NHS: GP surgeries; privatisation; physician associates

interesting thread from Keith Geraghty

https://twitter.com/user/status/1638655905448247299

 

Panorama from June 2022
Panorama investigates Britain's biggest GP network. US owned Operose Health provides GP services to the NHS, with 70 surgeries from Leeds to London and more than half a million registered patients. Reporter Jacqui Wakefield reveals a shortage of GPs, some less qualified medical staff working without adequate supervision and a backlog of important patient paperwork.

BBC iPlayer - Panorama - Undercover: Britain’s Biggest GP Chain

shocking.

 

My GP surgery was taken over by Centene / Operose and it’s been horrendous (my whole care is pretty much managed by pharmacists / “clinicians” who turn out not to be doctors, and even when a doctor does manage it, things keep going wrong). I was contacted by a journalist who wanted to interview me for this BBC programme (they found me through a Google review I left for my GP surgery), and I gave them details of what it’s been like, but I didn’t want to appear on TV because of my health.

 

they're called 'Physician Associates' and their use is becoming more widespread.
(in particular for patients with LTCs).

https://www.healthcareers.nhs.uk/ex...cal-associate-professions/physician-associate

 

One of the worrying thing about this is how good they will be in knowing when to pass patients back to doctors, particularly in patients with long term conditions where there is already a dangerous assumption in many professionals that taking patients symptoms seriously promotes ‘false illness beliefs’. Also one wonders why there is a need to create this new professional group rather than extending the role of practice and community nurses. We already have such as diabetic nurses, why not add other nurse specialisms.

I suppose there is already a shortage of nurses, but would these physician associates also have less training and cost less than nurses. I do not rule out the potential value of such a role, but worry that if not developed carefully would [correction] result in a diminution of care for such groups as ourselves, people with ME. I suspect with people with ME, such a role would only have value if it was in addition to current medical care rather than instead of medical care.

[added - There is a danger that this group would end up with the jobs that no one else liked doing, that are not necessarily the most appropriate to delegate to the least skilled. Hopefully things have changed over the last twenty five years plus, but when I worked with people in nursing homes and care homes often it was the newest and least experienced staff that ended up feeding people, with little or no training in recognising silent aspiration and the risks of aspiration pneumonia.]

 

lol when i was about 19 my grandmother was in hospital after a severe stroke, was pretty much only able to move her eyes. I fed her, i was given no advice just a bowl of slop which i gave her with a teaspoon.

 

Because GP practices are private businesses, on1y the GP's have an NHS contract. Other staff's pay varies from practice to practice. My very experienced (graduate) nurse practitioner sister (35 years of experience in A&E and Minor Injuries in the Navy and NHS, inc1uding as a c1inica1 manager running a who1e service in P1ymouth) was made redundant in the NHS 'restructuring' about 10 years ago (read austerity cuts). After a coup1e of years working in a 1oca1 sma11 hospita1's minor injury unit, where she was the on1y qua1ifed nurse practitioner (with no doctors in the unit) and was expected to work a fu11 shift without even a tea break, she worked for about 18 months in a GP surgery (initia11y thinking it wou1d be a better work environment).

Her pay was ha1f what she was earning under her NHS 'Agenda for Change' contract, the GP practice wou1dn't even pay her as a Nurse Practitioner. For this pittance she was expected to work 12 hour days and supervise inexperienced nurses and practice staff, despite her pay/contract being for on1y 8 hour days. She decided it wasn't worth the damage to her own hea1th and took ear1y retirement in her 1ate 50s.

So I don't see why any graduate wou1d want to work in this sort of environment for even 1ess pay than a qua1ified nurse! It must be even worse now than it was when my sister was working.

 

The bigger picture
https://twitter.com/user/status/1471796744455397379

 

Actress, 30, died after her blood clot symptoms were dismissed as 'anxiety' by associate doctor

Actress, 30, died after her blood clot symptoms were dismissed as 'anxiety' by associate doctor (msn.com)

 

To be fair i dont think this is about it being a PA, but about that particular PA being useless! A patient's leg being swollen & hot isnt anxiety is it!? Prat.
I'm not at all medically qualified & even i know that those symptoms in addition to shortness of breath = go to A&E it might be a clot, so i dont think the issue is that they were underqualified, I'd imagine even an experienced but unqualified HCA could have identified it.

 

Leading doctors launch legal action over physician associates

Leading doctors launch legal action over physician associates (msn.com)

 

the replacement of gps by pa has already happened in the U S A and will happen everywhere . Doctors have left it to late to protect their own interests this is not for the best interest of patients. This subject has been mentioned on pubmed many times with older doctors recognising that they were responsible for these outcomes.

 

Physician associates being used as ‘substitutes’ for doctors – academic

Physician associates being used as ‘substitutes’ for doctors – academic (msn.com)

 

The most surprising thing is that they aren't going straight to CBT therapists trained in 2 week-ends. Just a matter of time, I guess.

 

Britain's biggest GP body has voted to ban physician associates (PAs) from working in practices.

