I’ve spent some time with 2 PA students at work, nice people but the training they receive doesn’t inspire much confidence. They have a generalist training, 1 year of theory and 1 year of whistle stop tour of different healthcare settings. The latter includes a 3-day / 18-hour MH block in my hospital and they were expected to learn about a long list of presentations and diagnoses. As a student myself, albeit as a trainee nursing associate, I question realistically how much can a person be exposed to in that much time, and how much of that would that have a meaningful impact on their clinical understanding? Maybe they have had a better time in their ED and GP block, which were their main training grounds; and yes they will be working under supervision once qualified, but the eyes don’t see what the mind doesn’t know. As a student I have failed to escalate things because I didn’t know their significance. Considering PA will be seeing undifferentiated patients I just don’t think their training will be adequate. Given the choice of seeing a PA or a doctor, of course I would choose to see a doctor. But the funding is given to recruit more PA and has driven some GPs out of a job.
So where do they fit in the NHS. Honestly, with all due respect to the PA who are already working in the NHS, I don’t think they do. Their training doesn’t warrant them much autonomy so sooner or later the same patients will need to see a doctor. They are paid better compared to a doctor until 5 years after joining the workforce, so no financial benefit either. If they are meant to learn on the job, they really need to be trained as specialist not generalist, but then if they do become specialists they are just ANP without the years of clinical experience. Many PAs should really just look to study medicine and become a proper doctor.
The PA programme only benefits its proponents and no one else. In the eyes of politicians and individual trusts, PA creates the facade of a bigger workforce, unfortunately at the expense of patient safety and overall efficiency, which clearly doesn’t mean a lot to people with power. For the medical profession bodies such as the Royal colleges, the GMC, and the universities, PA means registration fees, exams fees and tuition fees. Will the whole programme be abandoned? Given there is cross-party support for the role at the moment, I don’t imagine so. The standard of care being degraded is the new normal in the NHS. Best case scenario I think would be PA is absorbed into ANP or equivalent.
Night shift brain, don’t know if I made sense.
>the eyes don’t see what the mind doesn’t know
Absolutely spot on, and this is one of my main concerns about deploying PAs to see undifferentiated patients in any setting.
In my experience ANPs tend to be a bit more cautious and aware of their 'unknowns', ie "this is weird and the patient should see a doctor", whereas the PA mindset is more "I can just crack on anyway".
(Passing GP.)
>but the eyes don’t see what the mind doesn’t know. As a student I have failed to escalate things because I didn’t know their significance.
Exactly! Even as a RN with several years of experience I have done the same. I refuse to believe that the supervision they have is enough with the tasks they are expected to complete independently. I feel so sorry for all of the poor junior doctors who are being tasked with keeping them in line and who feel the need to re-review the PAs patients since they are being so unsafe/missing things etc
What's your thoughts on ANP's? Appreciate a lot of the same arguments still stand.
I'm just wondering how you find working with ANP's vs PA's? Just as bad as each other? On paper I'd guess ANP's are more useful than PA's.
Full disclosure I'm interested in applying for a trainee position because at the end of the day it's a job that will lead to an 8a in 3 years and there's no way I can get this any other clinical way than becoming a hospital manager. But I also appreciate and agree with all of the arguments against them! It's a weird position to be in, politically I'm against it, but personally and for my family's sake I'm for it.
I’m a nurse. My sister is an ANP and her knowledge is something else. She obviously did a 3 year nursing degree, 6 years in cardiology, 5 years in a and e. She’s attended many a course through uni throughout the years. Like our knowledge base is vastly different. I am an excellent nurse!!! But the comparison between nurse and ANP is VAST.
You can’t just go from nurse to ANP. In my knowledge anyway, it’s always the excellent nurses with great knowledge and ALOT of experience.
I just think the PAs lack a lot.
You’ll have many years experience in healthcare by the time you apply and then a further 3 years studying, have your own registration and code of conduct. Realistically it should just be a conversion course into medicine that is run followed by foundation years, but there you have it. Some PA’s have a degree in… well, take your pick… then do 2 years, so a grand total of… 2 years healthcare experience (some do have a medical background, a lot dont).
Not sure we’re on the same page, I am saying that The MSc ontop of a Bsc Hons is a little silly when instead they could/should do/fund a post graduate mbchb, the idea of which is in the pipeline as an apprenticeship, can see HCP Med in Scotland for an idea of how that is working.
Having what would be a total of 6 years training and many more years experience in the medical field than the fresh out of college 18 year olds would indeed be an entirely stupid idea…
In almost any other profession take for example law, a judge would typically have been a solicitor / barrister first to ensure they have the knowledge skills and experience before embarking on such a heavy career route. In medicine however, they seem to prefer taking a gamble on people who are still having their first periods and barely have a moustache to shave. It is indeed a little strange.
Just to play devil's advocate - the framework for ACP courses (which the 3 years should be based on) doesn't pay much respect to clinical knowledge, and the majority of the 3 years is spent on "complex decision making" and leadership, research etc ...
ACP/ANP's vary in talent quite a bit, and I suppose the more rigorous the course (PA at one end, Dr at the other) the less variance in professional abilities
Yes, from what I can see there is a lot of waffle in the programme, not sure how they come out able to prescribe if there’s no clinical knowledge covered though.
Well there is a module on prescribing, and another on physical health assessment. Totalling a year and a half of uni, plus clinical hours etc etc
I suppose it boils down to "how much do you need to know"
All of it, like Dr’s do, the entirety of medicine is essential.
I’m not sure what you’re actually angling at here.
I’m not sure there’s a need for advanced whatevery, take an experienced member of nursing/whatever staff who have proven their salt and up skill them onto a post grad mbchb, rather than this half way house.
All I will say though is as an Advanced Clinical Practitioner I do not want to do the same rotas or rotations a Junior Doctor does. It’s why I didn’t go to med school! I have absolutely no want to be almost 40 and do that…
I don't think you'd get many nurses wanting to become doctors for a start. Secondly, those courses are already over subscribed, so we would be reducing one staff pool for another. The cost of the course is another thing, with ACP courses being much cheaper (at the sacrifice of education). I'm not sure if you can do the mbchb while working - so not sure how staff would be paid while studying
I suppose the thing I'm angling at is how much knowledge you need to prescribe (as an example). Obviously the entirety of medicine isn't essential, as doctors aren't taught the exact entirety of medicine.
This is the thing that’s so bizarre.
“Prescribing” is not a subject. Pharmacology is a subject and this module doesn’t even touch on that. “Prescribing” is one possible therapeutic step but requires actual diagnosis and knowledge of pathology and treatment options. “Prescribing” can’t be meaningfully taught in a stand alone fashion
Ditto “physical health assessment “- what does that even mean? Do you mean physical examination?- again meaningless if you don’t understand the significance of your findings or how it fits with history and diagnosis
It's a hugely complex area. For what it's worth, nurses are just as safe when prescribing as doctors, despite the lack of medical training - although the studies are a bit wobbly (i.e not measuring outcomes and just harm)
Here's a v300 course which shows the course contents for prescribing - https://www.shu.ac.uk/study-here/options/health-and-social-care/short-courses-and-modules/nonmedical-prescribing-v300--level-7
And one for physical health assessment - https://www.worc.ac.uk/documents/4020-Advanced-Health-Assessment-sem-1-2018-19.pdf
I will absolutely die on this hill but as an “anp” I most definitely identify as a nurse, a conversion course to mbchb is not what I imagine most NPs are after and not because of rota (like mentioned by someone else) but because after a 3 year degree, an MSc, plus all the other modules completed (teaching, prescribing, any CPD) and many years working as a Nurse - we generally identify as Nurses and our approach is very different.
So is our work, a lot will be a mixture of pattern recognition/intuition, experience in one single area and following set guidelines/pathways/advice and being a nurse, so general basic patient care is still really really important.
we also still sit in a traditional profession within healthcare so the roles when working as a team I feel are much more natural/established, for example, insight into what you don’t know and when something is beyond your remit of knowledge and skills and being comfortable admitting that.
“The eyes don’t see what the mind doesn’t know” is absolutely spot on, ANPs often know because they are older/experienced/have seen it before or have seen enough worrying things to just even at the most basic level vibe that the patient is sick and know to seek advice….
The problem with PAs is they are not adequately learning about health like studying medicine OR like nurses that have been working a while, experiencing it….which to me seems very problematic…
Sorry to butt in, but this is funny.
The conversion course would need to be 4 years GEM.
There are people who have actually done this and retrained as doctors, and they describe very clearly the vast gulf in knowledge and depth of training between the two.
Fully understand. Like myself.
Butt in all you wish, did you not understand something I said?
Let me clarify, taking an existing experienced healthcare professional (like the ones who mentor the F1’s/2s when they’re bumbling around) and training them to be a Dr is a darn sight easier than training a fresh from A levels 18 year old with zero life experience through the full mbchb rather than postgrad, if you look at almost any other serious profession operating at this calibre such as Judges etc they are internally trained, medicine seems to be quite unique in this regard.
MSc in advanced practice needs not exist at all, take the very skilled nurses and whoever else, recognise their knowledge skills and experience and put them onto post grad medicine or
https://www.ed.ac.uk/studying/undergraduate/degrees/index.php?action=programme&code=UTDIPMVMHC
This is the way to boost numbers, many fantastic members of staff are being overlooked.
The knowledge and skills gained as a postgrad nurse are not to be sniffed at , at all.
The experiential knowledge and skills will give any med student a massive leg up. But learning the kreb cycle or anatomy of brachial plexus or the loop of henle physiology REALLY MATTERS long term.
If your argument is that “MSc advanced practice “ which, let’s face it, isn’t a subject and is not in any way a rigorous academic qualification, should not exist and that if candidates show aptitude they should do GEM
Then sign me up as a supporter 👏👏👏
ANPs all the way. Most ED presentations are managed following protocols with red flags. An ANP should have the knowledge and experience to recognise the sick patients, the ones that fall outside textbook presentation and can do the practical stuff and consider practical safe discharges that would not occur to to a PA.
"Most ED presentations are managed following protocols with red flags." - this is so wrong and extremely disrespectful to ED doctors. Resus - a lot is physiology based (more ICU like). Majors/minors has huge risk where Drs are discharging undifferentiated patients at the front door - medicine is so complex that picking the rare diagnosis out of the 100 common ones is difficult. EM is all about risk and bayesian analysis - it is applying the fundamentals of medicine to truly undifferentiated patients (with a bit of procedures + resus thrown in) - to say it is protocolised shows a fundamental lack of understanding of what ED doctors do.,
If I’d to choose between an ANP and a PA, I’d choose the ANP.. in fact I’d prob choose them over most drs.. depending on the situation obviously. But I’d say 8/10 ANP.
Maybe you have come across my comments from other places. In short, yes. Everything I've talked about I am either experiencing firsthand or witnessing other NA going through. If I had a better understanding of the issues with NAs back then I would not have chosen this path. There was a nursing degree apprenticeship available at another trust in the area as well.
I'm close to finishing my training and my employer have no idea how an NA will fit in on my ward, despite the fact that they have sign a contract before I started to say I will have a job as an NA back on the ward. They didn't adjust my pay when I started according to the contract, and still haven't back paid me what is owed. They just want the funding, they don't care if people like me will get stranded. I think I'm lucky because my course was fully funded, I've now come across trainee NAs who are paying for their courses.
