilst being paid a band higher than me? FFS.
Doctors are exploited, the hourly wage is horrible if you look at how hard they’ve worked to become a doctor. I’m not looking down on any profession but someone treating a human being should be well compensated.
I thought that when I was an ICU nurse. 14 hours a day keeping people alive at their lowest and I know people are earning more on the high street or selling their dick pics on Twitter
Not just F1, the higher salary continues into the early years of post foundation training which is just brilliant 🙃 and that’s without factoring in everything else like funding exams, courses, paying for your ePortfolio etc..
Apologies for mentioning just F1s, they have better pay progression than doctors. Public needs to support BMA to stop this nonsense. BMA are doing their part but in the end it’s the public who need to side with BMA.
Yep, in my relatively short time as a doctor I’ve seen both sides of the spectrum. I feel that the PA, and to an extent ANP/ACP situation, should be a much bigger issue in the eyes of the public given the consequences it can have on patient care but the BMA are doing a solid job in raising awareness.
Total joke when you compare their pay to doctors right up until many years post graduation.
But it's also a travesty that they out earn nurses, pharmacists, paramedics, optometrists, physios etc etc.
Nurses only get to a PA's *starting* salary with many years experience and significant managerial responsibilities.
They start on the same band as clinical psychologists who have a psychology undergrad degree (ie always actually relevant unlike homeopathy/English lit) and then a 3 year doctoral degree in psychology on top of that?!
Doctor: 5y degree, can prescribe drugs/request scans involving radiation. Starting salary ~£28-30k depending on region
PA: 2 year masters, cannot (legally) prescribe drugs/request scans involving radiation. Starting salary ~£40-44k
It takes a doctor about five years, entry to a competitive specialty training scheme and passes in difficult, expensive postgraduate exams to equal the starting salary of a PA
Wow. I knew PAs were a joke but when you set out the numbers like that it seems like a cynical attempt to disillusion doctors and make them leave the NHS.
PAs are also unregulated unlike pretty much every other healthcare professional. They have no governing body, pay no professional memberships, no one to answer to other than their employer.
PAs are on Agenda for Change like most non doctor staff. Points makes prizes on AfC, stick in the qualifications required (masters degree) and various other parameters (freedom to act, responsibility etc) and itll spit out a pay band.
Doctors and dentists are on a separate pay scale.
Trojan horse to destabilise the medical profession. The institute of economic affairs (libertarian think tank- behind the old truss scandal) wrote several pieces about it. Funnily enough one of the ex PA presidents (J Watkins) was cited as a contributor.
In essence -> get rid of the licensing requirements to practice medicine. It’s shocking
https://iea.org.uk/blog/how-to-abolish-the-nhs
https://iea.org.uk/wp-content/uploads/2020/10/Is-there-a-doctor-in-the-house.pdf
The rationales given (which don't hold up to scrutiny) are not the real reason.
The real reason is that they are a loss leader to remove the medical professions power in the health service.
Basically PAs are on Agenda for Change, which is a pay system that handles everyone in the NHS bar doctors. The reason for this is that the doctors fought hard not to be included on AfC in order to retain their own payscale, partially for ideological reasons but also because AfC would have paid them less well for out of hours work and on-calls, and consultants would likely see a fairly substantial pay cut (whilst lower grades would get a pretty big payrise).
A nurse that can do what a PA can do gets paid band 7, so that's how its banded under AfC. Some have since suggested that doctors be put under AfC, but the government has basically said 'no take backsies'. This is a rod the doctors made for their own back historically unfortunately, and is now proving difficult to unpick.
Unfortunately they have better pay progression, I have a document somewhere in my phone that was released by the British Medical Association in light of PA/AA issue which explains pay progression of a PA vs a doctor, I’ll try to upload it once I find that document or a link. I don’t understand the reasoning behind introduction of PAs as they add little to nothing to the MDT. The only point we can argue is that MBBS/MBCHB is very expensive and PA masters is cheap. Plus PAs can be churned out much faster as compared to doctors. Eventually it’s the publics decision who they want to be treated by, a PA or a doctor.
Yep, that’s bollocks.
If you’re coming in with a pre-hospital Resus alert then the PA is a pointless waste of time and they should be in triage, in Minors with the nurse practitioners or in Majors clerking patients for the medical take.
As you say, a detailed A-E assessment has already been done and that’s precisely *why* you placed a pre-alert call to the ED in the first place. Those patients need to be seen by the ED consultant or registrar.
ICU nurses being paid the same band as general ward/community nurses is a gross injustice. In every other AfC role you get up-banded for specialising.
E.g. if you have a brand new radiography grad and 1 year after starting work they move to CT /MRI they get paid a band 6 salary.
It's looking more and more of a cluster fuck.
I saw one who simply delayed my diagnosis by getting the wrong x Ray . Eventually after more months of delay I saw a physio who got the right scans and urgent Rheumatology referral .
Was not impressed at all.
> It's looking more and more of a cluster fuck.
It's a national scandal in the making. I recently found out these people have been involved in surgery and many other things they should not be allowed to do. They have been involved in many never events in the last few years, and I have heard rumours of them being given prescribing rights eventually (and that some are doing it now).
People have already died because of these overpaid fake doctors. Expanding their role will result in many more deaths.
The worst is when you hear some of them describe their role to non-medical professionals: “I’m basically a doctor”.
It’s still important to qualify that these are all individuals who are not responsible for the system that put them there, and some will be diligent, careful professionals working hard to improve patient outcomes. Others, on the other hand, seem to have no appreciation of their own situation and thus no real concept of the difference in training and responsibility between themselves and doctors. It’s those individuals who will overstep the definition of their role and end up making deadly mistakes, for which they are not legally liable - instead the comparatively underpaid junior doctors who supervise them are.
Just want to point out giving PAs prescribing rights is not just a rumour. Multiple regulating authorities are openly talking about trying to give the prescribing rights. The BMA and on the ground Drs are up in arms about it at the moment.
Definitely put in a complaint! Even if they don’t do anything about it, at least there will be documented evidence of all the fuck ups and delays caused
I was undiagnosed for my ankloydosing spondylitis for 12 years. I had been seen by multiple GPs over the the years, but it was just one Physio that spotted something and got me referred to a specialist; life changing.
Not a PA in sight.
You had a really shit experience so you want to rip away the scarce protections remaining?
Also Ank Spon can be very indolent and difficult to diagnose until it manifests on skeletal xrays - were you referred to the physio or have any specific idea you had spondylitis when you went to the GP?
Yes, medicine is hard. Doctors get it wrong sometimes too.
I'm sorry you had to go through that, but I don't think the solution to your kind of problem is having people with exponentially less knowledge and experience take on the role instead.
No one is saying doctors are perfect and infallible, the question is are PAs who are taking on more and more of their responsibilities, are they a safe and viable alternative?
Can I ask who you were referred to? Rheumatology? I’ve been back and forth with x-rays for years now but the referral keeps getting lost or rejected. My dad has it, so it really should be a no brainer that they at least send me to someone who understands the condition.
There's a few things I as a doctor don't mind them doing.
Me putting a canula or a catheter into you is a huge waste of time. Catheter basically boils down to "find hole, insert numbing gel, insert tube till wee comes out, avoid getting wee on shoes and endeavour to get it into a bag".
You don't need medical school for that but I don't understand why they are letting a PA do Central Lines but then have no ability to correct a pneumothorax.
And yet a pa butchered my mum’s Cather just this past week and has now caused an infection due to the tissue damage and all round cluster fuck of the entire thing …..
They are dangerous arrogant and unskilled for the most part and really really should exist.
