NHS: GP surgeries; privatisation; physician associates

[Sly Saint]

interesting thread from Keith Geraghty

Given I could not get an appointment at my GP today, and have seen patients in tears at the desk and the reception staff told me they have to turn away most patients most days, I asked myself..."who owns and runs my local GP practice?"......here is what I found..............

1. the Care Qual Commission give my local GP practice a good rating for all scores, incl responsiveness! I had assumed the practice was run by a Dr Astles - it is back in Leicester home area. https://cqc.org.uk/location/1-559578647 - but is now Willowbrook

2. The practice manager is a very senior person, a GP, Professor, doctor and holder of many positions and directorships of many private companies - His name is on public record as Professor Rishabh Prasad.

3. here is a
@reachleicester
newspaper article on a story re a patient who could not get an app. back in 2019 (pre-covid) & interview with Dr. Prasad - about how he was aware patients were struggling to get appointments.

leicestermercury.co.uk
GP explains why patient at surgery struggle to see a doctor
'When we become GPs we do so to care for people, not to run efficient businesses'

4. My practice manager has a public record searchable as a
@HealthFdn
scholar & holds or held senior roles as Clinical Director at Digital Health Evaluation Services overseeing hundreds of millions of pounds budget for primary care services in the East Midlands region.

5. On public records I see my practice manager is actually Chairman Of The Board of 'Willows Health' who it seems may have control of my local GP practice, via ownership or management - it is hard to tell. So who are Willows Health? >
willowshealthcare.org
HOME | Willows Health

6. so just a recap: my local Dr GP practice is now Willowbrook, which is owned by Willows Health, with manager not onsite, Chair of a Company, multi-roled, multi-directorships. Ok - context, no appointments, patients unhappy, I'm still trying to understand who owns my GP?

Ok so Willows Health - "the Gold Standard for Care"? um really? Patients in tears, low quality ratings, awful comments about poor service and lack of appointments...who is deciding whats the Gold Standard here.


7. Mergers - private companies and Willows Health - why does this matter at all? Well its seems Willows owns more than one practice and patients are having to phone in from all practice areas in the morning at 8 am to fight for an appointment, all patients calling one phone line!

8. What Willows Health say their patients say about their care provision ....? Note the multiple practice locations

9. How patients rating Willowbrook, under Willows Health & patient feedback on google reviews "impossible to get an appointment here" & comments on Willows Medical Centre. Seems to me a consistent issue of complaint with lack of access to appointments and 8 am phone-in for all!



10. Willows Health is a Consortium of 10 GP practices owned/run by a private company. As a patient you have to phone at 8 am and most callers will not get an appointment - privatisation of this kind has implications for patient care, like me this morning & many others........

11. More from my search to understand who owns my home GP practice - to find out why its so difficult to get an appointment: looking at the consortium page the GP salaries link says across most of the 10 practice they only have 1 full-time GP salaried, https://willowshealthcare.org

 

[Sly Saint]

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.

 

[lunarainbows]

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.

 

[Sly Saint]

“clinicians” who turn out not to be doctors

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

Physician associate
Physician associates support doctors in the diagnosis and management of patients.
As a physician associate, you might work in a GP surgery or be based in a hospital, but wherever you work, you'll have direct contact with patients.
Working life
You’ll be a graduate who has undertaken postgraduate training and you'll work under the supervision of a doctor. You’ll be trained to perform a number of day-to-day tasks including:

• taking medical histories from patients
• performing physical examinations
• diagnosing illnesses
• seeing patients with long-term chronic conditions
• performing diagnostic and therapeutic procedures
• analysing test results
• developing management plans
• provide health promotion and disease prevention advice for patients.

Most physician associates currently work in general practice, acute (internal) medicine and emergency medicine.

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

 

[Peter T]

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.]

 

[JemPD]

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.

 

[Simbindi]

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

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.

 

[Amw66]

The bigger picture

 

[Sly Saint]

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

• Emily Chesterton, 30, was seen by a physician associate on October 31, 2022

The parents of a young actress who died after her blood clot symptoms were dismissed as 'anxiety' have said the spread of 'associate doctors' will spark more tragedies in the future.

Emily Chesterton, 30, was seen by a physician associate (PA) at her appointment at the Vale Practice surgery in north London on October 31, 2022.

Her symptoms included calf pain, a swollen and hot leg, shortness of breath and she was finding it increasingly difficult to walk.

Emily, who was from Greater Manchester but had moved to London to pursue a career in acting, believed she had been seen by a GP - but instead a physician associate prescribed her propranolol medication for anxiety.