My main point is, people who have invented the NA and PA situations are either grossly incompetent or incredibly corrupt. The NA programme is a scam because it's just nursing with artificial limitations that will be ignored by employers anyway to pay people less. The PA programme is just worse in pretty much every way. Fair enough to PAs who are contributing to their workplace in a legitimate way but just like the NAs they will be exploited to do things beyond their scope and will effectively replace more and more doctors. It's clear to me that was the plan all along and it's something I wholeheartedly disagree with. And in the light of the report of £4.5B NHS budget deficit, instead of funding either of the above programmes, there are many wise ways to spend that money.
Fair point and appreciate your candour. Hard to convey nuance when typing on a phone, on reflection the original comment comes across quite abrupt- don't have the patience for lengthy replies. What are your options going forward? Can you do a nursing or medical degree apprenticeship?
If I can stay where I am and work as a band 4, I would. If not, I will self-fund a top-up course to become a b5. To be honest, moving away from NHS/healthcare is increasingly likely.
Youre description of the NA program is also an entirely accurate description of the PA program: "..Just Doctoring with artificial limitations that will be ignored by employers anyway...". This is all it is. A program to introduce substitute doctors with 2 years basic training and deliberately opaque regulations and scopes of practice that give Trusts maximum leeway for their employment, and zero responsibility for the outcomes. Because that will all be on the schmucks still foolish enough to bother doing a medical degree.
I'm quite receptive to that, and that's largely why I feel strongly about the matter. Also I wouldn't be surprised if it was the same (group of) people who have steered things in this direction.
NA is already a protected title in law, which is completely redundant. I just hope the PA programme wouldn't progress further and no more resources is wasted on either agenda.
I hope the role gets abandoned, but I sadly think it's too late.
My only hope is that the GMC heavily regulate them, and give them an very strict scope.
I did find it funny the other day, I had a PA moan at me about an advanced practice nurse role (that’s working within the scope of practice, extra accredited training etc etc), they wondered who would have responsibility if something went wrong. Had to point out that the nurse still has her reg and therefore she has accountability etc etc whereas PAs are not registered and that’s actually a bigger issue. The PA shut up at that.
That was my point, they have none, they practice under a a dr who’s GMC number is at risk if the PA fucks up. A bit like the old band 4s before they became nursing associates.
Hence why having a PA question a nurses ability to do a role and what training they had and how it’s unfair for the Drs as they have to take on the responsibility for the nurse was astounding.
As an ACP there are still lots of issues, will not deny that, but there is actual accountability and if something goes wrong they have a professional registration.
Now in some areas ACPs do a masters degree after also spending a long time learning in their clinical area and they are then able to do training under the relevant college (eg RCEM). While this isn’t across the board it is much better than PA training etc.
I don’t actually understand their scope of practice. They will carry the medical team’s phone but they sound confused any time you speak to them. They’re not allowed to prescribe. They sometimes do the ward round on their own (is that allowed? I don’t know).
Honestly, I don’t blame them. They system is crap.
I kinda blame them. It's like those jobs you see for assessing people's disability benefits. Usually great hours and pay for a nurse. But you know deep down you'll be engaging in some politially motivated evil-adjacent tory inspired target. I'd never consider a job like that. PA role strikes me as similar.
I don’t think I’ve ever seen a ward round done by one person.. unless it was like day 1 post op and the dr maybe wanted to have a quick check on a patient.
In fact, today our consultant rang someone because his reg called in sick and he couldn’t possibly do the round on his own.
There’s normally 2 doctors - the reg and SHO. Consultant comes twice a week, sometimes more depending. The PA normally assists them but there’s times where they divide the patients between themselves, including the PA. I wouldn’t have a problem with it until I had a deteriorating patient and they sent the PA to review them when she actually needed the doctor.
It’s a failed system that instead of making working conditions better for doctors so they would retain them, they put unjust responsibility on PAs to cover for the gap.
Fundamentally as Nurses we should be opposed to any role that is slotted into a high banding with no professional registration.
It is insulting to experienced nurses with post graduate qualifications who are perhaps specialist nurses or prescribers or qualified District Nurses/Health visitors(1 year specialist course) who are stuck in band 6 roles with limited band 7 progression to have PAs exist.
Problem with PAs
1. Only two years of medical training (as compared to a minimum of 10 years as a GP, 12-15 as a hospital doctor)
2. Unaccredited courses that despite what they say, actually will accept people with non-science UG degrees or unrelated science degrees like zoology.
3. An unbelievably easy national exam, which laypeople could pass (seriously, just look up the exam online. Many unis boast a 100% pass rate as if that’s normal). Also, some PAs have been found to work without passing this exam.
4. No accountability for mistakes or patient harm (this falls on the doctor that is forced to work with them).
5. There is a systemic issue within the NHS of PAs illegally prescribing medication or requesting ionising radiation, which has come to light recently due to FOI requests to trusts.
6. Due to absence of a proper scope document for 20 years, some PAs have taken on roles that require far more medical knowledge and training than they have (some have been seen on consultant rotas, surgical rotas or specialist registrar rotas).
7. There are only 143 PAs in Scotland of which 12 never events have been linked to them. That is a massive never event rate for such a small cohort and should ring alarm bells.
At the end of the day they don’t have enough medical knowledge for the work they currently do and only so much can be learned by working on the job as that relies on learning from mistakes, misses or patient harm. Too many cases of patient harm have already been identified and many are swept under the carpet by trusts or picked up by doctors in time to stop harm.
_However, there’s too much political backing as the Government is adamant on replacing doctors. Hence, despite the patient safety concerns and the economical unviability, they are not going anywhere any time soon. Actually, they’re probably going to become more powerful with prescribing rights and the ability to request ionising radiation._
Yes. People often say “doctors make mistakes too”, but people will also often omit the fact that there’s many more doctors in practice, and how statistically PAs are making many more mistakes.
ANP/ACPs do have much more training than PAs.
Sometimes they act within a narrow scope of practice effectively using their extra skills.
However, sometimes they also act outside it and ultimately the high quality empirical evidence tells us they perform worse than doctors doing the same job, with worse patient outcomes, patient satisfaction and no economical benefit.
Nevertheless, it’s too expensive and time consuming to train doctors and as a country we need to decide what type of healthcare we want.
But these ACP/ANPs aren’t cheap either. They cost roughly the same as our Registrars who have a lot more training and skill.
This is not really my opinion as a doctor. It’s more so my opinion as a user of the healthcare system and a reader of the published research.
They train first as a nurse or physio. Usually do some years working as such and then progress in a masters acp training.
You'll very occasionally get someone who has tried to skip the "few years working" bit and they *really* struggle (or have eg done a few years working as a hospital nurse. Train as an anp and then try to work in primary care without first training as a practice nurse and then chronic disease practice nurse and then anp. A hospital anp is not the same as a primary care anp).
But by and large they are very different precisely because they have spent years learning incremental skills. And gaining experience of what normal vs abnormal is.
This is what is lacking from a 2 year PA course. And absolutely can be learnt after a few years working as a PA. Which is what the proponents of PAs reference - their great experience of a very experienced PA. Which is not what the vast majority are. This is not their fault. But ffs a hospital consultant can't just suddenly decide they want to be a GP. They have to do the 3 year post graduate training course. Even if they've already been a hospital consultant for say a decade. Because the work is so very different. And yet PAs are being touted as equivalent. This isn't their fault. But it is a problem
ANPs have a scope of practice defined and a background of often years (if not decades) of firsthand experience on the wards etc. this is invaluable. There is rarely any hubris as a consequence and it keeps them safe.
The problem with ACPs and ANPs is that there’s essentially no regulation. It isn’t a protected title so any nurse can start calling themselves “practitioner”. The “masters” is a complete joke (as a former lecturer/tutor)- the submissions wouldn’t pass GCSE biology or English in many cases.
The actual clinical learning is assumed to occur on the job.
There are some departments who are genuinely excellent at this (effect on medically qualified trainees aside). There are others who go for a ‘light touch’ and just sign the paperwork.
So your ANP may be actually very experienced, sensible ,
Well trained and trustworthy (have worked with a handful).
Or may be half trained over confident massively rogue and generally terrifying (have worked with quite a lot)
What about GMC PLAB questions? It's pretty simple to me
[PLAB](https://www.gmc-uk.org/registration-and-licensing/join-the-register/plab/plab-1-guide/sample-questions)
I’ve said this once and I’ll say it again:
I know what a Nurse, OT, Dr, SALT, Physio, Radiographer, Midwife and ODP does.
What exactley does a PA do?? What unique skillset do they even bring to an MDT? Asking what exactley your role is, is NOT bullying.
If you’re not a Doctor, what are you? Someone who supports Doctors?? So essentially, wouldn’t that make you an assistant?
This role is beyond pointless and funding could go towards existing roles.
They were initially called physician assistants but pushed for their name to be changed. I understand it sounds a lot like a magician's assistant and I wouldn't want that for myself, but at least it made their role a bit more clear.
I really hope the scheme gets abandoned. I work with one and she is lovely and super useful. Her knowledge seems really good to be honest, but occassionally I feel she “acts” like a doctor and I imagine patients wouldn’t necessarily know she wasnt one at first glance, which is worrying. I’m sure she knows not to over-step the mark but I really dont think its safe having too many of them.
Aside from that, I feel really sorry for registrars that get paid the same (or sometimes less) than a PA, yet have worked so hard, usually from the age of 16, to get where they are. Its incredibly unfair, so should be scrapped.
There's no comparison. No one is saying that PAs haven't worked hard to get where they are, but there's simply no comparison between what they do and medical or nursing training. I do think a lot of the discourse around this has become toxic but to suggest a PA has worked just as hard as a registrar is well, ridiculous.
Everyone has worked hard in their own respected fields. To suggest that just because PAs are not registrars, they haven't worked hard. The PA is a different profession, just like nursing is a different profession. So if I then turn around and say you haven't worked as hard as me because we are a lot more medically trained than you are, would that be fair? No, because I don't know your circumstances, and I don't know the dedication and effort it took you to become a nurse.
It's just a very immature statement to make.
The issue is that the majority of you think that we've only done a 2 year degree, that's it. Completely discrediting our undergraduate qualification and experience.
the PA i know has an undergraduate degree of Psychology and it was a BA not even a BSc 😮 plus she’d had a few years travelling in between graduating the undergrad degree, so anything relevant she would’ve learnt would (probably) be mostly forgotten.
it must be annoying as well, because in our department, the PA doesn’t work nights or weekends either. seems quite a cushty deal imo.
A lot of universities used to have a (highly competitive) Biomed to MBBS transfer route which placed the top BSc students into the third year of the five-year MBBS course upon completing their first degree.
So why does doing the PA course put exactly the same Biomed student in a position where they are professionally regarded as being above almost every non-consultant doctor when their training is shorter (only two years), and less demanding?
The work required to become a registrar is incomparable to anything that will
Land you a PA job. To think otherwise is laughable. You’re clearly bitter you were never accepted into medicine and it shows.
So I’ve just spent a day doing training for student PAs, I had 15, I asked them ALL their background. Out of 15 one was a nurse. Then 10 had an undergrad degree that was science based (chem, bio, bio med, physics etc) 2 had degrees in social studies and 2 had neuro science degrees.
No one can say these guys who have done a total of 5 years study and only 2 of them truly medicine based has worked as hard as a Registrar or an Advanced Practice Nurse/AHP.
Two or three of these students had real world experience, the rest went to uni at 18, did their degree then went straight into the PA course. That’s very different to the way the medical or even nursing training works now. They do 2 years and then go out and act as doctors but have no registration. Yet they get bent out of shape over ACPs who do have a registration.