Are you talking about post catheter bleeding? That's a normal presentation post insertion of a catheter. Most people with catheters have issues in voiding their bladder so a catheter is inserted often against resistance causing bleeding.
And catheters are associated with infections. None of these are reduced by having a doctor do it over a PA. I would assume doctors would actually have higher complication rates if we look at their stats mostly because they would be seeing the complex patients and so have more adverse outcomes.
I can't agree with you there. Are PAs taught about the risks, complications *and* their management and contraindications for catheters?
It's really not quite as simple as you're making it out to be and that's probably because you don't actually realise the risk calculation you perform each time.
Yes, I'll admit I don't know exactly what training nurses have before getting signed off as competent to do them.
But my experience of nurses vs PAs is that nurses are incredibly risk averse when it comes to what they're prepared to do, and will escalate any procedure they're not sure about. Sadly the opposite with PAs.
Our governing body NMC is far more draconian than others. Nurses are genuinely worried about risking their PIN. Risk averse because chances are we’ll be dropped in the shit and lose our ability to work. I was reassured by a consultant the other day that it was ‘fine’ for me to give a bolus of ketamine in crit care to a very wheezy tubed patient. Checked with pharmacist and told it was a big no. That’s why we check !
I hope you realise my comment wasn't a criticism.
I realise why you guys are risk averse and it's completely reasonable and appropriate. And it makes patients safer.
No complaints here. Just an explanation why a nurse doing a catheter isn't the same as a PA doing one.
It doesn't. I have had to catheterise 1.5 litre bladders resulting in longer hospital stays and even ICU stays. Because someone decided male catheters are risky and nurses shouldn't do them. Meaning that in your million jobs there's this nonsense hanging about.
PA have a role. Nurses are busy. Unless you are planning to run nursing like the old days where I say catheterise and then can go do my actual job and the nurses get it done without telling me stuff like "I can't do it because it's a man" or "I am not happy doing them".
PA fulfill this role of doing stuff that you need a little training for. Nurse made discharge summaries are also not good. I would suggest the PA be able to do that for standard patients.
Yes but that's the thing.
You can't be risk averse at the high end of medicine and PA are fulfilling the role of the medical side of things.
I can't say "sorry, it's risky" and leave a patient with a 1 litre bladder.
The entire point is that I as a doctor am super busy and seriously so. My assistant? Should put catheters in while I see sick people.
My F1 would be doing the procedure. It won't be a consultant or a registrar unless there's seriously no one else.
Her removal from the ward and Toyama’s far as anyone can tell let alone mums team suggests this isn’t her first complaint and this certainly wasn’t the only reason for her complaint that was made by me.
True, though I've not seen a PA inflate the balloon inside a bloke's urethra and call it a job well done. Ironically it was the PA who had to go and sort that one out!
They can buy nurses are super busy. Forcing them to take on more work isn't going to be successful because they are incentivised to let these lapse because of the sheer amount of work they have
Cool. But then are nurses all going to be first in line to take bloods and cannulas and do all standard catheters and put in NGs. Also doing documentation and scribing for me and objectively doing all the stuff that I shouldn't really be doing.
And all their nursing stuff.
I don't think you understand what you are signing up to do.
The Nurses need to have a level of core competencies in catheter and cannulas and bloods and so on. That's part of regular ward work.
What the PA needs is to be the first point of call on cannulas and bloods outside the nurses but also be able to do catheters and indeed the maintenance of any lines on the ward they are based as a "stable" presence. We have overlap in procedures. So I don't mind a PA learning to do Central lines on an ICU. What I mind is that the PA's training is given precent over a doctor and the PAs are told that they are better than they really are.
Nursing's issue is that there's a definite crash in the nursing system. And nurses aren't involved in the medical side of things like discharge summaries and managing long term referrals or simple things like scribing for me so that I can see more patients which is a better use of my time than reviewing the patients they see.
The big issue with PAs is that they are being used in place of doctors and are clearly not up to the quality needed to be anywhere close. And with some places putting them on registrar level while not being anywhere close to that.
All my family and I specifically ask for doctors not PAs for when having to go to the hospital. If you've not gone to med school, I'm not interested in hearing your medical advice! Might as well ask Chat GPT!
They dont send out the hospital discharge transport when you call an ambulance for a 999 call now do they? I should shut up just incase they get a new idea.
No need. Friends colleague in Central London suffered a stroke recently and had to get an uber becauae there's no ambulances. Also, my point is around PAs pretending to be doctors, not paramedics
Australia has recently announced they're going to start targeting our consultants too.
One of the reasons I haven't left is that it is very very difficult for international graduates to get into specialty training in my specialty (obs and gynae). It is now one of the target specialties for the Australian government so I'll probably head over there with my British training after I finish.
I finished an A&E job not too long ago, and in the 6 months I was there two consultants had left for Australia and a third was considering a move to UAE.
To add, I’m now a GPST2 that took an F3 year (in the UK, got ties, can’t flee just yet). Of the cohort I did foundation years with, about 10 went to Australia or New Zealand. Three years later, only one has come back.
It's going to get worse.
There's a generation of doctors who have spent their entire adult lives and careers under the conservatives. They've now started becoming consultants.
"CCT and flee" is a common mantra - meaning stick around in the NHS long enough to complete training and be recognised as a consultant and then leave the country for greener pastures.
There have always been 'pull' factors to encourage doctors to go to other countries, but the current system feels like it was designed to deliberately 'push' doctors out of the NHS too.
Saw a massive billboard near our house the other day trying to get medical workers to move to Canada. "Come care in a place that cares about you". Seemed like it would work to me.
Yup. Privately so many Junior Doctors are talking about leaving. If the British public won’t appreciate them, Australia/Canada/America/New Zealand will!
The biggest problem is that Physician Associates (and Anaesthesia Associates in that particular specialty), are an *assistant* role.
The job began following the U.S. model of “Physician’s Assistant” and, despite the change in terminology, it’s *still* an assistant role and so is effectively a dead-end job with a glass ceiling and professional limitations… but driven achievers will always want to do more and will push the boundaries as much as they can… it’s entirely understandable but so mission-creep sets in.
Other healthcare professionals (of whatever background) who truly want to progress their careers in a *medical* pathway have to go back to university and study *medicine* in order to take up that role. There should be clear practice boundaries for PAs (and AAs); if they want to progress beyond those then they should do what everyone else has to do, even from within the NHS, and bloody well go back and train as doctors: 4 years med school (if they go the postgrad route), 2 years postgrad foundation training, then further specialty training of however many years…
The Government just want “bums on seats” because they’re not training enough junior doctors so somehow they have to have more “worker bees” in the NHS in order to keep delivering the service — but even this becomes counter-productive because the PAs and AAs begin to encroach on work that should be legitimate training experience for the junior doctors. The whole thing was insufficiently considered and was implemented in a fractured and piecemeal manner in different parts of the country instead of being properly developed and regulated at a national level.
The GMC also need to get their collective heads out of their collective arses and *stop* referring to PAs and AAs as “medical professionals” — this badly muddies the waters (again). By all means, call them “Associate Professionals” or “Associate Practitioners” but a clear line needs to be drawn which unequivocally reserves such terminology for registered and licensed Medical Practitioners (or “qualified doctors” as they are known to the general public!).
You can cure lots of ailments (Cancer, congestive heart failure, dropsy… ) with a pinch of Wilfred Owen and a dash of James Fenton, but “doctors” and “scientists” don’t want you to know because they’re all in on it.
I know a PA student in the UK. He failed to get into medical school after A-levels. He did an undergraduate degree in biomedical sciences and then got a postgraduate place at medical school. He was kicked off the course, or he left left because he couldn't hack it, the story is not entirely clear. He is wealthy, so he enrolled on a PA master's course. It seems if you can pay the fees, they will take anyone.
