NHS: GP surgeries; privatisation; physician associates

[bobbler]

The bitter row between GPs and physician associates is threatening the NHS

The bitter row between GPs and physician associates is threatening the NHS

Really refreshing to hear the response of ‘we are finding out what they think before we reply’ from a patient association

which to me makes the potential for political and other things being involved rather than thinking and having enough of the right voices listened to that having a knee jerk stance at Theo ready cab indicate on many things

 

[Sly Saint]

Physician associates to be renamed to stop them being mistaken for doctors

Physician associates in the NHS will be renamed to stop patients mistaking them for doctors after a review found that their title caused widespread confusion....

However, Prof Gillian Leng, whose government-ordered review is looking into whether they pose a risk to patients’ safety, has concluded that they must be given a new name, so patients they treat are not misled into thinking they have seen a doctor, according to sources with knowledge of her thinking.

Doctors who fear the term has created widespread confusion among the public and risks undermining trust in the medical profession will regard ditching it as a major victory.

Wes Streeting, the health secretary, is expected to accept Leng’s recommendation and instigate the change, which could lead to physician associates being renamed “physician assistants” or “doctors’ assistants”. She will also specify in her final report, due later this month, that those who perform those roles must make clear to patients that they are assistants, not fully fledged medics.

When Streeting appointed Leng to undertake the review he said that while many PAs provided good care there were “legitimate concerns over transparency for patients, scope of practice and the substituting of doctors”.

A Department of Health and Social Care source said: “It’s clear there’s a legitimate problem of patients not knowing who they are seen by, which is their basic right. It is likely the review will make recommendations to address this problem, including changing the titles of PAs.”

“The secretary of state asked Prof Gillian Leng to produce an independent review into PAs and AAs that will provide certainty to patients and staff across the NHS.

Physician associates to be renamed to stop them being mistaken for doctors

 

[Kiristar]

I had my first experience of an associate physician this week. They were clearly badged and did not attempt a diagnosis, instead logged my symptoms account to my notes. They booked me in for the next available home visit slot the next day with a Dr familiar with the emerging issue at hand (none behave well re my ME) .

So basically it was a slightly more thorough triage appointment. Which I suppose on one hand delayed a Dr seeing me by half a day. But I found the interaction more empathetic than a regular Dr (perhaps an issue at my particular surgery) and it's the first time a Dr has done a home appointment so my symptoms were taken properly seriously.

Overall a positive experience similar to seeing a nurse practitioner, but I'd far rather sufficient Dr places were funded by the government and allocated at medical schools in the first place.

The challenge of healthcare systems isn't easy but rapid accurate differential diagnostics seems vital, especially when you read some of the personal stories shared that could have turned out so differently.

 

[Sly Saint]

Six deaths linked to NHS using less qualified PAs as substitute for doctors, review found​

Physician associates should be banned from seeing patients who have not been reviewed by a doctor to cut the risk of 'catastrophic' harm, a government-ordered review says.

Their job title should also be changed to physician assistant to reflect the fact they are supposed to support doctors rather than replace them, it adds.
More than 3,500 PAs work in the NHS and there have been previous calls for an expansion in their number.

But health secretary Wes Streeting ordered a review last November amid concerns they are being inappropriately used as substitutes for doctors, despite having significantly less training.

There have also been a number of high profile deaths of patients who had been misdiagnosed by PAs - sometimes unaware they had not seen a doctor.

Professor Gillian Leng, president of the Royal Society of Medicine, was commissioned to lead the review into the safety of the roles and how they can be effectively integrated into a multidisciplinary healthcare team.

Presenting her findings yesterday, she said she hopes her report will bring some ‘perspective’ to what has become a ‘heated debate’, with some doctors expressing fierce opposition to PAs.

Trainee doctors in particular are angry that PAs can earn more than them, work more sociable hours and take some of their training opportunities.
Professor Leng acknowledged PAs have been used to plug gaps on doctors’ rotas and called for major changes to how they work and are supervised.

This includes a requirement to work in a hospital for at least two years before being allowed to practice in a GP surgery or mental health trust and a need to have a named senior doctor as a line manager.

The Leng Review said safety concerns in relation to PAs were ‘almost always about making a diagnosis and deciding the initial treatment, particularly in primary care or the emergency department, where patients first present with new symptoms’.