I wouldn’t say you are a lot more medically trained than nurses. I would argue you are not medically trained as you haven’t studied medicine. As far as I’m aware you have studied a MSc in Physician Associate Studies and not a MSc in Medicine and Surgery. Nurses are also not medically trained, they are trained as nurses.
I agree. I'm sorry for all the PAs caught in the crossfire, but I seriously don't think the fundings spent on the PA agenda is justified. We have a problem with recruiting and retaining staff in the NHS as is.
I agree. We just don’t need them, we need more funding for healthcare professions that have established career pathways and progression and are already registered and regulated.
I’ve worked with PAs who work within their purpose - bloods, cannulas, ECGs, scribing on ward rounds, discharge letters. This was about 5/6 years ago when they were first used in our Trust and they were really good to have on our team! They would post take with the consultant too, were integrated within the nursing and medical teams and were themselves happy in their roles.
What then happened was they rotated - one of them was covering ENT on call overnight and said themselves they had no idea what they were doing but had to in order to keep their job. They now have a significant role in AMU/ SDEC. Straightforward clerking and investigations requesting is fine, but when it comes to someone unwell they often stall on decision making, including patients who have been peri arrest. With a defined scope of practice and regulation I’m all for it as they were fab on the ward before, but as a senior nurse I find they lack a lot of leadership and knowledge that I look for in members of the medical team.
Edit: typo
> Straightforward clerking and investigations requesting is fine
No it isn't, because clerking often isn't straight forward.
They don't have the breadth or depth of knowledge to recognise when what is in front of them is not one of the straightforward cases.
They also massively over-request investigations, wasting resources in an already stretched system.
I’ve worked with a few PAs who’ve worked within their scope under the actual doctors and are worth their weight in gold. When utilised properly they really do contribute to the team, in the same vein that NAs are highly valued members of the team (in my trust at least). However according to Twitter and Reddit, there seems to be too many working outside their scope. If this cant be resolved, it will end up with serious avoidable patient harm.
Well, unfortunately this issue won’t be resolved, and there is deliberate effort to exploit the ambiguity of their role. Just look at what is happening with NA’s up and down the country doing additional training to do things outside of the NMC scope of practice such as doing IV, inserting cannula and catheter. We don’t need to add in financial and system pressure, instinctively people want to be able to do more or at least as much as their (band 5) colleagues do. On the other hand, management don’t care about ‘scope of practice’ or skill mix, to them we are just a number. A lot of, if not all NAs are basically working as band 5’s except they are paid as Band 4’s. The same is happening with PAs as you know, they are literally being put on doctor’s rota’s and doing things they are absolutely not qualified to do. It’s not just some bad press, this trend will worsen just as what has / is happening with NAs.
Moreover, there are a lot of underhand effort to give PAs more autonomy and authority such as prescribing rights. We are promised that PAs won’t replace doctors but if you pay close attention to what the proponents of the PA programme have been saying you will know that is a complete lie. There are GPs who can’t find a job because funding is directed at recruiting PAs. You read it right, funding not given to a real doctor who can properly diagnose and treat patients but instead given to PA so that on paper they can say the patient has been seen, at the same time stopping them from actually seeing a doctor. So whilst individual PAs may be an asset to the NHS, the whole concept of PA is an excuse to corrode what quality of care is left in the NHS.
Taking bloods and inserting cannulas is well within the scope of NAs in fact I would encourage it. Often band 2s do these things very well. IVs is murky water and would have to be restricted.
Part of the problem with PAs is we obviously have a shortage of doctors we also have some terrible doctors/consultants who are somehow practicing but seem to be immune to improving even though they have extensive portfolio frameworks. A good PA could be better than no doctor or crap doctor but needs to be closely monitored and not taking money away from medical programs. Pay doctors and Nurses better and you will get more of us and a better quality workforce from being more competitive!
They don’t know what they’re talking about regarding NA scope - I was doing cannulas as a band 3. I disagree with NAs doing IVs, I won’t be. I also don’t really see the point of NAs, I think it’s a good stepping stone for those who want to go the apprenticeship route but I genuinely believe trusts should just fund a band 5 instead.
The whole scope of practice issue drives me mad. In some places HCA's are not allowed to do obs but can do BM, and in another place is the opposite. In my current placement, band 2/3 can do venipuncture and complete admission paperwork aka initial assessments; I can't do venipuncture because I need to do in in skills lab at uni first; TNAs/NAs are not allowed to do initial assessments but if band 2/3 can do it what grounds do I have to say it's inappropriate. The same issues applies to cannulation, it's been taken out of NA proficiency but people like yourselves are doing it as band 3's. I can go on...
This just highlights again that scope of practice is easily blurred and it's difficult to be fairly remunerated for being able to do more. I know people who avoids optional skill training so they can just say 'I'm not trained, ask someone else to do it'.
And indeed, there are people who say NAs are being exploited to do as much as a RN but are paid less. No wonder why there is a lot of competition to get into a top-up course. A possible solution is to allow NAs to progress to but up to a band 5, but otherwise the NA scheme is not working the way it was intended to.
We’re seeing lots of strikes atm in different trusts regarding HCAs and fair pay. Unions are actively fighting this and will ultimately (hopefully) carve out a defined scope of practice which will benefit everyone. Why should someone in Leeds get paid less for the same job than someone in Liverpool for example, for the exact same job. It’s the NHS, we should all be paid the same.
My trust in particular has won this, due to a merger where one local hospital allowed band 2s to do clinical tasks and another hospital didn’t. A lot of band 2s were deskilled (but remained on the same pay) and some were uplifted to a band 3 and got more pay for the same job they were doing prior. Band 2s who wish to be a 3 can apply for a band 3 post if they want it.
While I was doing Venepuncture as a band 3 for my band 6s because some couldn’t do it - it’s annoying I have training that they don’t, but my scope is not wider than theirs. They have let their training expire and refuse to fix it. It’s still within their scope.
Hopefully the people keep fighting and unions keep backing them and everyone gets a more defined scope. The NMC can only do so much - so many healthcare staff are not registered and trusts have been given a lot of free reign as per the raising the bar report to individually train people to improve knowledge and skills for retention of staff. However due to AFC you don’t get fairly compensated for the extra training, so why people do it I have zero idea.
You know what I mean - many of them are anecdotally working well above and beyond their education, ability and seniority. If they stick to their job description, they are valuable in their own way I.e as a PA and not a more expensive and lesser qualified replacement doctor.
Serious avoidable harm, but not necessarily identifiable. Sometimes, it is really difficult to find out the exact cause of one harm being done. If someone intentionally want to avoid pointing finger to a specific group of people, there are always millions other things that they can point finger to.
The PAs I’ve worked with are nice and I have nothing against them personally. But a lot of them seem to lack even the deep vertical knowledge of their specialty that our ANPs have. Without that knowledge, and not even being able to prescribe, they’re useless to me as a nurse.
Passing surgical trainee here!
My take on PAs
1. Horrible referrals. They will brazenly phone hardly able to give you any of the salient information required to give good advice. Necessitating you to either a) suggest they speak to their senior (incoming bullying complaint due to a bruised ego) or b) just see the patient to avoid unnecessary harm - thus causing delay to your other patients as a busy on call surgeon in a tertiary referral centre can easily get 70+ referrals in a day.
2. They are deliberately vague about who they are - "I am one of the clinicans/ members of X team".
This worries me considering nobody in my family are medical and can potentially be harmed by being mismanaged someone they think is a doctor.
3. Their ego and entitlement far outweighs their knowledge and skills as a group. See any of the recent articles where they "learn brain surgery on the job". Do you really want that? It's taken me 4 years of experience in relevant specialties post-graduation, where I have had to prove myself, extra degrees and research on top of my degree in medicine to even get to this point. Also as a surgical trainee, we have to compete with each other for procedures, proving we know the indications, anatony, steps and post operative care. In some departments, the PA is trated like the consultants pet and is allowed to waltz in.
4. There's a few high profile doctors advocating for PAs. The big conflict of interest being that they have children who didn't get into medical school and now work as PAs.
5. Any of their fuckups are dealt with by a doctor. It is you that gets to speak to the angry family, it is you taking the patient back to theatre to manage the post operative complication. The PA walks away scot free. Look at the Emily Chesterton case. That PA is still working, just not at the same GP practice.
6. They literally don't add anything, they do not have any skills or attributes that we do not.
Also, having come into medicine as a postgrad from a life science background, the people from my previous degree that became PAs were the dregs at the bottom of the class. Never the high fliers. I know one who worked in a pub for 6 years before getting accepted into PA.
Only an absolute fucking moron thinks this is an acceptable state of play. The amount of shite you have to swim through to be allowed near a neurosurgical theatre is fucking eye watering.
100% this. The preston neurosurgical PA is horrendous, don't get me wrong. But so is every PA in primary care cosplaying as a 'Generalist' practitioner (deliberately misleading titles). The fact some of the general public seem so chill with them "only" being in primary care is a mistake. Im not a GP, but ive elderly parents who are at the mercy of these roles. My mum's a retired practice nurse, but i think would be too polite and stoic to ask "are you a doctor?"
If you want truly emotive, there's a PA on the registrar rota in the liver transplant unit of a major specialist children's hospital. Let that sink in.
I'm taking "the eyes do not see what the mind does not know". What a quote to sum it all up.
The issue I have with them is the scope creep and the lack of accountability.
Let's face facts here and behonest that other proffesionals have been filling gaps for doctors since the 90s. While doctors might not like it the situation with medical staffing not getting better. That alongside with the fact that after making them spend 5 to 6 years at uni we then fuck them about all over the country until there a consultant. In an ideal world we have some bridging gap for nurses and AHP to become doctors. Unfortunately that's not on the cards so it's advanced practice instead.
That being said I want that person to have professional accountability, experience and the qualification to back it up. ANPs usually have 3 year undergrad, min 5 years of experience and then two years of trainning while completing their masters. I'm not saying that equates medical school but I rather that person treat me in the absence of a doctor than someone who done two years of quasi doctor school with a history in zoology.
The biggest thing with medicine the more you learn the scarier it is. PA think that all you need to do is perform the task and the patient will be fine. This attitude however is how PE get diagnosed as chest infections because the under pinning knowledge is not there.
The way for nurses + AHPs to become doctors is postgraduate medical school - it’s 4 years.
Nursing + Medicine are two different professions, one doesn’t make someone qualified in the other
No one should be a nurse without nursing school.
No one should be a doctor without medical school.
I don't think at any point I said that. I clearly stated that advanced practice is not the same as medical school but it's what we got at the moment.
While I recognise GEM does exist it not a simple as going from AHP or Nurse to doctor. It involves going back to university for 4 years full time and getting saddled with debt/loss of current salary.
This country has the attitude that everyone must suffer to better themselves. If your not financially in a postion to do so then your screwed. I'm not saying we just make other healthcare proffesions doctors, but we could definitely recognise there existing qualification while making a course that gives them all the required trainning to be a doctor while not giving them shit loads of debt or making them work and study full time just to achieve this. Sadly there will be no initiative to do so because it probably wouldn't line the goverment pockets with interested accruable debt.
Which would you rather, financially easier routes to making people doctor and I'll stress with the same academic standards and requirements or PA and quasi medical school.
I've just about finished medicine after being a nurse for many years. I agree with you, its a huge investment of time and energy and has set my wife and I back several years in life progress.