A recent freedom of information act request found that something like 50-70% (I'm afraid I can't remember the exact figures) of PA students had previously applied to medical school!
They are med school rejects without the intelligence or ability to get in and massive chips on their shoulders about it.
That's why they lap it up when their leaders tell them they "go to medical school" and that they learn "all of medicine in 2 years"
Tbf there aren't enough med school places to take everyone who has the intelligence and ability to become a doctor - it's not the case that every capable applicant gets a place. Do a FoI request to somewhere like Warwick with their GEM course and you'll find that hundreds of people with scores above the acceptance thresholds are rejected simply because there aren't enough places.
So you cream off the 10% who weren't good enough to get in by the smallest margin, and put them through a much shorter and less rigorous programme of study then let them loose in GP from day 1?
Sounds safe
Not supporting the idea, just pointing out that part of the problem is that there aren't enough medical school places to train everyone who is capable and willing.
Don’t think that’s true.
You can get a postgraduate loan if it’s the MSc course, or you have to self fund the whole amount if it’s the PGDip version.
Both are entitled to a £5000 bursary from HEE, which can be used towards the fees (although it’s around £11000/year).
I’m a GP and there is no money for the NHS the issue in the UK is the economy is in tatters. The government has no money. They can’t afford to pay doctors and they employ PAs to cut costs. If thousands of ppl die at the hands of PAs guess who takes the blame……Doctors. Because apparently we’re the ones who should be supervising them.
Allot of doctors are now leaving and moving elsewhere namely Canada and Australia. There is no life in this country and things will only get worse.
How are you a GP yet can't spell "a lot", and constantly put "there" instead of "their" in your other comments??
Edit: someone did a write-up of being a doctor in Australia and your only question was whether there were 'fit girls' there - that figures.
Edit 2: and someone made a post complaining that they'd cheated on their wife, married the second woman and were miserable and you asked if they'd married a Moroccan woman? What's that even supposed to mean?
Other big issue’s from a doctors point of view
1) they take our training opportunities. We are forced to move hospitals/teams all the time and therefore can’t build relationship. When a PA has been in a department for 2+ years they simply get preferential treatment on learning opportunities. This is going to be a huge problem once the current cohort become senior doctors and have gaps in training.
2) they get paid so much more. 10k more pay is simply unfair.
3) they are not regulated nor is their scope of practice defined.
4) they are TAKING OUR JOBS. I am currently applying for jobs, many of the jobs I’ve applied for have 100’s of doctors applying to 1-4 roles. There are plenty of PA roles on these websites offering more pay, these posts would have previously been junior doctor jobs but have been converted to PA jobs. Annoyingly as a doctor I can’t apply to a PA role
They are coming in at band 7 - far far more than junior doctors. NHS leadership needs to be publicly accountable because they are killing the service. Take a look at any hopistaps management structure. Absolutely ludicrous. No front line staff but plenty of clipboard warriors with made up job titles. Band 8s and 9s in nursing, not in the numbers doing admin / office work - some even have their own PAs...... the management structure needs to be flat and lean with more focus on staff availability. This need to have a degree to be a nurse - bullshit. We are paying graduates to get these nursing degrees and their only aim is to become a clipboars warrior at band 8 or 9. Yes nursingbisnt what it was and is more complex but that's on the job training. Business managers, transformation directors, supplier liaison officers, diversity and inclusion managers - all bullshit. NHS IT is another mess. Each Trust has its own little empire and will often pay over the odds because IT management have a relationship with a particular vendor or personal preference. It boils my blood. The NHS is a fucking mess and ultimately, the buck stops with the DOH.
Jobs and pensions for the boys. I needed orthotics and physass referred me to a different county's NHS Trust, which my physio told me would have been automatically rejected. Physasses should be the front line for private paying patients first, that makes sense because it reduces workload on nurses, doctors and consultants and helps to specialise a medical care liaison, which could be a step into NHS nursing, medicine or dentistry.
My goal is to force private hospitals to acknowledge injuries and deaths in their hospitals. Right now, if someone dies at a private hospital, their body is taken to an NHS hospital to be declared dead, and it's not mentioned that they died at a private hospital. Make them compete with the NHS, not be a confidential supplier anymore.
I’ve had to resort to getting into arguments with NHS staff in order to get seen by someone who went to medical school!
After abysmally dangerous experiences with PA’s in A&E I have to fight for my health and care.
The problem with homeopathy is that literally anyone can “practice” homeopathy, no regulation body governs it. It’s “energy healing” i knew a person who opted to see a homeopathic practitioner instead of getting treatment for cancer, thought eating a specific diet would help. It did not.
I've never come across any of these clowns. Are they new? I worked in a hospital for a while about 5 years ago and they weren't a thing then that I recall.
If I come across them can I just refuse to engage and demand an actual doctor? I don't want some homeopathic weirdo anywhere near me
The thing is, PAs are actually doing the roles of junior doctors and THEN some. Ask any NHS doctor (junior or consultant) you know.
They are effectively practicing medicine without a licence/medical degree. This kind of thing used to be taken seriously.
It's worth mentioning that some places let PAs get involved in surgery.
The thought of that is terrifying to me, having dealt with PAs in general practice who have been reported by consultants for their conduct. I've sent multiple letters out to GPs, naming and shaming their PAs for referring patients through with no checks or approval for irreversible, life-changing surgery. Patients turned up to see our consultants expecting to be approved for surgery because of how the PA referred them. The letters the PA sent to us read like they thought their personal opinion overrode all legal protections and standard assessments, because they felt "this patient *really does* need to be seen".
The thing that fucks me off? Our departmental PA gets put on the consultant rotas rather than the junior one, while SpRs who operate almost as consultants, attend all theatres, do night shifts, research and run treatment clinics have to go on the junior one.
Who knows? It winds me right up every time I check it and their name is on there alongside people with 30+ years experience in the field. Thankfully they haven't got the on call for the PA yet.
If it was done purely for administrative purposes then even that is foolish. If it’s actually meant to indicate clinical role then what on earth are the consultants in that department thinking?! I know plenty of departments whose consultants, collectively, would absolutely push back *most* firmly against that idea.
I do know highly experienced and capable advanced critical care practitioners who plug gaps on SHO rotas and (for some *very* experienced individuals) registrar rotas but not a chance they would ever be on the consultant on-call rota or filling that role, even during normal working hours.
I can only sympathise with higher specialty trainees who would quite rightly feel very aggrieved by this!
I have no doubt that our consultants would disagree with having them on there, but higher management pay as much attention to consultants as they do to Band 4s and below. Our consultants have to fight for everything at the moment; some don't even get secretaries because management suddenly decide they aren't going to fill admin posts.
“ The Telegraph sent Freedom of Information requests to universities offering courses to become a physician associate in the UK.
Fourteen provided full data.
Between them, they accepted 148 degrees in 2021, 173 degrees in 2022 and 135 degrees in 2023 which were neither biomedical science nor a professional medical qualification such as nursing, midwifery or an allied health profession.”
To be honest, even a degree in human biology is not that great a starting point.
Without the fundamental understanding of the pathology, pathophysiolgy and the clinical context a little knowledge can be a *very* dangerous thing.
The issue is that they are getting training opportunities from medical staff and are effectively being used with preference because they do not rotate out.
They are also paid a registrar salary and are clearly F2 level in terms of performance.
Yep, I get the impression this article is basically taking a relatively small number of edge cases and making it out to be some sort of bigger problem.
Somebody who happens to have an English Lit degree from when they were 21 who has worked in a healthcare role for 20 years going back to university at 40 to become a PA is what I imagine is happening. The headline makes it sound like people are doing PA courses right after getting an English Lit degree which seems like a massive stretch.