She collapsed later that evening and was rushed to hospital. However her heart had stopped beating and doctors could not save her life.

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

 

[JemPD]

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.

 

[Sly Saint]

Leading doctors launch legal action over physician associates

Leading doctors are to launch legal action against the medical regulator amid rising concerns about the use of physician associates.

The British Medical Association said it needed to take action before the “uncontrolled experiment” of the use of medical associate professions (MAPs) “before it leads to more unintended patient harm”.

The union said it is launching legal action against the General Medical Council (GMC) over the way it plans to regulate MAPs.

We have had enough of the Government and the NHS leadership eroding our profession. We are standing up for both doctors and patients to block this ill thought through project before it leads to more unintended patient harm

Professor Philip Banfield, BMA council chairman
It said that there is a “dangerous blurring of lines” for patients between doctors and assistant roles.

MAPs have been under increased scrutiny following the death of Emily Chesterton in November 2022.

The 30-year-old had been under the impression that she was seeing a GP, but was actually seen twice by a PA who failed on both occasions to spot that her leg pain and breathlessness was a blood clot, which ultimately travelled to her lungs.

Leading medics, including the Royal College of GPs and the BMA, have called for a halt of the recruitment of physician associates while concerns are addressed.
From December 2024, the GMC will become the regulator for physician associates and anaesthesia associates – known as Medical Associate Professions (MAPs).

Professor Philip Banfield, chairman of the council at the BMA, told the union’s annual meeting in Belfast: “Today I want to announce that we are taking legal action against the GMC.

“We’re taking this action because of the dangerous blurring of the lines between doctors and MAPs specifically with challenging their frankly unsafe use of the term ‘medical professionals’ when they’re referring to people who are not doctors.

“This legal action is supported by our colleagues, the grassroots movement Anaesthetists United who will be pursuing a complimentary legal challenge.

“We have had enough of the Government and the NHS leadership eroding our profession.

“We are standing up for both doctors and patients to block this ill thought through project before it leads to more unintended patient harm.

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

 

[alktipping]

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.

 

[Sly Saint]

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

Physician associates have “become substitutes” for doctors in many hospitals and GP surgeries, a leading academic has said.

Professor Martin McKee said there appears to be a “powerful ideological pressure” to expand the roles across the NHS.

Writing a commentary piece in the Journal of the Royal Society of Medicine, he warned that “growing concerns about patient safety have been ignored”, though the situation “may now be changing”.

Leading medics, including the Royal College of GPs and the British Medical Association, have called for a halt to the recruitment of physician associates (PAs) while concerns about the roles are addressed.

The contractual and funding arrangements that have been established to promote the expansion of PA numbers, including salaries much higher than newly graduated doctors, reflect a powerful ideological pressure to expand their roles

Professor Martin McKee
Prof McKee, from the Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, highlighted measures which have been designed to increase the medical workforce in the UK, including the introduction of physician associates, the expansion of medical school places and proposals to “shorten and simplify the medical degree”.

He added: “But changing the medical curriculum will take time, so politicians need a quick fix.

“The answer is to create a new group of workers, physician associates.

“Conceived as health workers who can assist doctors, in many hospitals and primary care facilities they have become substitutes for them.

“They offer a means by which those living in places where it has been impossible to retain doctors can get some basic care.

“Although required to have a degree to enter training, in reality this can be in anything, including homeopathy or the humanities.

“There are many examples on social media of job descriptions and other documents that imply that their two-year training is equivalent to a medical degree. Growing concerns about patient safety have been ignored.

“This situation may now be changing following growing awareness among both doctors and the public of problems, mostly about patient safety, but also illegal prescribing, unclear accountability and damage to specialist training.

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

 

[rvallee]

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.

 

[Sly Saint]

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

It follows months of vocal concern by medics over the NHS's growing reliance on so-called 'cut-price medics', which has been linked to three deaths.

These staff members do not go to medical school and instead do two years of post-graduate training on top of a degree in a subject like biomedical sciences.

The College — which represents 50,000-plus GPs — said almost two thirds of voters agreed to oppose PAs from working in surgeries.

The NHS employs more than 3,500 PAs in England and plans to increase this to 10,000 by 2036. Around 2,000 currently work in general practices across the country.

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

 

[Jonathan Edwards]

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.

 

[shak8]

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.

 

[Arnie Pye]

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.

 

[Jonathan Edwards]

Primary care doesn't take an Einstein, usually.

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!

 

[Ash]

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.