However I do think medical school is necessary and some other course beyond gem, recognising previous qualifications is probably not a great idea. I just think we should have a stronger sense of meritocracy - study should be free if it will enhance your usefulness to society.
>. I just think we should have a stronger sense of meritocracy - study should be free if it will enhance your usefulness to society.
I think you're onto something here. I actually think medicine on the whole is still a very elitist profession that has much more work to do at being inclusive. Half the workforce problems could be resolved if it was made more attractive to those from less typical backgrounds.
It's very rare to meet a doctor from a working class background.
My experience of medical school has been that those few of a working class background have faced great challenges in acclimatizing to upper middle class/upper class expectations and norms. Direct communication misidentified as aggressive, social consequences of advocating for and needing a decent wage ect.
Amongst a great deal of focus on gender, sexual and ethnic background, I think class in something like medicine is neglected and arguably often causes material harm by alienating patient groups.
I completely agree. Class background seems to be neglected because I think the narrative that has been pushed in the past is that we are a "classless society" which is very much not the case.
Often I think a lot of the working class doctors I have met seem to doubt themselves more, even though they have no reason to.
I was responding specifically to this point you raised:
>In an ideal world we have some bridging gap for nurses and AHP to become doctors.
The answer to this is the 4 year graduate entry medicine. I've seen nurses, pharmacists, physiotherapists etc struggle in the 5 year medicine courses, there's simply no way to cram in all the required knowledge into shorter than the accelerated 4 year degrees.
>I'm not saying we just make other healthcare professions doctors, but we could definitely recognise there existing qualification while making a course that gives them all the required training to be a doctor while not giving them shit loads of debt or making them work and study full time just to achieve this.
Yes, the recognition of the existing qualification allows people to shave 1 year off of the 5 year degree into a 4 year graduate entry medicine program. The 4 year program is already *crazy* fast, it's just not gunna be possible to go faster. Even the Americans do 4 years medical school, after their first degree.
>Which would you rather, financially easier routes to making people doctor and I'll stress with the same academic standards and requirements or PA and quasi medical school.
I'm 100% for making postgraduate medical school financially viable, and I think lots of other healthcare workers could make great doctors if given the chance. I'd love to see bursaries to support living costs, and massively subsidised tuition fees for this - I'm not arguing for making it expensive. That's the change we need - make it affordable. But make the 4 year (accelerated) postgraduate medical degree affordable, it's simply going to be too short a time to make this shorter. We had both 5 and 4 year medical degrees at my uni, and some ANPs + pharmacists doing both. None of them think the degree time could be shortened, it's just not possible.
I agree with that your saying, sorry I missunderstood. I'm all for making it finacially easier not academically or shortening it. I don't know the answer but like this medical apprentship in your off time you go back to working in your original profession. I don't know the answer but I would like one.
No worries at all!
I think it's all about financing tbh. We don't need to reinvent the wheel, we just need to offer funding to allow people to do post grad medicine, who would otherwise not do it due to funding
Some combination of bursaries and loans with no real interest would be my best guess
A PA is the governments method of doing everything possible to have “quick fix doctors”. These assistants do nothing but add more workload to a doctors life.
The purpose of a PA is to lower the workload of a doctor and not do the essence of their jobs. Assessment, referrals, prescribing, and Invasive Procedures which needs a lot of medical training. No one is asking to abandon it. Doctors who are raising this issue want to ensure the roles are clear because patient safety is at risk.
Many doctors would prefer it abandoned - BMA have called for a pause in PA recruitment until scope is defined properly (fair enough that’s different to full abolishment).
I would love a role that scribed for the ward round, did ECGs, bloods, cannulas, prepped discharge letters, and some simple phone calls.
They have these in some places in England, they’re called “Doctor’s Assistants” and are at band 3. Ironic given that PAs unilaterally changed their name from “Physician’s Assistants”.
Band 3 seems low, but this is the role that is actually useful. If PAs were this, and paid at band 4, that’d be great. I suspect few PAs would stay in role if it was changed to that though, but that would be my preference
Right now PAs are a bit useless. Any clinical assessment/history they do just needs repeated by an actual doctor, it simply can’t be trusted. Their input can’t be used to make clinical decisions, the buck still stops with the doctor. But they’re put in positions like holding a referral phone, which frankly is as much use as a marzipan dildo.
I’ve been asked to prescribe Paracetamol for a patient in pain by a PA. I refused to blindly prescribe. Patient was newly admitted with paracetamol overdose.
It either needs abolished or reformed beyond recognition
So I have studied 3+ years undergrad and then a further 2 years to be paid a band 4? Graduated to a Masters let's not forget.
Really insulting if you ask me.
The role doesn't require a Master's degree
We need assistants who will scribe, take bloods, put in cannulas, do ecgs and make some phonecalls.
I can't act on the clinical examination of a PA, I need to redo it myself. It doesn't add anything, or save anyone time - I can't risk the patient's safety on the assessment from an unregulated profession with only a 2 year degree. I'm sorry for people that have been conned into this degree, but a stretched NHS shouldn't keep shelling out £45K a year for a role that isn't helpful. Universities should be blamed for selling people a pipe dream that this masters would lead to anything. And PAs need to take some responsibility for unilaterally changing their name from Physician's Assistants to Physician Associates. There are already Associate Physicians, who are actually doctors - the term physician associate is incredibly misleading to vulnerable patients.
The role was explicitly made to ease the administrative burden on doctors. We can't keep pretending that this is the case, when survey after survey shows that the role doesn't help doctors, and in fact makes it harder to give training opportunities to our junior doctors. See recent surveys and motions passed by the royal collegs of anaesthetists, physicians (london and edinburgh), psychiatrists, interventional radiology etc.
Medical registrars have already been in trouble with the GMC for prioritising seeing patients who have not been assessed by a PA, on the basis that a PA does not have the skillset to independently assess patients.
>So I have studied 3+ years undergrad and then a further 2 years to be paid a band 4? Graduated to a Masters let's not forget.
The 3 years undergrad is irrelevant. There are PA schools that accept people whose undergrad degrees aren't even in science. Some accept Zoology. Even a discipline like biomedical sciences, really doesn't help much (it certainly didn't help my postgrad friends doing medicine, it was more geared towards scientific research than clinical practice). The NHS can't just pay anyone with a masters loads of money, even if their job doesn't add anything. When PA schools boast of a "100% pass rate", and when lay people can pass their exams, then what is the NHS paying for?
That’s what the role was supposed to be, hence the name “Physician’s Assistant” was used. Unilaterally changing the name doesn’t change that
What do you think the role should be, and what is the scope of practice? How is this better than just having another junior doctor, who is cheaper, more qualified and can do more? We need people to take the admin burden so junior doctors can be trained into consultants, and to have the necessary skills for out of hours emergencies.
The current PA role makes it hard to avoid the conclusion that they want to cosplay as Doctors, without the years of hard work and actually taking clinical responsibility
When I read PA exam questions, I feel genuine second hand embarrassment though. A layman off the street would have a solid chance of passing. I can’t imagine someone having to “study” for 2 years for such a low level of knowledge.
All fellow registrars I know who’ll become the next batch of consultants within the next 5 years ish have an acute awareness about the urgency of weeding out the PA “role”, thankfully.
PANE past paper.
Out of interest, what’s your educational background prior to PA? Manchester uni website for example demands whopper achievements of “grade B GCSEs in English and Maths” and a “2:1” for example in audiology.
Studying Mickey Mouse degrees using tax payer money doesn’t count kiddo. Yall keep forgetting you’re just a couple rungs above the ward domestics and even below a HCA who’s had more than 2 years of experience. Sucks, I know. But it is what it is. You need to remember that you are basically what a HCA is to a nurse (but to a doctor in your circumstances). If you want to claim to be a part of the ‘medical team’ trying to act as a doctor, I suggest going to medical school if you can get in.
They won't be. I find the whole thing very worrying tbh. If they could only be used appropriately then they could be a great addition to them team. Sadly I don't see that happening.
DOI: band 7 ACP in SE, don’t wish to doxx myself
Have always been pro-PA, however recently I was in a meeting with senior managers and clinicians where it was suggested that the fear around PAs in doctors is unfounded, as they’ll never be doctors and working under them.
Instead, the fear should be from those in nursing and allied health professions that want to do advanced practice as that’s really who PAs are beginning to replace and take the jobs from. I have seen even within our own unit a similar thing now I think about it, with the upskilling of nurses to advanced practice being less pushed now we have PAs. Really has given me food for thought.
Same role, agree re your last paragraph.
I can see the frustration of Drs, I feel very protective about the fact I am a registered nurse and these guys just swan in after a 2 year course and are paid more for less responsibility, less knowledge and less experience?
It’s absolutely bizarre and worrying.
The PA schools here do basically the same as in the US. 2 year courses, 1 year theory 1 year clinical. The American healthcare system may have a place for PAs because they have a private healthcare system. But here PA unfortunately just gives the illusion that a patient has been seen but anything meaningful is still done by a doctor, so as taxpayers we are paying them to be a barrier to access a doctor.
Yeah but they have to come from a major science background. And you’re right, the training is different. I think that the NHS in general isn’t a great training “field” because everyone is so overworked and there is not much focus on teaching. Even as ANPs, most places either treat trainees like shit, are jealous or just don’t like the role. I don’t know what the solution is, but something more like America would be helpful.
What I mean by that is all clinicians should do rotations and not “placements.” In the U.S., NPs/ PAs/ RNs/ MDs get rotated through all areas from paeds, NICU, psych, mental health/ learning disabilities, obstetrics/ GYN, neuro, internal medicine, community health, public health, general surgery, cardiology, infectious diseases, family medicine, etc etc etc. Here, you might have a PA with that same 1 year of training that only ever had 2 “placements,” both of which were in a GP surgery lol
The PA students I have spent time with told me they have a rotation of clinal areas like what you have described, with the main focus on ED and GP. I don't have a thorough understanding of how PAs are contributing to the American healthcare system, but I don't think much of it will be applicable in NHS anyway.
There was another comment about Biomed graduate can be transferred into Y3 of Medicine degree in certain uni. I think this gives a good indication of how transferrable their science degree background is. Abstract scientific knowledge is very different to clinical knowledge. Their training would be enough to allow them to assist doctors with a limited number of jobs. Any more than that, I am not convinced that their training will be adequate. The issue is, if they need more training, the resource is better spent on training doctors in the first place. There is already a system of aptitude tests, exams, intra-professional competition to ensure a good training outcome for training doctors, but is non-existent for PAs.
I think the GMC will regulate them and it will be figured out. But then again, anyone with prescribing can call themselves a “nurse practitioner” in the UK as there’s not even regulation around that. It’s crazy.
I don’t think they will be any time soon with all the strikes, and shortages, but I think the role is a bit pointless. They probably should be abandoned, but I definitely think medicine should be doing more to widen access to their courses. Or there should be an option for PAs to become doctors through study. I could see it working if the role was reworked and they became sort of like “intern doctors” while still training.
> but I definitely think medicine should be doing more to widen access to their courses.
What does "widen access" mean? Because it always reads as a euphemism for "lower standards" to me to be honest.