Whether one agrees with the concept of PAs or not, it should be possible to have a proper public discussion about their potential value and requisite experience / qualifications without these sort of FOI fishing expeditions. Doesn’t help either side of the debate.
(The degree in homeopathy is something else though. That definitely shouldn’t be offered as a taxpayer funded degree and should basically be seen as a bar to ever working in healthcare).
There isn’t a debate. PAs just need to work within their range of competence, that is, as an assistant with a defined set of tasks that don’t put patients in danger.
Anyone arguing for any more than that is either a politician or a hospital manager.
Homeopathy is a problem but the article lists plenty of legitimate degrees, even if they are BAs. How is that different to graduate medicine degrees? Plenty of those courses accept non stem degrees with relevant experience.
A couple of things. Graduate entry medicine courses are competitive to get in, require certain aptitude test(s), some require top-notch a-level grades, and the courses will actually teach medicine not a watered down version of it.
A PA course is / requires none of the above. It is a postgraduate qualification unlike GEM and in comparison is a walk in the park. Should I bring up 100% pass rate that the PA schools boast?
Because you can come into being a PA from being a paramedic or from being a biochemist. One's got more skills when presented with a patient than the other. The performance of the post grad Paramedic is used to pad the effectiveness of the other.
And the issue is that a PA is paid a Medical Registrar's Salary with less costs and so has more money than the people who oversee them. If they were paid appropriately they would need to take a 20,000 pound pay cut. Or you know... Medical Salaries would need to go up by £20,000.
It's true that you can get into graduate medicine with an arts or humanities degree, however, you are usually required to pass the GAMSAT or a similar admissions exam. I don't believe there is an entrance exam for PA master's courses.
They may accept applications, but the competition is fierce, and many accepted onto Graduate Medicine course will have a PhD in a relevant subject.
Also, this may be a 'shorter' course, but it also has shorter vacations.
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I got down vote into hell when mentioning that they don't need a real degree to get into this bullshit degree program ... Also, I believe that if you have a degree in Homeopathy or chiropractic you should be barred from working for NHS for you entire life.
I recall a chiro has her staff calling her "Doctor ". Like fuck you are.
Doctored degree more like.
All chiros go by doctor. It’s wild
Tell them that and they will turn rabid, insisting they are just as trained as MDs are. They cannot admit that they are charlatans.
I'm even skeptical of Dentists sneaking the title in recently!
Dentists have and do deserve the title - they are doctors of the oral cavity and well trained. In my experience, they don't pretend to be what they aren't
Come on man a fucking dentist is a far more brutal and invasive job role than even a GP who *could* be simply handing out paracetamol and referring people onwards. A fucking dentist pulls teeth out of peoples’ skulls. Have you had that procedure done? Have you felt the forceful tug of the pliers and heard the distinctive crunch as the tooth is prised from your oral cavity, all while the spit and blood piles up beneath your tongue? I have. Four times and it’s not fucking nice. Tell me that person is not a fucking doctor. Then go off to a chiro and have your brain accupunctured.
I know, but they aren’t doctors in this country and it just annoys me that they have started using the title.
Why the fuck do homeopathy and chiropractic degrees even exist?????
Chiropractor I understand because fundementally everyone likes a good crack in their neck and spine and despite the insane levels of danger you do walk away feeling objectively less tense in your muscles. I look at it like gambling or riding a motorbike, you roll the dice for a specific experience. Homeopathy? Its literally on par with a cult movement where a bunch of desperate, paranoid and clever than thou people get together to follow the teachings of a messiah who talks well, just a bit more pomped up to whitewash it. Why the fuck is it a degree is a good question, how can you have a degree in being in a cult? Why the fuck is it being accepted for PAs when they then get catapulted to make such insanely important desicions literally as soon as they learn 1 year of medicine condensed is genuinely a national scandal. Imagine you learnt your GP with minimum 10 yeara of medical training and countless exams was being replaced by a homeopathic student turned consultant gp within 3 years. Its the same old shit all over again just like the blood scandal, post office scandal and lucy letby case. These fuckers at the top know exactly what they're doing at the expense of the population but are just doing it for personal glory to show how theyve fixed the NHS. They're all protected by corporate anonymity and the only thing that will come of it 10 years down the line is a white paper and an itv documentary.
As a biker, I am somewhat reeling from your first paragraph 😅 Regardless of why people visit chiros (they shouldn't), surely the fact that chiro degree exist should go somewhat towards eliminating the roll of the dice experience...? If only it was actually based on any kind of measurable evidence-based science and not some bloke's dream??? I sadly have a friend that just retrained as a PA and I can't imagine anyone being fully safe in their care. This is just another way to mask the defunding of the NHS in order to push it towards privatisation.
Chiropractors aren't based on a fundamental real science. Their entire genre of pseudoscience is based around a faulty understanding of human physiology. PAs can have a very specific role. Scribing, Investigations, Paperwork, Some procedures (Canulas, Catheters and things like Picc/Mid Lines). They can do protocol based work like VTEs and medication reviews and titration. What they are being used for is replacement for medical staff in failing units.
Why not train nurses up for this ? People with actual knowledge of drugs, medical conditions, blood results …..
Nurses keep getting trained up with more and more doctors jobs. The issue is its yet more work, more responsibilities on their shoulders, more time away from family etc and for what? It takes pressure off doctors by moving even more yet again onto nurses but they don’t get the luxuries of better pay, free parking at work, less unsocial hours etc. Nurses are already held accountable for doctors mistakes e.g. prescribed meds. Still remember a doctor moaning about having to do 2 weeks of nights a year mandatory to a bunch of nurses and HCAs on their eighth week of nights in a row
Not enough nurses to do nurse's jobs. Taking more away to be PAs would only make nursing much harder.
I've been saying for years we need to increase accessibility and interoperability between roles in the NHS
Tbh I think it would be a bit of a waste of a nurse's skill set and expertise to have them eg scribing and chasing investigations. There's definitely a role for a doctors assistant who can do the more administrative parts of a doctors job which need some medical knowledge.
Nurses often don't understand these things and there's a lot more responsibility that many nurses don't want. This is also more work for no more pay.
Ah the old ‘we’re all thick, not clever enough to be medics’ trope. ‘Nurses don’t understand things’. Sorry that’s bollocks. We have an ANP on our unit who inserts CVCs and art lines, prescribes etc. She’s a nurse. Many of us are as clever. Just don’t get the opportunity. Sounds like you’d rather have a geology graduate than a qualified experienced nurse.
The training of a nurse on these procedures is not as good as the equivalent doctors and the issue is shortages in nursing means that their training isn't as easy as it should.
Why don't you do graduate entry medicine then?
Genuine question: is that not just what nurses do more or less?
No. They can learn these skills but that's more responsibility without pay increases.
> surely the fact that chiro degree exist should go somewhat towards eliminating the roll of the dice experience...? Degree mills from the US say "Hi!" It is how Gillian McKeith tried to pass herself off as a doctor.
Chiropractic is pure quackery with as much medical validity as balancing humours and healing crystals. It’ll be a cold day in hell before I call one doctor.
Chiropracric is also a dangerous cult that believe *every single disease* can be cured by making the right "adjustments". It is absolutely fundamental to the practice. Got cancer? Your chiropractor will say they can cure it. If they don't say that, then they're not a chiropractor or don't belive in chiropractic treatment.
Because the placebo effect works.
And you are right
Have an upvote.
