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.

 

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).

 

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

 

The RCGP last week discussed the position of Physician Associates and voted to oppose a position for PAs in general practice.
There are currently 2000 PAs in general practice and regulation is needed according to the RGGP.

https://www.rcgp.org.uk/news/physician-associates-council-update

 

Children's doctors urge NHS to halt hiring of physician associates

Children's doctors urge NHS to halt hiring of physician associates

 

This is like shutting the stable door after the horse has bolted.

 

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.

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

Streeting looking into concerns about role of NHS physician associates

 

Physician associates sounds bad enough - anaesthetic associates -really ?

 

Interesting that nobody has suggested hiring airline pilot associates or bomb-disposal expert associates to do the stuff that you don't need a [pilot to do.

 

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.