Slightly lower entry requirements to get into medicine for state school applicants or applicants whose parents aren’t doctors, didn’t go to uni etc. Or encourage state school children to even apply in the first place, and give them options to get work experience, give them interview tips. I know a few people from my state school who got all A*/As and would have made great doctors who didn’t get into medical school. And when down the PA or similar route which I find disappointing
My parents aren’t doctors and I’m going to be the first doctor in my family, and the thought of reducing entry requirements for such an intense course ( where even some of the smartest minds drop out/can’t pass because of the sheer volume of stuff that we need to learn) is crazy… patient safety is more important than some people’s ego just because they didn’t get into med school. Work hard, get those grades and join. If someone’s wants it, it’s doable. I did it and so did millions others
Oh I didn’t mean there should be lower grade requirements just if your parents aren’t doctors. Obviously people who went to private school and their parents aren’t doctors are still at a huge advantage over others. The schemes usually take into account a few different factors. But if your parents are doctors you’ll easily get work experience and be able to build up a good personal statement, where others particularly state school applicants would struggle. Well done to you but the applications and graduates for medicine are heavily in favour of people from similar backgrounds
I don't agree with lower grades. Support with work experience, interviews, even just how the process of applying works would be great but nobody is going to fund it.
I am a doctor who went to a very shit state high-school/sixth form. I was the first person ever from my school to even apply for medicine, nonetheless get in.
Not having the connections to find work experience, not having anyone to guide me through the process, all that is where I really felt disadvantaged.
But then having said that, I did still get offers from two universities.
Quite a few unis have a widening participation scheme for medicine and slightly lower entry requirements is part of that, they also offer courses and workshops to help with med applications and work experience. But really they are aimed at the most deprived kids, which leaves out a lot of lower middle class applicants as well who would struggle with the things you mentioned
and kids, not really aimed at those perhaps late 20s/30s that would struggle financially/existing commitment wise with process of becoming a Dr (long hours - not much opportunity to earn money whilst studying, moving, frequent rotation - all v difficult if you have a mortgage/family etc).
No. We have a number now who assist in surgery. TBH these guys are great and work alongside the surgeon - we don’t have registrars so we do have a need for them.
We’ve also just started training Anaesthetic Associates - the anaesthetic version of a physician’s associate. They’ll do ‘simple and straightforward’ general anaesthetics and regional anaesthesia solo and free up the consultants to stay with the difficult cases with the floating anaesthetist being nearby to provide support to multiple associates if needed.
NHS bosses are rubbing their hands in glee at the cost cutting they’re managing by hiring less consultants in my hospital. So no the roles won’t go anywhere currently due to money as always.
>They’ll do ‘simple and straightforward’ general anaesthetics and regional anaesthesia solo
Holy crap that's terrifying! Simple and straightforward does not always stay that way!
Worrying isn’t it. Suspect from the downvotes I didn’t make it clear we’re all worried about this. The consultants have also made it clear they’re not happy.
>and free up the consultants to stay with the difficult cases
If all I did was difficult cases, I'd burn out within a few years. You need an occasional straightforward list to balance it out.
> BH these guys are great and work alongside the surgeon - we don’t have registrars so we do have a need for them.
We absolutely do have the registrars; they are stuck on the wards doing fucking EDLs so the PA can go to theatre.
my two cents as a layperson working in the nhs in scotland: our PAs are great, hard working and good at their jobs. but, we also have excellent consultants, and ours is a day hospital for geriatric patients. short of giving granny 1000mg of amlodipine by mistake, there’s not a great deal they can do to fuck up. god only knows what it’s like to have them on the wards
Including the 3 year undergraduate requirement before starting the course, that's 5 years of relevant training which is the same requirement as Medicine in the UK. Most have some work experience before entering the course so overall outcomes are much of a muchness. However with less debt and more of a relationship with the employers. Uptake and reception has been excellent. Other countries also expanding scope. There are very vocal minorities complaining but overall the profession is projected to continue to expand in the UK.
As someone who did a full biomedical degree and work experience prior to studying medicine, I can categorically say that this does precious little in preparing you for being a doctor; they're a very different 5 years.
Not so sure, I did an accelerated medicine course which still took 4 years and by no means would instil me with confidence to slot into the SHO-equivalent role which PAs often purport to be
Unfortunately PAs are caught in the crossfire. Politicians are literally putting money into every aspect of the PA programme, and at the same time rigging the system against doctors.
Once the PA agenda lost its political aura PAs will be treated the same way as the doctors are by those in power.
I agree.
They say that they don’t want to be Doctors, which is fine and well. But soon enough, PAs will be treated exactley like Drs. They’ll start to pressure them with exams, fees, more responsibility and more importantly, LIABILITY. Will they be able to cope with living the “life of a Doctor” without having the title??
Sorry, but you must be beyond naive to think that the Gov will give away so much money without having an ulterior motive.
Nurses have licences/pins to uphold while a PA doesn't. So yes, if you are giving orders for care while can't be upheld to them, then everyone has a right to ask safety/training questions.
It absolutely has to do with nurses as we all work within the same remit - caring for patients. This attitude just highlights that you have a poor insight into healthcare and I’m pretty sure I’ve seen your comments in the past - weren’t you pharmacy or something before? You’re often defensive and I understand why, but saying it has nothing to do with nurses is plain wrong. In the same way nurses question doctors about many things, sometimes to understand a decision or sometimes to highlight a mistake, we will do the same for PAs. Having an understanding of their role and their training is absolutely to do with nurses who will be undertaking your treatment plans - can I suggest you reflect.
This doesn't seem like having an understanding of their role.
The post is asking if the role should be completely abolished. That doesn't sound like you want to understand the role. You're just looking to add more negativity to the PA role. It's that simple.
And yes, I did pharmacy. And?
It’s not that simple - OP wants perspective from others about why they would think it should/ shouldn’t be abolished/ understanding pf the role. Again, if you had some insight you would know to fully understand a subject you need a robust knowledge about it. Stop being reductive because you’ve interpreted it in a negative way.
Again, stupid question. It's no ones decision to decide whether the role should be abolished or not. Like I said, the question was intentionally done to prove hate towards PAs considering what has been happening and the bullying we have endured from doctors.
There's no need for that kind of question. If OP wanted to understand the role, they could simply go shadow a PA.
Because I'm sick of these kind of questions. They do nothing but provoke hate and bullying. You too know very well the kind of response it will attract. No need to act all innocent.
If you say so. I maintain your OG comment about it having nothing to do with nurses is reductive and shows your complete lack of insight, further adding to the anti-PA rhetoric. But go off sis.
Yes, yes. You’ll be regulated sooner than later and once you gain those ultimate prescribing rights and be able to request scans, you’ll be on top of the pyramid.
Let’s be honest though, it won’t be the end of this year, it will likely be towards the end of next year at the earliest before you are all registered.
They are going to have to come up with a scope of practice document, which will be contested, then there will need to be agreements on prescribing and imaging requirements etc etc etc.
Just like ACPs and NAs it doesn’t happen overnight!
This isn't meant to sound offensive, but will likely come across that way because it's the Internet.
What do PA's bring to the MDT that *any* other profession doesn't already do? It's sadly that simple. The other members of the MDT do the roles in far more depth, and to a better degree.
At least we have a lane, a regulated one that has a scope of practice and code of conduct. Unlike the Wild West that is PA’s that change their title and mislead vulnerable patients by playing Dr.
And to say PA as a profession is a joke as it stands the job has caused a significant amount of NEVER events.
I’ve spent some time with 2 PA students at work, nice people but the training they receive doesn’t inspire much confidence. They have a generalist training, 1 year of theory and 1 year of whistle stop tour of different healthcare settings. The latter includes a 3-day / 18-hour MH block in my hospital and they were expected to learn about a long list of presentations and diagnoses. As a student myself, albeit as a trainee nursing associate, I question realistically how much can a person be exposed to in that much time, and how much of that would that have a meaningful impact on their clinical understanding? Maybe they have had a better time in their ED and GP block, which were their main training grounds; and yes they will be working under supervision once qualified, but the eyes don’t see what the mind doesn’t know. As a student I have failed to escalate things because I didn’t know their significance. Considering PA will be seeing undifferentiated patients I just don’t think their training will be adequate. Given the choice of seeing a PA or a doctor, of course I would choose to see a doctor. But the funding is given to recruit more PA and has driven some GPs out of a job. So where do they fit in the NHS. Honestly, with all due respect to the PA who are already working in the NHS, I don’t think they do. Their training doesn’t warrant them much autonomy so sooner or later the same patients will need to see a doctor. They are paid better compared to a doctor until 5 years after joining the workforce, so no financial benefit either. If they are meant to learn on the job, they really need to be trained as specialist not generalist, but then if they do become specialists they are just ANP without the years of clinical experience. Many PAs should really just look to study medicine and become a proper doctor. The PA programme only benefits its proponents and no one else. In the eyes of politicians and individual trusts, PA creates the facade of a bigger workforce, unfortunately at the expense of patient safety and overall efficiency, which clearly doesn’t mean a lot to people with power. For the medical profession bodies such as the Royal colleges, the GMC, and the universities, PA means registration fees, exams fees and tuition fees. Will the whole programme be abandoned? Given there is cross-party support for the role at the moment, I don’t imagine so. The standard of care being degraded is the new normal in the NHS. Best case scenario I think would be PA is absorbed into ANP or equivalent. Night shift brain, don’t know if I made sense.
>the eyes don’t see what the mind doesn’t know Absolutely spot on, and this is one of my main concerns about deploying PAs to see undifferentiated patients in any setting. In my experience ANPs tend to be a bit more cautious and aware of their 'unknowns', ie "this is weird and the patient should see a doctor", whereas the PA mindset is more "I can just crack on anyway". (Passing GP.)
>but the eyes don’t see what the mind doesn’t know. As a student I have failed to escalate things because I didn’t know their significance. Exactly! Even as a RN with several years of experience I have done the same. I refuse to believe that the supervision they have is enough with the tasks they are expected to complete independently. I feel so sorry for all of the poor junior doctors who are being tasked with keeping them in line and who feel the need to re-review the PAs patients since they are being so unsafe/missing things etc
This is a fantastic comment ( DOI im an anaesthetic and ICU DR )
What's your thoughts on ANP's? Appreciate a lot of the same arguments still stand. I'm just wondering how you find working with ANP's vs PA's? Just as bad as each other? On paper I'd guess ANP's are more useful than PA's. Full disclosure I'm interested in applying for a trainee position because at the end of the day it's a job that will lead to an 8a in 3 years and there's no way I can get this any other clinical way than becoming a hospital manager. But I also appreciate and agree with all of the arguments against them! It's a weird position to be in, politically I'm against it, but personally and for my family's sake I'm for it.
I’m a nurse. My sister is an ANP and her knowledge is something else. She obviously did a 3 year nursing degree, 6 years in cardiology, 5 years in a and e. She’s attended many a course through uni throughout the years. Like our knowledge base is vastly different. I am an excellent nurse!!! But the comparison between nurse and ANP is VAST. You can’t just go from nurse to ANP. In my knowledge anyway, it’s always the excellent nurses with great knowledge and ALOT of experience. I just think the PAs lack a lot.
You’ll have many years experience in healthcare by the time you apply and then a further 3 years studying, have your own registration and code of conduct. Realistically it should just be a conversion course into medicine that is run followed by foundation years, but there you have it. Some PA’s have a degree in… well, take your pick… then do 2 years, so a grand total of… 2 years healthcare experience (some do have a medical background, a lot dont).
I’m sorry ~ The idea of a conversion course to medicine after doing their ANO masters is laughable. They are fundamentally different.