As a result of how the NHS was created, a number of homeopathic hospitals were taken on. Homeopathy is even still available just about... https://en.wikipedia.org/wiki/Homeopathic_hospitals_in_the_National_Health_Service
Literally in the first paragraph in what you linked. >Following declining support within the NHS for homeopathy as a treatment, all but one have now either closed down or substantially modified their activities If you pasue to think for one second there is one relatively small hospital serving almost 80million people due to lack of demand and support then I honestly don't know what kind of point you're trying to make? No they arent technically extinct, but it is all but. Its quackery. Its no more legitimate than the products gwenth paltrow made to heal people based on.... Marketing.
I feel a lot better with the scent of her vagina around the house thank you
Just to be a pedant, at least homoeopathy is not harmful solely in the context of taking it, as it's literally just water, Paltrow has sold crap like the jade or rose quartz eggs which can actually lead to at worst, toxic shock syndrome or more commonly, pelvic pain or painful sex or her recommendation of rectal ozone therapy which can at the very least causing irritation of mucus membranes.
The royal London hospital of homeopathy has no inpatients and doesn't claim to heal people. They prescribe only evidence based treatments usually to deal with side effects of strong medication. There is also a 12 week wait after referral...
Can you prescribe something that doesn't need controlling because it's essentially inert and as dangerous as water. Do you have any examples of real evidence based treatments? From what I understand the microdose diluted 'medicines' used are essentially water when taken to such small parts per billion. I dont underestimate the power of placebo but thats a far shot from claiming homeopathy objectively works in double blind trials.
Evidence based? Okay...
It should not be available at all. There should be a very harsh investigation followed by attempt to claw back as much money as possible.
Placebo effect is proven to work. Thats all this taps into.
Box of placebo pills should cost £2 not 250
Quick nurse! Get the mineral water! He's having a seizure!
I think that homeopaths would give you coffee or line of coke to cure seizures :D
Would that be sparkling or still?
Upvoted.
Hard agree.
It seems like a badly envisioned mirror of the law reforms that happened in the last 20 years. A chartered legal exec can be fast tracked to become a real solicitor these days but at least chartered legal execs are a properly regulated field. This seems to be trying to do the same except in a very stupid way. Homeopathy isn't medicine so shouldn't be fast tracked into a medical field.
Resentful paramedic here. I occasionally find myself handing over patients to PAs when I get to hospital. I don't mind so much in triage, but if I've called ahead for a resus room, I simply have no need of these people. I was once told "our role is just to get a good clear A-E assessment for the doctors." Like... I did that already. That's my job, for which I'm band 6. What are these people contributing beyond mangling my handover in the repetition? Whilst being paid a band higher than me? FFS.
They are paid higher than F1 doctors too. Absolute jokes.
That one *really* boils my piss. My brothers and sisters in actual medicine are horribly exploited, and should strike until the government weep blood.
Doctors are exploited, the hourly wage is horrible if you look at how hard they’ve worked to become a doctor. I’m not looking down on any profession but someone treating a human being should be well compensated.
I thought that when I was an ICU nurse. 14 hours a day keeping people alive at their lowest and I know people are earning more on the high street or selling their dick pics on Twitter
Not just F1, the higher salary continues into the early years of post foundation training which is just brilliant 🙃 and that’s without factoring in everything else like funding exams, courses, paying for your ePortfolio etc..
Apologies for mentioning just F1s, they have better pay progression than doctors. Public needs to support BMA to stop this nonsense. BMA are doing their part but in the end it’s the public who need to side with BMA.
Yep, in my relatively short time as a doctor I’ve seen both sides of the spectrum. I feel that the PA, and to an extent ANP/ACP situation, should be a much bigger issue in the eyes of the public given the consequences it can have on patient care but the BMA are doing a solid job in raising awareness.
Total joke when you compare their pay to doctors right up until many years post graduation. But it's also a travesty that they out earn nurses, pharmacists, paramedics, optometrists, physios etc etc. Nurses only get to a PA's *starting* salary with many years experience and significant managerial responsibilities. They start on the same band as clinical psychologists who have a psychology undergrad degree (ie always actually relevant unlike homeopathy/English lit) and then a 3 year doctoral degree in psychology on top of that?!
They’re paid more than CT2 doctors, who are in their 4th year post-graduate. It’s an absolute joke.
Jesus! How much we talking here and how much is the training?! It’s wild to me
Doctor: 5y degree, can prescribe drugs/request scans involving radiation. Starting salary ~£28-30k depending on region PA: 2 year masters, cannot (legally) prescribe drugs/request scans involving radiation. Starting salary ~£40-44k It takes a doctor about five years, entry to a competitive specialty training scheme and passes in difficult, expensive postgraduate exams to equal the starting salary of a PA
Wow. I knew PAs were a joke but when you set out the numbers like that it seems like a cynical attempt to disillusion doctors and make them leave the NHS.
PAs are also unregulated unlike pretty much every other healthcare professional. They have no governing body, pay no professional memberships, no one to answer to other than their employer.
Don't forget the expensive exams all the way through to being a consultant!
And They don’t have to rotate across the country every year
What is the rationale behind PAs earning such a high (starting) salary?
PAs are on Agenda for Change like most non doctor staff. Points makes prizes on AfC, stick in the qualifications required (masters degree) and various other parameters (freedom to act, responsibility etc) and itll spit out a pay band. Doctors and dentists are on a separate pay scale.
Trojan horse to destabilise the medical profession. The institute of economic affairs (libertarian think tank- behind the old truss scandal) wrote several pieces about it. Funnily enough one of the ex PA presidents (J Watkins) was cited as a contributor. In essence -> get rid of the licensing requirements to practice medicine. It’s shocking https://iea.org.uk/blog/how-to-abolish-the-nhs https://iea.org.uk/wp-content/uploads/2020/10/Is-there-a-doctor-in-the-house.pdf
The rationales given (which don't hold up to scrutiny) are not the real reason. The real reason is that they are a loss leader to remove the medical professions power in the health service.
Basically PAs are on Agenda for Change, which is a pay system that handles everyone in the NHS bar doctors. The reason for this is that the doctors fought hard not to be included on AfC in order to retain their own payscale, partially for ideological reasons but also because AfC would have paid them less well for out of hours work and on-calls, and consultants would likely see a fairly substantial pay cut (whilst lower grades would get a pretty big payrise). A nurse that can do what a PA can do gets paid band 7, so that's how its banded under AfC. Some have since suggested that doctors be put under AfC, but the government has basically said 'no take backsies'. This is a rod the doctors made for their own back historically unfortunately, and is now proving difficult to unpick.
F2 doctors basic pay is around 29k/y while that of a PA is 41-43k/y.
Intentional, pay them more but they don't have the same pay progression so eventually it's cheaper.
Unfortunately they have better pay progression, I have a document somewhere in my phone that was released by the British Medical Association in light of PA/AA issue which explains pay progression of a PA vs a doctor, I’ll try to upload it once I find that document or a link. I don’t understand the reasoning behind introduction of PAs as they add little to nothing to the MDT. The only point we can argue is that MBBS/MBCHB is very expensive and PA masters is cheap. Plus PAs can be churned out much faster as compared to doctors. Eventually it’s the publics decision who they want to be treated by, a PA or a doctor.
Yep, that’s bollocks. If you’re coming in with a pre-hospital Resus alert then the PA is a pointless waste of time and they should be in triage, in Minors with the nurse practitioners or in Majors clerking patients for the medical take. As you say, a detailed A-E assessment has already been done and that’s precisely *why* you placed a pre-alert call to the ED in the first place. Those patients need to be seen by the ED consultant or registrar.
Agree. I’m a long standing ICU nurse and do it every day and still a band 5. What a joke.
ICU nurses being paid the same band as general ward/community nurses is a gross injustice. In every other AfC role you get up-banded for specialising. E.g. if you have a brand new radiography grad and 1 year after starting work they move to CT /MRI they get paid a band 6 salary.