It added: ‘It is here that the risk of missing an unusual disease or condition is highest, and where the more extensive training of doctors across a breadth of specialties is important.

‘Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.’

Despite the shorter two years of training for PAs, where local NHS services have struggled with filling roles, ‘the easy option in some cases was simply to fill gaps in medical rotas with PAs’, the report went on.

MSN

 

[Arnie Pye]

Being a dyed-in-the-wool cynic about the medical profession generally, I tried to find information on the people who had died after being seen only by physician associates. And I noticed that all the patients I found were female. Are men considered to be too important to be seen by PAs, and they must therefore be seen by real doctors? (I'm being sarcastic.)

 

[Sly Saint]

meanwhile
article in the Telegraph (available at link)........:

‘I’ve wanted to be a doctor my whole life but after seven years of training I can’t get a job’​

After seven years of medical training, gruelling hospital shifts and more than £100,000 in student debt, Dr Luke Craddock can’t believe he is now facing unemployment. The NHS is chronically short of staff, and his training has cost an estimated £250,000 – yet when his contract ends in early August, there may be no job for him.
The 26-year-old from Nottinghamshire, whose lifelong goal was to become the first doctor in his family, is devastated. “It’s completely demoralising and depressing,” he says. “I feel exhausted and betrayed. After seven years of training, it’s hard to accept that I’m now facing unemployment when the NHS desperately needs doctors.”

Dr Craddock is one of thousands of junior doctors finishing their Foundation Year 2 placements this summer with no job to go to – at least not in medicine. A shortage of specialist training posts, the next step on the ladder to becoming consultants, has left many newly qualified doctors scrambling for a dwindling number of non-training roles and locum shifts. Some are leaving the profession altogether, while others are relocating abroad, where their skills are in high demand.

The crisis stems from a surge in medical school places without a corresponding rise in postgraduate training posts. Meanwhile, overseas recruitment has soared since 2019, when medicine was added to the shortage occupation list and rules prioritising UK candidates were scrapped.

MSN

 

[rvallee]

There have also been a number of high profile deaths of patients who had been misdiagnosed by PAs - sometimes unaware they had not seen a doctor.

Professor Gillian Leng, president of the Royal Society of Medicine, was commissioned to lead the review into the safety of the roles and how they can be effectively integrated into a multidisciplinary healthcare team.

Presenting her findings yesterday, she said she hopes her report will bring some ‘perspective’ to what has become a ‘heated debate’, with some doctors expressing fierce opposition to PAs.

Imagine how insane it would be to admit to this while the extremely insane project of building up entire multidisciplinary teams working on medical issues not only without a physician involved, but with the explicit goal of "de-medicalizing" them has been ongoing for years. Maybe the tell here is that it's very hard to find "some doctors" to oppose this. Which they should, as it's the same problem but 10x worse in every meaningful way.

The Leng Review said safety concerns in relation to PAs were ‘almost always about making a diagnosis and deciding the initial treatment, particularly in primary care or the emergency department, where patients first present with new symptoms’.

It added: ‘It is here that the risk of missing an unusual disease or condition is highest, and where the more extensive training of doctors across a breadth of specialties is important.

‘Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.’

Despite the shorter two years of training for PAs, where local NHS services have struggled with filling roles, ‘the easy option in some cases was simply to fill gaps in medical rotas with PAs’, the report went on.

This is happening while the dream of building up biopsychosocial teams, led by barely-trained therapists with no input from even a junior physician is doing exactly that. Sometimes I wonder if these people ever stop to think for even a second about what they're saying, and almost without fail the only available option is a clear: no, absolutely not.

Because if "making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic", then doing so as a matter of policy in a psychobehavioral-first approach is, well, what is far beneath catastrophic? Murderous? Criminal? Demonic? Evil? Those all apply at least a bit here.

Especially as it's motivated entirely by the same goal: to save money. Even though it not only doesn't save money, but comes at the cost of far worse outcomes. Which is basically peak business consultant brain: make some recommendations, pocket a ton of money, leave with everything and everyone worse off.

And this shows that they know, not that it should be a surprise, but are going ahead with it anyway. Even though it delivers far less than using PAs.

Maybe some PAs could try having a close enough personal relationship with Leng to be able to chat with her about how to pervert the system's rules and intent in some way that makes it appear legitimate, but is explicitly corrupt. Apparently that's the way to do it when you're an eminent MD.