NHS: GP surgeries; privatisation; physician associates

Comparison of GP (UK) to Family Practice MDs (US) in 1999. https://www.jabfm.org/content/jabfp/12/2/162.full.pdf

I didn't know that in UK you go into 5 yrs of medical school directly after finishing secondary school.

In the US, after secondary school, you go to uni for 4 years--you usually do a science degree, but if not, you do some science courses to pass the MCAT test, to be accepted to medical school which is 4 years long.

Lots of differences in systems, teams, funding of course and population coverage.

On the debt load at the end of medical school in the US in 1999 (or earlier) the article noted the average then was $60,000. You can imagine what it is now.
 
Bizarre things happen here in the US system: separate health systems which are private get ratings by their clients. This can result in over-prescribing of antibiotics per patient request. It's a consumer driven meausres of "quality" which aren't, necessarily.

Then these separate private health systems (insurance companies allied with medical groups-hospital alliances) tout their ratings to entice more consumers to sign up (and pay the monthly cost of premiums, which are often absurdly high).

I have been hounded incessantly last year because I didn't make an appointment (that charges our government $350--I have medicare so that's like a national health service but only for the disabled or over 65s) for a 45 minute senior wellness check (preventive tests, check if you're demented or depressed).

It's a measure of "quality" at the physician group/hospital--insurance company maze-mess).

One almost believes that there is incentive for the system to promote obesity and diabetes because there is higher utilization of "services" aka more charges, more profits.

So, our system is an expensive mess that leaves out many people. It lacks compassion. And with serious illness, the health insurance companies, will short you and deny coverage for needed care, that's how they make their CEOs rich. At that point, many people here will switch to original Medicare, because what's covered (skilled nursing home days) is covered. There isn't the haggling.

I don't think using a market approach is wise in healthcare. Maybe for innovations, but not spreading the best care around to ALL the people equally.

I'll stop for now.
 
shak8 said:
Comparison of GP (UK) to Family Practice MDs (US) in 1999. https://www.jabfm.org/content/jabfp/12/2/162.full.pdf

I didn't know that in UK you go into 5 yrs of medical school directly after finishing secondary school.

In the US, after secondary school, you go to uni for 4 years--you usually do a science degree, but if not, you do some science courses to pass the MCAT test, to be accepted to medical school which is 4 years long.

Lots of differences in systems, teams, funding of course and population coverage.

On the debt load at the end of medical school in the US in 1999 (or earlier) the article noted the average then was $60,000. You can imagine what it is now.
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I think it is probably a US vs Europe thing. Here people go to medical school directly after secondary school too but is 6 years (plus specializing afterwards).
 
Wyva said:
I think it is probably a US vs Europe thing. Here people go to medical school directly after secondary school too but is 6 years (plus specializing afterwards).
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There is also in the UK the graduate-entry medical school option. Which requires an undergraduate degree (3yrs after school, doesn't have to be science - depends I assume on demand, school itself and so on) and is 4yrs.

PLus Oxbridge, and I think Scotland still (although I'm not sure whether that can vary if you have 'higher' qualifications because of how the scottish options for 'A levels' work vs A levels) have medicine courses that are 6yrs after school.
 
Moved post

@Jonathan Edwards. Apologies ( and to MODS) for posting out of topic because there doesn't seem to be a thread for PAs.

The Times today on page 2 of hard copy headed " Top doctors voice safety fears over more physician associates". It is about a letter to the Times ( p24 today) from a group of members of the RCP. Govt aims to triple number of PAs to 10,000 over next decade. Medical leaders fear this will put patients in danger. Training is 2 years. Letter has been signed by 27 fellows of the RCP and is on page 24.


https://www.thetimes.com/uk/healthc...ysician-associates-top-doctors-urge-r68rgdpjh
 
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Children's doctors urge NHS to halt hiring of physician associates
The NHS should stop recruiting physician associates on paediatric wards because of concerns over safety, children’s doctors say.

The Royal College of Paediatrics and Child Health has called for an immediate ‘pause’ until there are clearer guidelines on how they are deployed.

It follows a ‘comprehensive consultation’ with its members on their views and experiences of physician associates (PAs), who undergo less rigorous training than doctors.

Over 2,000 paediatricians in the UK responded to a survey, with 80 per cent of respondents agreeing or strongly agreeing that ‘PA recruitment should be halted whilst the NHS develops structures for appropriate deployment of PAs’.
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Children's doctors urge NHS to halt hiring of physician associates
 
I just came across this BBC article about Physician Associates being used in the NHS. A very cynical thought crossed my mind... I wondered if PAs will be used more for female patients than male patients.

https://www.bbc.co.uk/news/articles/czxvww97pleo

I noticed the reference to the NHS Long Term Plan. The name sounds very dystopian to me.

According to the NHS Long Term Plan, there will be 12,000 physician and anaesthetic associates by 2036.
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One thing that would help is making name tags and position much more obvious to patients, and other staff.
 