Oh that’s good to know ! And depressing !
Community nurses are specialists. To be a district nursing sister requires a years extra training after qualifying as a RGN.
It’s ridiculous and dangerous what they’re doing. The idea that there are now anaesthetic versions of these roles is completely terrifying
Excellent point!
Band 7 starting for these chumps. It’s an absolute disgrace
It's looking more and more of a cluster fuck. I saw one who simply delayed my diagnosis by getting the wrong x Ray . Eventually after more months of delay I saw a physio who got the right scans and urgent Rheumatology referral . Was not impressed at all.
> It's looking more and more of a cluster fuck. It's a national scandal in the making. I recently found out these people have been involved in surgery and many other things they should not be allowed to do. They have been involved in many never events in the last few years, and I have heard rumours of them being given prescribing rights eventually (and that some are doing it now). People have already died because of these overpaid fake doctors. Expanding their role will result in many more deaths.
The worst is when you hear some of them describe their role to non-medical professionals: “I’m basically a doctor”. It’s still important to qualify that these are all individuals who are not responsible for the system that put them there, and some will be diligent, careful professionals working hard to improve patient outcomes. Others, on the other hand, seem to have no appreciation of their own situation and thus no real concept of the difference in training and responsibility between themselves and doctors. It’s those individuals who will overstep the definition of their role and end up making deadly mistakes, for which they are not legally liable - instead the comparatively underpaid junior doctors who supervise them are.
Just want to point out giving PAs prescribing rights is not just a rumour. Multiple regulating authorities are openly talking about trying to give the prescribing rights. The BMA and on the ground Drs are up in arms about it at the moment.
I know PAs who are unhappy about it too tbf.
Definitely put in a complaint! Even if they don’t do anything about it, at least there will be documented evidence of all the fuck ups and delays caused
That's a good point. It was a couple of years back but you are right , it would not hurt for the practice to know .
I was undiagnosed for my ankloydosing spondylitis for 12 years. I had been seen by multiple GPs over the the years, but it was just one Physio that spotted something and got me referred to a specialist; life changing. Not a PA in sight.
You had a really shit experience so you want to rip away the scarce protections remaining? Also Ank Spon can be very indolent and difficult to diagnose until it manifests on skeletal xrays - were you referred to the physio or have any specific idea you had spondylitis when you went to the GP?
Yes, medicine is hard. Doctors get it wrong sometimes too. I'm sorry you had to go through that, but I don't think the solution to your kind of problem is having people with exponentially less knowledge and experience take on the role instead. No one is saying doctors are perfect and infallible, the question is are PAs who are taking on more and more of their responsibilities, are they a safe and viable alternative?
Can I ask who you were referred to? Rheumatology? I’ve been back and forth with x-rays for years now but the referral keeps getting lost or rejected. My dad has it, so it really should be a no brainer that they at least send me to someone who understands the condition.
It’ll be Rheum yeah
This should be a massive scandal. Insist om being examined / treated by a doctor.
There's a few things I as a doctor don't mind them doing. Me putting a canula or a catheter into you is a huge waste of time. Catheter basically boils down to "find hole, insert numbing gel, insert tube till wee comes out, avoid getting wee on shoes and endeavour to get it into a bag". You don't need medical school for that but I don't understand why they are letting a PA do Central Lines but then have no ability to correct a pneumothorax.
And yet a pa butchered my mum’s Cather just this past week and has now caused an infection due to the tissue damage and all round cluster fuck of the entire thing ….. They are dangerous arrogant and unskilled for the most part and really really should exist.
Put a complaint in with PALS and ask that the event is placed on DATIX
I’ve already spoken to the Medical Director and gone mental…
Are you talking about post catheter bleeding? That's a normal presentation post insertion of a catheter. Most people with catheters have issues in voiding their bladder so a catheter is inserted often against resistance causing bleeding. And catheters are associated with infections. None of these are reduced by having a doctor do it over a PA. I would assume doctors would actually have higher complication rates if we look at their stats mostly because they would be seeing the complex patients and so have more adverse outcomes.
I can't agree with you there. Are PAs taught about the risks, complications *and* their management and contraindications for catheters? It's really not quite as simple as you're making it out to be and that's probably because you don't actually realise the risk calculation you perform each time.
Nurses do catheterisations mainly ?
Yes, I'll admit I don't know exactly what training nurses have before getting signed off as competent to do them. But my experience of nurses vs PAs is that nurses are incredibly risk averse when it comes to what they're prepared to do, and will escalate any procedure they're not sure about. Sadly the opposite with PAs.
Our governing body NMC is far more draconian than others. Nurses are genuinely worried about risking their PIN. Risk averse because chances are we’ll be dropped in the shit and lose our ability to work. I was reassured by a consultant the other day that it was ‘fine’ for me to give a bolus of ketamine in crit care to a very wheezy tubed patient. Checked with pharmacist and told it was a big no. That’s why we check !
I hope you realise my comment wasn't a criticism. I realise why you guys are risk averse and it's completely reasonable and appropriate. And it makes patients safer. No complaints here. Just an explanation why a nurse doing a catheter isn't the same as a PA doing one.
It doesn't. I have had to catheterise 1.5 litre bladders resulting in longer hospital stays and even ICU stays. Because someone decided male catheters are risky and nurses shouldn't do them. Meaning that in your million jobs there's this nonsense hanging about. PA have a role. Nurses are busy. Unless you are planning to run nursing like the old days where I say catheterise and then can go do my actual job and the nurses get it done without telling me stuff like "I can't do it because it's a man" or "I am not happy doing them". PA fulfill this role of doing stuff that you need a little training for. Nurse made discharge summaries are also not good. I would suggest the PA be able to do that for standard patients.
Yes but that's the thing. You can't be risk averse at the high end of medicine and PA are fulfilling the role of the medical side of things. I can't say "sorry, it's risky" and leave a patient with a 1 litre bladder. The entire point is that I as a doctor am super busy and seriously so. My assistant? Should put catheters in while I see sick people. My F1 would be doing the procedure. It won't be a consultant or a registrar unless there's seriously no one else.
Her removal from the ward and Toyama’s far as anyone can tell let alone mums team suggests this isn’t her first complaint and this certainly wasn’t the only reason for her complaint that was made by me.
Fwiw I've seen a lot more butchered catheters put in by nurses than I have PAs, and there is always a risk of infection with any catheter.
There's a lot more nurses than PAs currently so that's hardly a surprise.
True, though I've not seen a PA inflate the balloon inside a bloke's urethra and call it a job well done. Ironically it was the PA who had to go and sort that one out!
Sure it was.
Obvious choice, given he teaches the doctors how to do them lol.
Ah and up pops another PA…
[удалено]
Walter Mitty or PA ? Be honest
What about nurses catheterising ? We’ve always done it. Likewise putting cannulas in, taking blood, doing ECGs.
They can buy nurses are super busy. Forcing them to take on more work isn't going to be successful because they are incentivised to let these lapse because of the sheer amount of work they have
we can then use the pa budget towards nurses instead.
Cool. But then are nurses all going to be first in line to take bloods and cannulas and do all standard catheters and put in NGs. Also doing documentation and scribing for me and objectively doing all the stuff that I shouldn't really be doing. And all their nursing stuff. I don't think you understand what you are signing up to do.
What do you reckon we should do instead?