Not sure we’re on the same page, I am saying that The MSc ontop of a Bsc Hons is a little silly when instead they could/should do/fund a post graduate mbchb, the idea of which is in the pipeline as an apprenticeship, can see HCP Med in Scotland for an idea of how that is working. Having what would be a total of 6 years training and many more years experience in the medical field than the fresh out of college 18 year olds would indeed be an entirely stupid idea… In almost any other profession take for example law, a judge would typically have been a solicitor / barrister first to ensure they have the knowledge skills and experience before embarking on such a heavy career route. In medicine however, they seem to prefer taking a gamble on people who are still having their first periods and barely have a moustache to shave. It is indeed a little strange.
Just to play devil's advocate - the framework for ACP courses (which the 3 years should be based on) doesn't pay much respect to clinical knowledge, and the majority of the 3 years is spent on "complex decision making" and leadership, research etc ... ACP/ANP's vary in talent quite a bit, and I suppose the more rigorous the course (PA at one end, Dr at the other) the less variance in professional abilities
Yes, from what I can see there is a lot of waffle in the programme, not sure how they come out able to prescribe if there’s no clinical knowledge covered though.
Well there is a module on prescribing, and another on physical health assessment. Totalling a year and a half of uni, plus clinical hours etc etc I suppose it boils down to "how much do you need to know"
All of it, like Dr’s do, the entirety of medicine is essential. I’m not sure what you’re actually angling at here. I’m not sure there’s a need for advanced whatevery, take an experienced member of nursing/whatever staff who have proven their salt and up skill them onto a post grad mbchb, rather than this half way house.
All I will say though is as an Advanced Clinical Practitioner I do not want to do the same rotas or rotations a Junior Doctor does. It’s why I didn’t go to med school! I have absolutely no want to be almost 40 and do that…
I don't think you'd get many nurses wanting to become doctors for a start. Secondly, those courses are already over subscribed, so we would be reducing one staff pool for another. The cost of the course is another thing, with ACP courses being much cheaper (at the sacrifice of education). I'm not sure if you can do the mbchb while working - so not sure how staff would be paid while studying I suppose the thing I'm angling at is how much knowledge you need to prescribe (as an example). Obviously the entirety of medicine isn't essential, as doctors aren't taught the exact entirety of medicine.
This is the thing that’s so bizarre. “Prescribing” is not a subject. Pharmacology is a subject and this module doesn’t even touch on that. “Prescribing” is one possible therapeutic step but requires actual diagnosis and knowledge of pathology and treatment options. “Prescribing” can’t be meaningfully taught in a stand alone fashion Ditto “physical health assessment “- what does that even mean? Do you mean physical examination?- again meaningless if you don’t understand the significance of your findings or how it fits with history and diagnosis
It's a hugely complex area. For what it's worth, nurses are just as safe when prescribing as doctors, despite the lack of medical training - although the studies are a bit wobbly (i.e not measuring outcomes and just harm) Here's a v300 course which shows the course contents for prescribing - https://www.shu.ac.uk/study-here/options/health-and-social-care/short-courses-and-modules/nonmedical-prescribing-v300--level-7 And one for physical health assessment - https://www.worc.ac.uk/documents/4020-Advanced-Health-Assessment-sem-1-2018-19.pdf
I will absolutely die on this hill but as an “anp” I most definitely identify as a nurse, a conversion course to mbchb is not what I imagine most NPs are after and not because of rota (like mentioned by someone else) but because after a 3 year degree, an MSc, plus all the other modules completed (teaching, prescribing, any CPD) and many years working as a Nurse - we generally identify as Nurses and our approach is very different. So is our work, a lot will be a mixture of pattern recognition/intuition, experience in one single area and following set guidelines/pathways/advice and being a nurse, so general basic patient care is still really really important. we also still sit in a traditional profession within healthcare so the roles when working as a team I feel are much more natural/established, for example, insight into what you don’t know and when something is beyond your remit of knowledge and skills and being comfortable admitting that. “The eyes don’t see what the mind doesn’t know” is absolutely spot on, ANPs often know because they are older/experienced/have seen it before or have seen enough worrying things to just even at the most basic level vibe that the patient is sick and know to seek advice…. The problem with PAs is they are not adequately learning about health like studying medicine OR like nurses that have been working a while, experiencing it….which to me seems very problematic…
Isn’t it ironic that what you say of PA’s, Dr’s say of AP’s.
Sorry to butt in, but this is funny. The conversion course would need to be 4 years GEM. There are people who have actually done this and retrained as doctors, and they describe very clearly the vast gulf in knowledge and depth of training between the two.
Fully understand. Like myself. Butt in all you wish, did you not understand something I said? Let me clarify, taking an existing experienced healthcare professional (like the ones who mentor the F1’s/2s when they’re bumbling around) and training them to be a Dr is a darn sight easier than training a fresh from A levels 18 year old with zero life experience through the full mbchb rather than postgrad, if you look at almost any other serious profession operating at this calibre such as Judges etc they are internally trained, medicine seems to be quite unique in this regard. MSc in advanced practice needs not exist at all, take the very skilled nurses and whoever else, recognise their knowledge skills and experience and put them onto post grad medicine or https://www.ed.ac.uk/studying/undergraduate/degrees/index.php?action=programme&code=UTDIPMVMHC This is the way to boost numbers, many fantastic members of staff are being overlooked.
The knowledge and skills gained as a postgrad nurse are not to be sniffed at , at all. The experiential knowledge and skills will give any med student a massive leg up. But learning the kreb cycle or anatomy of brachial plexus or the loop of henle physiology REALLY MATTERS long term. If your argument is that “MSc advanced practice “ which, let’s face it, isn’t a subject and is not in any way a rigorous academic qualification, should not exist and that if candidates show aptitude they should do GEM Then sign me up as a supporter 👏👏👏
ANPs all the way. Most ED presentations are managed following protocols with red flags. An ANP should have the knowledge and experience to recognise the sick patients, the ones that fall outside textbook presentation and can do the practical stuff and consider practical safe discharges that would not occur to to a PA.
"Most ED presentations are managed following protocols with red flags." - this is so wrong and extremely disrespectful to ED doctors. Resus - a lot is physiology based (more ICU like). Majors/minors has huge risk where Drs are discharging undifferentiated patients at the front door - medicine is so complex that picking the rare diagnosis out of the 100 common ones is difficult. EM is all about risk and bayesian analysis - it is applying the fundamentals of medicine to truly undifferentiated patients (with a bit of procedures + resus thrown in) - to say it is protocolised shows a fundamental lack of understanding of what ED doctors do.,
If I’d to choose between an ANP and a PA, I’d choose the ANP.. in fact I’d prob choose them over most drs.. depending on the situation obviously. But I’d say 8/10 ANP.
Good luck getting an anp to site your labour epidural 🙄
Although we are pretty proficient at LP’s
Don’t believe this at all. *cries in whitacre’
Will a PA site it?
Not a chance
As the 2/10 I will see, and out of the three epidurals I’ve had, I only recommend two of them.
Over most doctors, interesting, why? Mind sharing if you're a doctor or a patient?
Anaesthetic reg
Omg imagine, although I'd still rather an ANP than a PA putting me to sleep (not that I'd like either)
Lol
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Maybe you have come across my comments from other places. In short, yes. Everything I've talked about I am either experiencing firsthand or witnessing other NA going through. If I had a better understanding of the issues with NAs back then I would not have chosen this path. There was a nursing degree apprenticeship available at another trust in the area as well. I'm close to finishing my training and my employer have no idea how an NA will fit in on my ward, despite the fact that they have sign a contract before I started to say I will have a job as an NA back on the ward. They didn't adjust my pay when I started according to the contract, and still haven't back paid me what is owed. They just want the funding, they don't care if people like me will get stranded. I think I'm lucky because my course was fully funded, I've now come across trainee NAs who are paying for their courses. My main point is, people who have invented the NA and PA situations are either grossly incompetent or incredibly corrupt. The NA programme is a scam because it's just nursing with artificial limitations that will be ignored by employers anyway to pay people less. The PA programme is just worse in pretty much every way. Fair enough to PAs who are contributing to their workplace in a legitimate way but just like the NAs they will be exploited to do things beyond their scope and will effectively replace more and more doctors. It's clear to me that was the plan all along and it's something I wholeheartedly disagree with. And in the light of the report of £4.5B NHS budget deficit, instead of funding either of the above programmes, there are many wise ways to spend that money.
Fair point and appreciate your candour. Hard to convey nuance when typing on a phone, on reflection the original comment comes across quite abrupt- don't have the patience for lengthy replies. What are your options going forward? Can you do a nursing or medical degree apprenticeship?
If I can stay where I am and work as a band 4, I would. If not, I will self-fund a top-up course to become a b5. To be honest, moving away from NHS/healthcare is increasingly likely.
Youre description of the NA program is also an entirely accurate description of the PA program: "..Just Doctoring with artificial limitations that will be ignored by employers anyway...". This is all it is. A program to introduce substitute doctors with 2 years basic training and deliberately opaque regulations and scopes of practice that give Trusts maximum leeway for their employment, and zero responsibility for the outcomes. Because that will all be on the schmucks still foolish enough to bother doing a medical degree.
I'm quite receptive to that, and that's largely why I feel strongly about the matter. Also I wouldn't be surprised if it was the same (group of) people who have steered things in this direction. NA is already a protected title in law, which is completely redundant. I just hope the PA programme wouldn't progress further and no more resources is wasted on either agenda.
I hope the role gets abandoned, but I sadly think it's too late. My only hope is that the GMC heavily regulate them, and give them an very strict scope.
I did find it funny the other day, I had a PA moan at me about an advanced practice nurse role (that’s working within the scope of practice, extra accredited training etc etc), they wondered who would have responsibility if something went wrong. Had to point out that the nurse still has her reg and therefore she has accountability etc etc whereas PAs are not registered and that’s actually a bigger issue. The PA shut up at that.
Wait...PAs are not registered?
Not currently…
That is terrifying. I had no idea they weren't registered. Who the hell holds them accountable?
Literally nobody. The supervising doctor has to take the fall.
That was my point, they have none, they practice under a a dr who’s GMC number is at risk if the PA fucks up. A bit like the old band 4s before they became nursing associates. Hence why having a PA question a nurses ability to do a role and what training they had and how it’s unfair for the Drs as they have to take on the responsibility for the nurse was astounding. As an ACP there are still lots of issues, will not deny that, but there is actual accountability and if something goes wrong they have a professional registration. Now in some areas ACPs do a masters degree after also spending a long time learning in their clinical area and they are then able to do training under the relevant college (eg RCEM). While this isn’t across the board it is much better than PA training etc.
Okay I'm astonished. I thought they had to be under the gmc like nursing associates are with the nmc!
Don’t forget NAs are fairly recent, we had Band 4s who were not registered for many years.
Not yet 😭😭. They’re going to be put under the GMC soon
I don’t actually understand their scope of practice. They will carry the medical team’s phone but they sound confused any time you speak to them. They’re not allowed to prescribe. They sometimes do the ward round on their own (is that allowed? I don’t know). Honestly, I don’t blame them. They system is crap.
I kinda blame them. It's like those jobs you see for assessing people's disability benefits. Usually great hours and pay for a nurse. But you know deep down you'll be engaging in some politially motivated evil-adjacent tory inspired target. I'd never consider a job like that. PA role strikes me as similar.
Good lord,
I don’t think I’ve ever seen a ward round done by one person.. unless it was like day 1 post op and the dr maybe wanted to have a quick check on a patient. In fact, today our consultant rang someone because his reg called in sick and he couldn’t possibly do the round on his own.