Streeting looking into concerns about role of NHS physician associates
Health Secretary Wes Streeting said there are “legitimate concerns” over the role of physician associates (PAs) amid worries they are being used to replace fully-qualified doctors.

He said he wanted to look into the issues around the roles before a planned expansion in the number of medical associates.

“I think they do have a role to play and can add value, not least in freeing up doctors’ time to do the things that only doctors can do.

“But I think there are legitimate concerns about the extent of doctor substitution and replacing doctors with PAs, there are issues around transparency.

“As patients, we should know who we’re seeing, who’s in front of us and why, and we’ve got to take those issues seriously.”

Under the NHS long-term workforce plan the number of associates will expand from around 3,500 at present to 10,000 physician associates and 2,000 anaesthesia associates by 2036/37.
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Streeting looking into concerns about role of NHS physician associates
 
Jonathan Edwards said:
I actually think this is a myth. I spent three months doing a GP locum just before my specialty training, having done my acute general medicine. I found it terrifyingly difficult much of the time. The only appointments that really matter are the ones where someone presents with something important like cancer or multiple sclerosis, or even ME/CFS. Judging from my social circle and also from my experience as a physician, fully trained GPs get these wrong about half of the time. If I was not a physician my cancer would have been missed until too late - as was the case for a couple of friends in the road. God help anyone going to see an untrained assistant. Serious disease often presents with very ordinary symptoms dismissible as anxiety, or hypochondriasis. as we all know.

The US has come out the very worst value for money yet again, so I guess that may be another indicator of what not to do!
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We had a similar experience in Jan 2022 Jo when husband presented with urinary symptoms.
Due to Covid restrictions. a urinary sample was requested by surgery who do a dip test to see if its an infection.
No face to face, examination etc.
Dip test ( inherently unreliable) says no. Infection, do have antibiotics and wait and see......!!!
I refused to wait.
I refused to take home the antibiotics if there was no infection reliably found.
Asked for another proper micro biology check and was told not available.
I checked hospital lab and was told it was available.
So presented at GP surgery with another sample and said I would sit there until I could speak with a doctor.
Meanwhile I looked up Nuffield/ also NHS Consultant and had appointment examination and tests booked next day.
Challenged surgery about management. He said, 'That's what we do'........ wait and see...
In the circumstances, family history husband's particular presentation. I said that's not safe or acceptable.
He conceded and fast tracked matters.
The Nuffield appointment, thoughness and personalised care/ attention to detail probably saved my husband from untreatable cancer.
After kidney stones were diagnosed, prostate follow up happened and cancer was also diagnosed in 2023. Treated and further attention to detail discovered and unrelated early bladder cancer in March 2024.

Though he has ME, the local since diagnosis of cancer the NHS hospital cancer service has been exemplary.

BUT, like Jo, if I had accepted the , 'We do things this way'.. if I refuse to take no for and answer, things could have turned out less favourably.
 
I don't have an in principle problem with experienced senior nurse having some kind of associate role. My very limited experience with them is satisfactory. No red flags, so far.

Given the increasing shortage of GPs and health budget shortfalls, at least here in Australia, we don't really have much choice for now but to work with what resources we have available. My GP's practice is nominally 3 doctors, but only has one now, and she is old and part-time, and clearly is not going to be working for much longer, and the practice cannot find long-term replacements, even short-med term locums are hard to find.

But using associates is something that is also ripe for exploitation to paper over the massive holes in the health service created by persistent funding deficits and staff shortages, and for major medical disasters due to inadequate training and resources.
 
Physician associates face being struck off if they mislead patients to think they are doctors
Physician associates (PA) face being struck off if they mislead patients into thinking they are doctors under new guidance.

The workers will be regulated for the first time from next week by the General Medical Council (GMC), which has updated its guidance at the 11th hour to include deliberately misleading patients about their role as “serious misconduct”.

It comes after doctors criticised the decision not to make misleading the public a serious offence in the initial plans – which it is considered for doctors – during a consultation.

Plans to expand the use of PAs across the NHS have caused controversy over the last year with a series of patients coming to harm after being cared for by a PA.

Emily Chesterton, a 30-year-old actress, died after she was twice misdiagnosed by a PA as having an ankle sprain, when she actually had a blood clot that travelled from her leg to her lung. She had thought she was seeing a GP.

Under the new guidance any PA who does not declare that they are not a doctor, or allows a patient to believe they are being cared for by a doctor, will face a fitness-to-practise hearing.

If found guilty they will face a suspension or permanent ban from practising.
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Physician associates face being struck off if they mislead patients to think they are doctors
 
Physician associates banned from treating patients alone, leaked rules reveal
Physician associates will be banned from treating patients on their own under new guidance seen by The Telegraph.

The new guidance by the Royal College of Physicians, which will be launched this week, will restrict what physician associates (PAs) can do independently, and ensure there is tight supervision by a senior doctor or consultant at all times.
It comes after reports of patients coming to harm or dying after seeing a PA, with medics criticising hospitals for allowing them to do the work of doctors despite having no medical degree.