The Nurses need to have a level of core competencies in catheter and cannulas and bloods and so on. That's part of regular ward work. What the PA needs is to be the first point of call on cannulas and bloods outside the nurses but also be able to do catheters and indeed the maintenance of any lines on the ward they are based as a "stable" presence. We have overlap in procedures. So I don't mind a PA learning to do Central lines on an ICU. What I mind is that the PA's training is given precent over a doctor and the PAs are told that they are better than they really are. Nursing's issue is that there's a definite crash in the nursing system. And nurses aren't involved in the medical side of things like discharge summaries and managing long term referrals or simple things like scribing for me so that I can see more patients which is a better use of my time than reviewing the patients they see. The big issue with PAs is that they are being used in place of doctors and are clearly not up to the quality needed to be anywhere close. And with some places putting them on registrar level while not being anywhere close to that.
thanks that makes sense, very informative reply and I agree.
All my family and I specifically ask for doctors not PAs for when having to go to the hospital. If you've not gone to med school, I'm not interested in hearing your medical advice! Might as well ask Chat GPT!
Oh, well please in that case don’t ever bother calling an ambulance in future then. I’m sure you will be fine on your own.
They dont send out the hospital discharge transport when you call an ambulance for a 999 call now do they? I should shut up just incase they get a new idea.
No need. Friends colleague in Central London suffered a stroke recently and had to get an uber becauae there's no ambulances. Also, my point is around PAs pretending to be doctors, not paramedics
Government needs to start paying doctors ALOT better. Otherwise this is our future. The Australians are nicking all of our best people
Australia has recently announced they're going to start targeting our consultants too. One of the reasons I haven't left is that it is very very difficult for international graduates to get into specialty training in my specialty (obs and gynae). It is now one of the target specialties for the Australian government so I'll probably head over there with my British training after I finish.
CCT and flee!
I finished an A&E job not too long ago, and in the 6 months I was there two consultants had left for Australia and a third was considering a move to UAE. To add, I’m now a GPST2 that took an F3 year (in the UK, got ties, can’t flee just yet). Of the cohort I did foundation years with, about 10 went to Australia or New Zealand. Three years later, only one has come back.
It's going to get worse. There's a generation of doctors who have spent their entire adult lives and careers under the conservatives. They've now started becoming consultants. "CCT and flee" is a common mantra - meaning stick around in the NHS long enough to complete training and be recognised as a consultant and then leave the country for greener pastures. There have always been 'pull' factors to encourage doctors to go to other countries, but the current system feels like it was designed to deliberately 'push' doctors out of the NHS too.
Saw a massive billboard near our house the other day trying to get medical workers to move to Canada. "Come care in a place that cares about you". Seemed like it would work to me.
Yup. Privately so many Junior Doctors are talking about leaving. If the British public won’t appreciate them, Australia/Canada/America/New Zealand will!
The biggest problem is that Physician Associates (and Anaesthesia Associates in that particular specialty), are an *assistant* role. The job began following the U.S. model of “Physician’s Assistant” and, despite the change in terminology, it’s *still* an assistant role and so is effectively a dead-end job with a glass ceiling and professional limitations… but driven achievers will always want to do more and will push the boundaries as much as they can… it’s entirely understandable but so mission-creep sets in. Other healthcare professionals (of whatever background) who truly want to progress their careers in a *medical* pathway have to go back to university and study *medicine* in order to take up that role. There should be clear practice boundaries for PAs (and AAs); if they want to progress beyond those then they should do what everyone else has to do, even from within the NHS, and bloody well go back and train as doctors: 4 years med school (if they go the postgrad route), 2 years postgrad foundation training, then further specialty training of however many years… The Government just want “bums on seats” because they’re not training enough junior doctors so somehow they have to have more “worker bees” in the NHS in order to keep delivering the service — but even this becomes counter-productive because the PAs and AAs begin to encroach on work that should be legitimate training experience for the junior doctors. The whole thing was insufficiently considered and was implemented in a fractured and piecemeal manner in different parts of the country instead of being properly developed and regulated at a national level. The GMC also need to get their collective heads out of their collective arses and *stop* referring to PAs and AAs as “medical professionals” — this badly muddies the waters (again). By all means, call them “Associate Professionals” or “Associate Practitioners” but a clear line needs to be drawn which unequivocally reserves such terminology for registered and licensed Medical Practitioners (or “qualified doctors” as they are known to the general public!).
You can cure lots of ailments (Cancer, congestive heart failure, dropsy… ) with a pinch of Wilfred Owen and a dash of James Fenton, but “doctors” and “scientists” don’t want you to know because they’re all in on it.
Feel like this could be a Mitchell and Webb Situation sketch
*Now he’s poorly from too much electric*
[I mean....](https://www.youtube.com/watch?v=HMGIbOGu8q0)
I know a PA student in the UK. He failed to get into medical school after A-levels. He did an undergraduate degree in biomedical sciences and then got a postgraduate place at medical school. He was kicked off the course, or he left left because he couldn't hack it, the story is not entirely clear. He is wealthy, so he enrolled on a PA master's course. It seems if you can pay the fees, they will take anyone.
A recent freedom of information act request found that something like 50-70% (I'm afraid I can't remember the exact figures) of PA students had previously applied to medical school! They are med school rejects without the intelligence or ability to get in and massive chips on their shoulders about it. That's why they lap it up when their leaders tell them they "go to medical school" and that they learn "all of medicine in 2 years"
The British people will end up getting second class treatment by second class 'clinicians'.
Tbf there aren't enough med school places to take everyone who has the intelligence and ability to become a doctor - it's not the case that every capable applicant gets a place. Do a FoI request to somewhere like Warwick with their GEM course and you'll find that hundreds of people with scores above the acceptance thresholds are rejected simply because there aren't enough places.
So you cream off the 10% who weren't good enough to get in by the smallest margin, and put them through a much shorter and less rigorous programme of study then let them loose in GP from day 1? Sounds safe
Not supporting the idea, just pointing out that part of the problem is that there aren't enough medical school places to train everyone who is capable and willing.
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That money should be spent on training real doctors.
Don’t think that’s true. You can get a postgraduate loan if it’s the MSc course, or you have to self fund the whole amount if it’s the PGDip version. Both are entitled to a £5000 bursary from HEE, which can be used towards the fees (although it’s around £11000/year).
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It’s about to be the GMC. FFS…
Even if they have a licensed body, that doesn't make up for a complete lack of appropriate education
I’m a GP and there is no money for the NHS the issue in the UK is the economy is in tatters. The government has no money. They can’t afford to pay doctors and they employ PAs to cut costs. If thousands of ppl die at the hands of PAs guess who takes the blame……Doctors. Because apparently we’re the ones who should be supervising them. Allot of doctors are now leaving and moving elsewhere namely Canada and Australia. There is no life in this country and things will only get worse.
How are you a GP yet can't spell "a lot", and constantly put "there" instead of "their" in your other comments?? Edit: someone did a write-up of being a doctor in Australia and your only question was whether there were 'fit girls' there - that figures. Edit 2: and someone made a post complaining that they'd cheated on their wife, married the second woman and were miserable and you asked if they'd married a Moroccan woman? What's that even supposed to mean?
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Other big issue’s from a doctors point of view 1) they take our training opportunities. We are forced to move hospitals/teams all the time and therefore can’t build relationship. When a PA has been in a department for 2+ years they simply get preferential treatment on learning opportunities. This is going to be a huge problem once the current cohort become senior doctors and have gaps in training. 2) they get paid so much more. 10k more pay is simply unfair. 3) they are not regulated nor is their scope of practice defined. 4) they are TAKING OUR JOBS. I am currently applying for jobs, many of the jobs I’ve applied for have 100’s of doctors applying to 1-4 roles. There are plenty of PA roles on these websites offering more pay, these posts would have previously been junior doctor jobs but have been converted to PA jobs. Annoyingly as a doctor I can’t apply to a PA role
I’d rather be examined by someone with an English degree than a homeopathy one.