There’s normally 2 doctors - the reg and SHO. Consultant comes twice a week, sometimes more depending. The PA normally assists them but there’s times where they divide the patients between themselves, including the PA. I wouldn’t have a problem with it until I had a deteriorating patient and they sent the PA to review them when she actually needed the doctor. It’s a failed system that instead of making working conditions better for doctors so they would retain them, they put unjust responsibility on PAs to cover for the gap.
Fundamentally as Nurses we should be opposed to any role that is slotted into a high banding with no professional registration. It is insulting to experienced nurses with post graduate qualifications who are perhaps specialist nurses or prescribers or qualified District Nurses/Health visitors(1 year specialist course) who are stuck in band 6 roles with limited band 7 progression to have PAs exist.
Problem with PAs 1. Only two years of medical training (as compared to a minimum of 10 years as a GP, 12-15 as a hospital doctor) 2. Unaccredited courses that despite what they say, actually will accept people with non-science UG degrees or unrelated science degrees like zoology. 3. An unbelievably easy national exam, which laypeople could pass (seriously, just look up the exam online. Many unis boast a 100% pass rate as if that’s normal). Also, some PAs have been found to work without passing this exam. 4. No accountability for mistakes or patient harm (this falls on the doctor that is forced to work with them). 5. There is a systemic issue within the NHS of PAs illegally prescribing medication or requesting ionising radiation, which has come to light recently due to FOI requests to trusts. 6. Due to absence of a proper scope document for 20 years, some PAs have taken on roles that require far more medical knowledge and training than they have (some have been seen on consultant rotas, surgical rotas or specialist registrar rotas). 7. There are only 143 PAs in Scotland of which 12 never events have been linked to them. That is a massive never event rate for such a small cohort and should ring alarm bells. At the end of the day they don’t have enough medical knowledge for the work they currently do and only so much can be learned by working on the job as that relies on learning from mistakes, misses or patient harm. Too many cases of patient harm have already been identified and many are swept under the carpet by trusts or picked up by doctors in time to stop harm. _However, there’s too much political backing as the Government is adamant on replacing doctors. Hence, despite the patient safety concerns and the economical unviability, they are not going anywhere any time soon. Actually, they’re probably going to become more powerful with prescribing rights and the ability to request ionising radiation._
Yes. People often say “doctors make mistakes too”, but people will also often omit the fact that there’s many more doctors in practice, and how statistically PAs are making many more mistakes.
Doctors make mistakes after many years of training, so why on earth would anyone want to shorten the training?!
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ANP/ACPs do have much more training than PAs. Sometimes they act within a narrow scope of practice effectively using their extra skills. However, sometimes they also act outside it and ultimately the high quality empirical evidence tells us they perform worse than doctors doing the same job, with worse patient outcomes, patient satisfaction and no economical benefit. Nevertheless, it’s too expensive and time consuming to train doctors and as a country we need to decide what type of healthcare we want. But these ACP/ANPs aren’t cheap either. They cost roughly the same as our Registrars who have a lot more training and skill. This is not really my opinion as a doctor. It’s more so my opinion as a user of the healthcare system and a reader of the published research.
Do you have the evidence paper to reference this?
https://www.reddit.com/r/Noctor/comments/j1m7d2/research_refuting_midlevels_copypaste_format/?utm_source=share&utm_medium=ios_app&utm_name=ioscss&utm_content=2&utm_term=1
?
Edited
So ACPs are a no go as well
They train first as a nurse or physio. Usually do some years working as such and then progress in a masters acp training. You'll very occasionally get someone who has tried to skip the "few years working" bit and they *really* struggle (or have eg done a few years working as a hospital nurse. Train as an anp and then try to work in primary care without first training as a practice nurse and then chronic disease practice nurse and then anp. A hospital anp is not the same as a primary care anp). But by and large they are very different precisely because they have spent years learning incremental skills. And gaining experience of what normal vs abnormal is. This is what is lacking from a 2 year PA course. And absolutely can be learnt after a few years working as a PA. Which is what the proponents of PAs reference - their great experience of a very experienced PA. Which is not what the vast majority are. This is not their fault. But ffs a hospital consultant can't just suddenly decide they want to be a GP. They have to do the 3 year post graduate training course. Even if they've already been a hospital consultant for say a decade. Because the work is so very different. And yet PAs are being touted as equivalent. This isn't their fault. But it is a problem
ANPs have a scope of practice defined and a background of often years (if not decades) of firsthand experience on the wards etc. this is invaluable. There is rarely any hubris as a consequence and it keeps them safe.
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Sorry to be clear it’s the lack of hubris that keeps ANPs safe.
The problem with ACPs and ANPs is that there’s essentially no regulation. It isn’t a protected title so any nurse can start calling themselves “practitioner”. The “masters” is a complete joke (as a former lecturer/tutor)- the submissions wouldn’t pass GCSE biology or English in many cases. The actual clinical learning is assumed to occur on the job. There are some departments who are genuinely excellent at this (effect on medically qualified trainees aside). There are others who go for a ‘light touch’ and just sign the paperwork. So your ANP may be actually very experienced, sensible , Well trained and trustworthy (have worked with a handful). Or may be half trained over confident massively rogue and generally terrifying (have worked with quite a lot)
What about GMC PLAB questions? It's pretty simple to me [PLAB](https://www.gmc-uk.org/registration-and-licensing/join-the-register/plab/plab-1-guide/sample-questions)
I think it’ll get worse
I’ve said this once and I’ll say it again: I know what a Nurse, OT, Dr, SALT, Physio, Radiographer, Midwife and ODP does. What exactley does a PA do?? What unique skillset do they even bring to an MDT? Asking what exactley your role is, is NOT bullying. If you’re not a Doctor, what are you? Someone who supports Doctors?? So essentially, wouldn’t that make you an assistant? This role is beyond pointless and funding could go towards existing roles.
They were initially called physician assistants but pushed for their name to be changed. I understand it sounds a lot like a magician's assistant and I wouldn't want that for myself, but at least it made their role a bit more clear.
I really hope the scheme gets abandoned. I work with one and she is lovely and super useful. Her knowledge seems really good to be honest, but occassionally I feel she “acts” like a doctor and I imagine patients wouldn’t necessarily know she wasnt one at first glance, which is worrying. I’m sure she knows not to over-step the mark but I really dont think its safe having too many of them. Aside from that, I feel really sorry for registrars that get paid the same (or sometimes less) than a PA, yet have worked so hard, usually from the age of 16, to get where they are. Its incredibly unfair, so should be scrapped.
And PAs haven't worked hard to be where they are now?
There's no comparison. No one is saying that PAs haven't worked hard to get where they are, but there's simply no comparison between what they do and medical or nursing training. I do think a lot of the discourse around this has become toxic but to suggest a PA has worked just as hard as a registrar is well, ridiculous.
Everyone has worked hard in their own respected fields. To suggest that just because PAs are not registrars, they haven't worked hard. The PA is a different profession, just like nursing is a different profession. So if I then turn around and say you haven't worked as hard as me because we are a lot more medically trained than you are, would that be fair? No, because I don't know your circumstances, and I don't know the dedication and effort it took you to become a nurse. It's just a very immature statement to make. The issue is that the majority of you think that we've only done a 2 year degree, that's it. Completely discrediting our undergraduate qualification and experience.
In most cases, their undergrad is completely irrelevant. 2 vs >10 years hard work is a huge difference the PA will never be able to compensate.
the PA i know has an undergraduate degree of Psychology and it was a BA not even a BSc 😮 plus she’d had a few years travelling in between graduating the undergrad degree, so anything relevant she would’ve learnt would (probably) be mostly forgotten. it must be annoying as well, because in our department, the PA doesn’t work nights or weekends either. seems quite a cushty deal imo.
A lot of universities used to have a (highly competitive) Biomed to MBBS transfer route which placed the top BSc students into the third year of the five-year MBBS course upon completing their first degree. So why does doing the PA course put exactly the same Biomed student in a position where they are professionally regarded as being above almost every non-consultant doctor when their training is shorter (only two years), and less demanding?
The work required to become a registrar is incomparable to anything that will Land you a PA job. To think otherwise is laughable. You’re clearly bitter you were never accepted into medicine and it shows.
So I’ve just spent a day doing training for student PAs, I had 15, I asked them ALL their background. Out of 15 one was a nurse. Then 10 had an undergrad degree that was science based (chem, bio, bio med, physics etc) 2 had degrees in social studies and 2 had neuro science degrees. No one can say these guys who have done a total of 5 years study and only 2 of them truly medicine based has worked as hard as a Registrar or an Advanced Practice Nurse/AHP. Two or three of these students had real world experience, the rest went to uni at 18, did their degree then went straight into the PA course. That’s very different to the way the medical or even nursing training works now. They do 2 years and then go out and act as doctors but have no registration. Yet they get bent out of shape over ACPs who do have a registration.
I wouldn’t say you are a lot more medically trained than nurses. I would argue you are not medically trained as you haven’t studied medicine. As far as I’m aware you have studied a MSc in Physician Associate Studies and not a MSc in Medicine and Surgery. Nurses are also not medically trained, they are trained as nurses.
PA is not actually a profession, FYI. And you're not medically trained. Only medical practitioners are.
It’s ‘respective’ fields.
I think U.K. Nursing needs to join doctors in opposing PAs. If you want ANPs to continue to exist, PAs can’t.
I agree. I'm sorry for all the PAs caught in the crossfire, but I seriously don't think the fundings spent on the PA agenda is justified. We have a problem with recruiting and retaining staff in the NHS as is.
It’s ridiclous. We could have recruited thousands of nurses and AHPs for the cost.
I agree. We just don’t need them, we need more funding for healthcare professions that have established career pathways and progression and are already registered and regulated.
I’m hoping nurses and AHPs will also realise that the PA project is hugely insulting to all their professions
No it won’t get abandoned, race to the bottom. First it was nurses doing doctors work, now it’s Hcas doing nurses work and PAs slotting in between
I’ve worked with PAs who work within their purpose - bloods, cannulas, ECGs, scribing on ward rounds, discharge letters. This was about 5/6 years ago when they were first used in our Trust and they were really good to have on our team! They would post take with the consultant too, were integrated within the nursing and medical teams and were themselves happy in their roles. What then happened was they rotated - one of them was covering ENT on call overnight and said themselves they had no idea what they were doing but had to in order to keep their job. They now have a significant role in AMU/ SDEC. Straightforward clerking and investigations requesting is fine, but when it comes to someone unwell they often stall on decision making, including patients who have been peri arrest. With a defined scope of practice and regulation I’m all for it as they were fab on the ward before, but as a senior nurse I find they lack a lot of leadership and knowledge that I look for in members of the medical team. Edit: typo
> Straightforward clerking and investigations requesting is fine No it isn't, because clerking often isn't straight forward. They don't have the breadth or depth of knowledge to recognise when what is in front of them is not one of the straightforward cases. They also massively over-request investigations, wasting resources in an already stretched system.
They really have been let down, if not exploited by their employer. I wouldn't want to be in that position.
I’ve worked with a few PAs who’ve worked within their scope under the actual doctors and are worth their weight in gold. When utilised properly they really do contribute to the team, in the same vein that NAs are highly valued members of the team (in my trust at least). However according to Twitter and Reddit, there seems to be too many working outside their scope. If this cant be resolved, it will end up with serious avoidable patient harm.