Going forward, PAs will also have an educating supervisor who will carve out time in their week to spend on the PAs’ long-term development and manage any issues that arise, it is understood.

The General Medical Council (GMC) formally began to regulate the profession for the first time on Friday, but this will not be enforced for two years.

While the Royal College of Physicians’ guidance is not legally binding, the GMC is expected to use it while the Government conducts a review of the PA and anaesthetic associate (AA) professions.

Insiders told The Telegraph they expect the GMC to use the scope of practice guidance to prevent PAs working beyond their remit and to hold both them and their supervising consultants accountable. It means doctors could be sanctioned if they fail to follow the new rules.
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Physician associates banned from treating patients alone, leaked rules reveal
 
NHS to hire physician associates from abroad despite training quality fears
The General Medical Council (GMC) will accept foreign-trained PAs to practise in the UK as long as they have a “relevant qualification” legally accepted in their country.

But doctors have said the “corner-cutting” approach will further risk patient safety, with the regulator yet to properly assess UK-based courses for the controversial positions.

The GMC will register PAs and anaesthetist associates (AAs) from 15 countries, in some of which the quality of training has been described as “inconsistent at best”.

As well as Ghana, Zimbabwe and Bangladesh, the other countries are: Kenya, Malawi, Liechtenstein, South Africa, Norway, Switzerland, US, Canada, Iceland, Ireland, Israel and the Netherlands.

..
The Royal College of Physicians has told doctors to supervise PAs in person at all times, while the Royal College of GPs this week told the Government’s review, led by Professor Gillian Leng, there was “no place” for PAs in general practice despite about 2,000 currently being employed there.

..
The GMC requires a £500 fee, and will test each applicant’s command of English and assess their core competencies.

In guidance seen by The Telegraph, it sets out nine key criteria for someone to be successful, which it says have “been developed to broadly reflect the core components of a UK PA qualification”.

However, the tension between doctors and PAs over their competency is a global phenomenon. In Ghana, the Medical and Dental Council (MDC) has de-accredited more than half of the country’s university PA training programmes, an article in the BMJ claimed.
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NHS to hire physician associates from abroad despite training quality fears
 
One serious indicator of a failing state is their inability to train up, and retain, their own citizens for technical positions in particular.

The same problem is happening here is Australia. The health system is being flooded by people from overseas. Not just the health system, all sorts of jobs and businesses are being taken over by people from overseas, many coming in on bogus education visas.

It is a massive problem and rapidly getting worse. This is not good for stability and democracy, and will be its undoing if it is not brought under control, which I see no sign of happening. Governments seem either incapable of doing it, or don't want to.
 
Fewer than 10 per cent of physician associates are regulated
The vast majority of PAs practising in the UK are not signed up to the watchdog’s register, data shared with this paper show.

The General Medical Council (GMC) began regulating PAs and anaesthesia associates (AAs) in December as part of measures to improve the standards and accountability that the roles are held to.

The associates have been asked to register voluntarily for the first two years before regulation becomes a legal requirement in December 2026.

But data shared with the Telegraph shows that fewer than one in 10 were registered as of February 14, despite the GMC inviting them all to sign up by the end of January.

Just 359 PAs and 13 AAs had joined the register, the figures showed. The regulator said it was in the process of assessing a further 1,242 applications.

More than 3,500 PAs are working in the NHS in England and about 100 AAs, with around 150 associates working in Scotland, 220 in Wales, and 80 in Northern Ireland.
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Fewer than 10 per cent of physician associates are regulated
 
The bitter row between GPs and physician associates is threatening the NHS
A review published by the Nuffield Department of Primary Care Health Sciences, University of Oxford, and the London School of Hygiene and Tropical Medicine, found “little evidence supporting the safety and efficacy of PAs and AAs” in the UK.

The research, led by Professor Trisha Greenhalgh and Professor Martin McKee, was published in The BMJ.

PAs and AAs are being rapidly introduced across the NHS as a solution to workforce shortages and funding cuts, the authors said. However, many question if these roles will improve the challenges facing the NHS and whether the training is sufficient.

“I think we need to review how PAs are deployed,” Prof Greenhalgh told The i Paper. “There are two issues: are they effective/safe? And are they cost effective?”

Prof Greenhalgh added “there are clearly some roles that PAs could fulfil (low-risk tasks), but since they’re actually quite highly paid [average starting salary is between £46,000 and £53,000], such roles may not be cost-effective”.

The Patients Association said it was unable to comment on the proposal to expand PAs to 10,000 as it is currently running patient focus groups with a view to updating its position but welcomed the launch of the review.

The Leng review
The BMJ study was written to inform the government-commissioned Leng review which is examining the effectiveness and safety of the roles of PAs.

Department of Health officials said they want to “establish the facts and make sure that we get the right people in the right places providing the right care”.

The review team said it was important to note the question about safety and effectiveness is “a complex one” and acknowledged the “regular toxic debate” around the roles of PAs and AAs.
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The bitter row between GPs and physician associates is threatening the NHS
 
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