Britain's biggest GP body votes to ban physician associates (msn.com)

 

Good for them. If the president of the college of physicians hadn't gerrymandered the rules the bill would probably never have got through Parliament.

 

Here in the US, the starting pay for an anesthesiologist is about 400K/annum). Being a family physician (GP) is also a specialty (requires 3 additional years in a residency program after the internship year post medical school) but the starting pay varies, per region, but is probably in the 200k range.

Medical school is very expensive in the US and the huge debt burden upon graduation has led to a dearth of family practice (GPs) physicians. Can take 20-30 years to pay off the debt, I think.

So NPs and PAs have filled in part of primary care shortage. Some physicians and surgeons employ their own PA (more often male) to assist with surgery, and do the humdrum answer patients emails and calls, do routine exams in follow-ups and the physician hires and fires this person. A physician extender, a good thing, I think.

Physicians here shiver under the perceived threat of medical malpractice so a faulty-thinking PA or NP would be out on his/her ear.

NPs and PAs are on offer as your primary care health practitioner here. Some varying percentage compared to MDs. The American Medical Association (the AMA) has occasional battles with the PA and NP associations over encroachment of their professional turf, as more procedures and widened scope of practice are done by the PA or NP.
What is allowed in their scope of practice (and how much independence of practice vs direct supervision and responsibility for the NP or PA; prescribing drugs, without supervision, for instance) has greatly increased over the decades, encroachment by encroachment.


Is the NP or PA smart enough to know what they don't know? Have they had significant experience in a healthcare setting (ie ICU nursing, ER nursing, floor nurse, ambulance medic).

Primary care doesn't take an Einstein, usually. But there are times when a physician's knowledge and experience are going to make a diagnostic difference--they've been exposed during training and afterward to a hell of lot more pathology and can connect the dots (or at least some/most of them).

There is still a shortage of primary care physicians or NPs and PAs in family practice.
Especially in rural areas of the US.

 

For the first time ever I looked up my NHS surgery on Google Reviews today. The vast majority of them were one star reviews with a few reviews saying my surgery must be the worst in the UK. *Sigh*

According to the surgery website the practice is owned by a subset of the doctors who work there.

What baffles me is that some sources of information tell me that they don't answer calls between 8am and 10am, and yet to get an appointment I have to call at 8am. This probably explains why they never answer.

 

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!

 

Certainly an indicator of what not to do.

People in the UK ME communities have an overly rosy picture of what ME care in a fully US-ifyed system might be like for most. Going by reports from all the middle class professionals who haven’t been kicked off of their good insurance plans yet, or some who are fortunate enough to be under decent insurance via well off parents (if they get sick younger) or spouses with the best possible employment benefits healthcare wise, who don’t lose their jobs or something in a layoff. Or have to quit work to care for anyone, or get sick themselves, or die.

What causes me to fall into despair about the NHS is the lack of supportive care or treatment and investigations for all the many other conditions or complications that people with people with ME succumb to just like everyone else, for pwME on account of ME being viewed as reason enough to be unconcerned, is that the services are being broken up and sold off before our eyes, far faster than we can convince doctors and politicians to not dispose of us as they do.

So as things stand it’s unlikely we’ll ever benefit from the free at the point of access universal healthcare service that we do theoretically but not actually have available to us now. As the icey grip of BPS is melted off of UK medicine we may assess the situation and find nothing is left.

Since it’s not ever going to be profitable to provide us (or anyone else really but that’s another story) with good quality healthcare our prospects for achieving access look grim under a future further perhaps fully privatised system. We aren’t going to get it. Ever. Not even if a cure is discovered.

It’s just instead of begging doctors to treat us, we’ll be begging insurance companies to pay out for lifesaving treatment for cancer or whatever. Or petitioning the government to stop being so stingy so miserly with their poorper plans for low income or unemployed or kicked off their insurance for having too ‘complex’ health needs people.


As for GPs, yes.

Its the widest spread of cases. GPs need to know a lot to do this safely. That can’t relied upon currently. It would be impossible to catch every serious illness. But current healthcare policies and politics discourages referrals. So it’s more dangerous than it needs to be for patients with serious illnesses.

Is this fatigue and or pain pain for this person
Being pregnant?
Working night shifts?
Being a landscaper?
Being a teenager?
Being a new parent?
Being elderly?
Having a virus that’s probably self limiting and not likely to cause serious illness?
Slightly prolonged but normal recovery from a virus?


Or is it a sign of something I have to deal with right away?
Some kind of cancer?
Autoimmune crisis?
Silent pneumonia?
Blood clots?
Sepsis?

Or am I overthinking this?
Maybe anxiety over normal bodily sensations knocks and bumps or mild ailments. Patient just needs reassurance. From a trained professional.

Okay this getting ridiculous reassurance given, and given, and given. Patient not accepting it. Symptoms multiply.

I surely it is clear I am now dealing with classic case of the Time Waster. A professional of my standing can always recognise them a mile off. She’s too much. If it’s not one thing it’s another always something wrong, and here far too often.