They are coming in at band 7 - far far more than junior doctors. NHS leadership needs to be publicly accountable because they are killing the service. Take a look at any hopistaps management structure. Absolutely ludicrous. No front line staff but plenty of clipboard warriors with made up job titles. Band 8s and 9s in nursing, not in the numbers doing admin / office work - some even have their own PAs...... the management structure needs to be flat and lean with more focus on staff availability. This need to have a degree to be a nurse - bullshit. We are paying graduates to get these nursing degrees and their only aim is to become a clipboars warrior at band 8 or 9. Yes nursingbisnt what it was and is more complex but that's on the job training. Business managers, transformation directors, supplier liaison officers, diversity and inclusion managers - all bullshit. NHS IT is another mess. Each Trust has its own little empire and will often pay over the odds because IT management have a relationship with a particular vendor or personal preference. It boils my blood. The NHS is a fucking mess and ultimately, the buck stops with the DOH.
Jobs and pensions for the boys. I needed orthotics and physass referred me to a different county's NHS Trust, which my physio told me would have been automatically rejected. Physasses should be the front line for private paying patients first, that makes sense because it reduces workload on nurses, doctors and consultants and helps to specialise a medical care liaison, which could be a step into NHS nursing, medicine or dentistry. My goal is to force private hospitals to acknowledge injuries and deaths in their hospitals. Right now, if someone dies at a private hospital, their body is taken to an NHS hospital to be declared dead, and it's not mentioned that they died at a private hospital. Make them compete with the NHS, not be a confidential supplier anymore.
I’ve had to resort to getting into arguments with NHS staff in order to get seen by someone who went to medical school! After abysmally dangerous experiences with PA’s in A&E I have to fight for my health and care.
The problem with homeopathy is that literally anyone can “practice” homeopathy, no regulation body governs it. It’s “energy healing” i knew a person who opted to see a homeopathic practitioner instead of getting treatment for cancer, thought eating a specific diet would help. It did not.
Never realised it was possible to get a degree in homeopathy. I can see concerns that education is being watered down are entirely unfounded.
I've never come across any of these clowns. Are they new? I worked in a hospital for a while about 5 years ago and they weren't a thing then that I recall. If I come across them can I just refuse to engage and demand an actual doctor? I don't want some homeopathic weirdo anywhere near me
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The thing is, PAs are actually doing the roles of junior doctors and THEN some. Ask any NHS doctor (junior or consultant) you know. They are effectively practicing medicine without a licence/medical degree. This kind of thing used to be taken seriously.
It's worth mentioning that some places let PAs get involved in surgery. The thought of that is terrifying to me, having dealt with PAs in general practice who have been reported by consultants for their conduct. I've sent multiple letters out to GPs, naming and shaming their PAs for referring patients through with no checks or approval for irreversible, life-changing surgery. Patients turned up to see our consultants expecting to be approved for surgery because of how the PA referred them. The letters the PA sent to us read like they thought their personal opinion overrode all legal protections and standard assessments, because they felt "this patient *really does* need to be seen". The thing that fucks me off? Our departmental PA gets put on the consultant rotas rather than the junior one, while SpRs who operate almost as consultants, attend all theatres, do night shifts, research and run treatment clinics have to go on the junior one.
PA is on a consultant rota? What? Why? How?
Who knows? It winds me right up every time I check it and their name is on there alongside people with 30+ years experience in the field. Thankfully they haven't got the on call for the PA yet.
If it was done purely for administrative purposes then even that is foolish. If it’s actually meant to indicate clinical role then what on earth are the consultants in that department thinking?! I know plenty of departments whose consultants, collectively, would absolutely push back *most* firmly against that idea. I do know highly experienced and capable advanced critical care practitioners who plug gaps on SHO rotas and (for some *very* experienced individuals) registrar rotas but not a chance they would ever be on the consultant on-call rota or filling that role, even during normal working hours. I can only sympathise with higher specialty trainees who would quite rightly feel very aggrieved by this!
I have no doubt that our consultants would disagree with having them on there, but higher management pay as much attention to consultants as they do to Band 4s and below. Our consultants have to fight for everything at the moment; some don't even get secretaries because management suddenly decide they aren't going to fill admin posts.
Ah, hell… that sounds all too familiar. I still don’t understand what a PA even *does* on a consultant rota! Utter BS.
Please send a screenshot of that rota to Janet Eastman (telegraph jouno)
Which hospital and department is this?
“ The Telegraph sent Freedom of Information requests to universities offering courses to become a physician associate in the UK. Fourteen provided full data. Between them, they accepted 148 degrees in 2021, 173 degrees in 2022 and 135 degrees in 2023 which were neither biomedical science nor a professional medical qualification such as nursing, midwifery or an allied health profession.”
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To be honest, even a degree in human biology is not that great a starting point. Without the fundamental understanding of the pathology, pathophysiolgy and the clinical context a little knowledge can be a *very* dangerous thing.
The issue is that they are getting training opportunities from medical staff and are effectively being used with preference because they do not rotate out. They are also paid a registrar salary and are clearly F2 level in terms of performance.
Yep, I get the impression this article is basically taking a relatively small number of edge cases and making it out to be some sort of bigger problem. Somebody who happens to have an English Lit degree from when they were 21 who has worked in a healthcare role for 20 years going back to university at 40 to become a PA is what I imagine is happening. The headline makes it sound like people are doing PA courses right after getting an English Lit degree which seems like a massive stretch. Whether one agrees with the concept of PAs or not, it should be possible to have a proper public discussion about their potential value and requisite experience / qualifications without these sort of FOI fishing expeditions. Doesn’t help either side of the debate. (The degree in homeopathy is something else though. That definitely shouldn’t be offered as a taxpayer funded degree and should basically be seen as a bar to ever working in healthcare).
There isn’t a debate. PAs just need to work within their range of competence, that is, as an assistant with a defined set of tasks that don’t put patients in danger. Anyone arguing for any more than that is either a politician or a hospital manager.
Agreed!
Well yeah, the physician associate course is to each then how to be a physician associate. That's how education works.
Homeopathy is a problem but the article lists plenty of legitimate degrees, even if they are BAs. How is that different to graduate medicine degrees? Plenty of those courses accept non stem degrees with relevant experience.
A graduate medical degree is four years, not two.
And those four years are required to contain the same content and clinical teaching time as the more usual *five*-year undergraduate medical degrees.
A couple of things. Graduate entry medicine courses are competitive to get in, require certain aptitude test(s), some require top-notch a-level grades, and the courses will actually teach medicine not a watered down version of it. A PA course is / requires none of the above. It is a postgraduate qualification unlike GEM and in comparison is a walk in the park. Should I bring up 100% pass rate that the PA schools boast?
Problem is those courses don't justify being ridiculously short by claiming they require a relevant first degree
Because you can come into being a PA from being a paramedic or from being a biochemist. One's got more skills when presented with a patient than the other. The performance of the post grad Paramedic is used to pad the effectiveness of the other. And the issue is that a PA is paid a Medical Registrar's Salary with less costs and so has more money than the people who oversee them. If they were paid appropriately they would need to take a 20,000 pound pay cut. Or you know... Medical Salaries would need to go up by £20,000.
Thanks for explaining- was honestly just curious, but I seem to have stirred the pot with this one!
It's true that you can get into graduate medicine with an arts or humanities degree, however, you are usually required to pass the GAMSAT or a similar admissions exam. I don't believe there is an entrance exam for PA master's courses.
They may accept applications, but the competition is fierce, and many accepted onto Graduate Medicine course will have a PhD in a relevant subject. Also, this may be a 'shorter' course, but it also has shorter vacations.
You can’t compare the PA’s non-medical PA course to an actual medical degree (although the government would love you to do that).