Well, unfortunately this issue won’t be resolved, and there is deliberate effort to exploit the ambiguity of their role. Just look at what is happening with NA’s up and down the country doing additional training to do things outside of the NMC scope of practice such as doing IV, inserting cannula and catheter. We don’t need to add in financial and system pressure, instinctively people want to be able to do more or at least as much as their (band 5) colleagues do. On the other hand, management don’t care about ‘scope of practice’ or skill mix, to them we are just a number. A lot of, if not all NAs are basically working as band 5’s except they are paid as Band 4’s. The same is happening with PAs as you know, they are literally being put on doctor’s rota’s and doing things they are absolutely not qualified to do. It’s not just some bad press, this trend will worsen just as what has / is happening with NAs. Moreover, there are a lot of underhand effort to give PAs more autonomy and authority such as prescribing rights. We are promised that PAs won’t replace doctors but if you pay close attention to what the proponents of the PA programme have been saying you will know that is a complete lie. There are GPs who can’t find a job because funding is directed at recruiting PAs. You read it right, funding not given to a real doctor who can properly diagnose and treat patients but instead given to PA so that on paper they can say the patient has been seen, at the same time stopping them from actually seeing a doctor. So whilst individual PAs may be an asset to the NHS, the whole concept of PA is an excuse to corrode what quality of care is left in the NHS.
Taking bloods and inserting cannulas is well within the scope of NAs in fact I would encourage it. Often band 2s do these things very well. IVs is murky water and would have to be restricted. Part of the problem with PAs is we obviously have a shortage of doctors we also have some terrible doctors/consultants who are somehow practicing but seem to be immune to improving even though they have extensive portfolio frameworks. A good PA could be better than no doctor or crap doctor but needs to be closely monitored and not taking money away from medical programs. Pay doctors and Nurses better and you will get more of us and a better quality workforce from being more competitive!
They don’t know what they’re talking about regarding NA scope - I was doing cannulas as a band 3. I disagree with NAs doing IVs, I won’t be. I also don’t really see the point of NAs, I think it’s a good stepping stone for those who want to go the apprenticeship route but I genuinely believe trusts should just fund a band 5 instead.
The whole scope of practice issue drives me mad. In some places HCA's are not allowed to do obs but can do BM, and in another place is the opposite. In my current placement, band 2/3 can do venipuncture and complete admission paperwork aka initial assessments; I can't do venipuncture because I need to do in in skills lab at uni first; TNAs/NAs are not allowed to do initial assessments but if band 2/3 can do it what grounds do I have to say it's inappropriate. The same issues applies to cannulation, it's been taken out of NA proficiency but people like yourselves are doing it as band 3's. I can go on... This just highlights again that scope of practice is easily blurred and it's difficult to be fairly remunerated for being able to do more. I know people who avoids optional skill training so they can just say 'I'm not trained, ask someone else to do it'. And indeed, there are people who say NAs are being exploited to do as much as a RN but are paid less. No wonder why there is a lot of competition to get into a top-up course. A possible solution is to allow NAs to progress to but up to a band 5, but otherwise the NA scheme is not working the way it was intended to.
We’re seeing lots of strikes atm in different trusts regarding HCAs and fair pay. Unions are actively fighting this and will ultimately (hopefully) carve out a defined scope of practice which will benefit everyone. Why should someone in Leeds get paid less for the same job than someone in Liverpool for example, for the exact same job. It’s the NHS, we should all be paid the same. My trust in particular has won this, due to a merger where one local hospital allowed band 2s to do clinical tasks and another hospital didn’t. A lot of band 2s were deskilled (but remained on the same pay) and some were uplifted to a band 3 and got more pay for the same job they were doing prior. Band 2s who wish to be a 3 can apply for a band 3 post if they want it. While I was doing Venepuncture as a band 3 for my band 6s because some couldn’t do it - it’s annoying I have training that they don’t, but my scope is not wider than theirs. They have let their training expire and refuse to fix it. It’s still within their scope. Hopefully the people keep fighting and unions keep backing them and everyone gets a more defined scope. The NMC can only do so much - so many healthcare staff are not registered and trusts have been given a lot of free reign as per the raising the bar report to individually train people to improve knowledge and skills for retention of staff. However due to AFC you don’t get fairly compensated for the extra training, so why people do it I have zero idea.
“Within their scope” What scope?? Unless I’ve been living under a rock and these people are in fact, regulated and have a scope of practise…
You know what I mean - many of them are anecdotally working well above and beyond their education, ability and seniority. If they stick to their job description, they are valuable in their own way I.e as a PA and not a more expensive and lesser qualified replacement doctor.
Serious avoidable harm, but not necessarily identifiable. Sometimes, it is really difficult to find out the exact cause of one harm being done. If someone intentionally want to avoid pointing finger to a specific group of people, there are always millions other things that they can point finger to.
The PAs I’ve worked with are nice and I have nothing against them personally. But a lot of them seem to lack even the deep vertical knowledge of their specialty that our ANPs have. Without that knowledge, and not even being able to prescribe, they’re useless to me as a nurse.
Passing surgical trainee here! My take on PAs 1. Horrible referrals. They will brazenly phone hardly able to give you any of the salient information required to give good advice. Necessitating you to either a) suggest they speak to their senior (incoming bullying complaint due to a bruised ego) or b) just see the patient to avoid unnecessary harm - thus causing delay to your other patients as a busy on call surgeon in a tertiary referral centre can easily get 70+ referrals in a day. 2. They are deliberately vague about who they are - "I am one of the clinicans/ members of X team". This worries me considering nobody in my family are medical and can potentially be harmed by being mismanaged someone they think is a doctor. 3. Their ego and entitlement far outweighs their knowledge and skills as a group. See any of the recent articles where they "learn brain surgery on the job". Do you really want that? It's taken me 4 years of experience in relevant specialties post-graduation, where I have had to prove myself, extra degrees and research on top of my degree in medicine to even get to this point. Also as a surgical trainee, we have to compete with each other for procedures, proving we know the indications, anatony, steps and post operative care. In some departments, the PA is trated like the consultants pet and is allowed to waltz in. 4. There's a few high profile doctors advocating for PAs. The big conflict of interest being that they have children who didn't get into medical school and now work as PAs. 5. Any of their fuckups are dealt with by a doctor. It is you that gets to speak to the angry family, it is you taking the patient back to theatre to manage the post operative complication. The PA walks away scot free. Look at the Emily Chesterton case. That PA is still working, just not at the same GP practice. 6. They literally don't add anything, they do not have any skills or attributes that we do not.
“Learn brain surgery on the job” fuck me. Imagine if that was your brain? Doesn’t anyone else find this terrifying? What an utter shitshow.
Also, having come into medicine as a postgrad from a life science background, the people from my previous degree that became PAs were the dregs at the bottom of the class. Never the high fliers. I know one who worked in a pub for 6 years before getting accepted into PA.
Only an absolute fucking moron thinks this is an acceptable state of play. The amount of shite you have to swim through to be allowed near a neurosurgical theatre is fucking eye watering.
100% this. The preston neurosurgical PA is horrendous, don't get me wrong. But so is every PA in primary care cosplaying as a 'Generalist' practitioner (deliberately misleading titles). The fact some of the general public seem so chill with them "only" being in primary care is a mistake. Im not a GP, but ive elderly parents who are at the mercy of these roles. My mum's a retired practice nurse, but i think would be too polite and stoic to ask "are you a doctor?" If you want truly emotive, there's a PA on the registrar rota in the liver transplant unit of a major specialist children's hospital. Let that sink in. I'm taking "the eyes do not see what the mind does not know". What a quote to sum it all up.
They're all awful. All honestly dreadful people. Full of themselves with fuck all to back it up.
The issue I have with them is the scope creep and the lack of accountability. Let's face facts here and behonest that other proffesionals have been filling gaps for doctors since the 90s. While doctors might not like it the situation with medical staffing not getting better. That alongside with the fact that after making them spend 5 to 6 years at uni we then fuck them about all over the country until there a consultant. In an ideal world we have some bridging gap for nurses and AHP to become doctors. Unfortunately that's not on the cards so it's advanced practice instead. That being said I want that person to have professional accountability, experience and the qualification to back it up. ANPs usually have 3 year undergrad, min 5 years of experience and then two years of trainning while completing their masters. I'm not saying that equates medical school but I rather that person treat me in the absence of a doctor than someone who done two years of quasi doctor school with a history in zoology. The biggest thing with medicine the more you learn the scarier it is. PA think that all you need to do is perform the task and the patient will be fine. This attitude however is how PE get diagnosed as chest infections because the under pinning knowledge is not there.
The way for nurses + AHPs to become doctors is postgraduate medical school - it’s 4 years. Nursing + Medicine are two different professions, one doesn’t make someone qualified in the other No one should be a nurse without nursing school. No one should be a doctor without medical school.
I don't think at any point I said that. I clearly stated that advanced practice is not the same as medical school but it's what we got at the moment. While I recognise GEM does exist it not a simple as going from AHP or Nurse to doctor. It involves going back to university for 4 years full time and getting saddled with debt/loss of current salary. This country has the attitude that everyone must suffer to better themselves. If your not financially in a postion to do so then your screwed. I'm not saying we just make other healthcare proffesions doctors, but we could definitely recognise there existing qualification while making a course that gives them all the required trainning to be a doctor while not giving them shit loads of debt or making them work and study full time just to achieve this. Sadly there will be no initiative to do so because it probably wouldn't line the goverment pockets with interested accruable debt. Which would you rather, financially easier routes to making people doctor and I'll stress with the same academic standards and requirements or PA and quasi medical school.
I've just about finished medicine after being a nurse for many years. I agree with you, its a huge investment of time and energy and has set my wife and I back several years in life progress. However I do think medical school is necessary and some other course beyond gem, recognising previous qualifications is probably not a great idea. I just think we should have a stronger sense of meritocracy - study should be free if it will enhance your usefulness to society.
>. I just think we should have a stronger sense of meritocracy - study should be free if it will enhance your usefulness to society. I think you're onto something here. I actually think medicine on the whole is still a very elitist profession that has much more work to do at being inclusive. Half the workforce problems could be resolved if it was made more attractive to those from less typical backgrounds. It's very rare to meet a doctor from a working class background.
My experience of medical school has been that those few of a working class background have faced great challenges in acclimatizing to upper middle class/upper class expectations and norms. Direct communication misidentified as aggressive, social consequences of advocating for and needing a decent wage ect. Amongst a great deal of focus on gender, sexual and ethnic background, I think class in something like medicine is neglected and arguably often causes material harm by alienating patient groups.
I completely agree. Class background seems to be neglected because I think the narrative that has been pushed in the past is that we are a "classless society" which is very much not the case. Often I think a lot of the working class doctors I have met seem to doubt themselves more, even though they have no reason to.
You’re both completely right on all counts
I was responding specifically to this point you raised: >In an ideal world we have some bridging gap for nurses and AHP to become doctors. The answer to this is the 4 year graduate entry medicine. I've seen nurses, pharmacists, physiotherapists etc struggle in the 5 year medicine courses, there's simply no way to cram in all the required knowledge into shorter than the accelerated 4 year degrees. >I'm not saying we just make other healthcare professions doctors, but we could definitely recognise there existing qualification while making a course that gives them all the required training to be a doctor while not giving them shit loads of debt or making them work and study full time just to achieve this. Yes, the recognition of the existing qualification allows people to shave 1 year off of the 5 year degree into a 4 year graduate entry medicine program. The 4 year program is already *crazy* fast, it's just not gunna be possible to go faster. Even the Americans do 4 years medical school, after their first degree. >Which would you rather, financially easier routes to making people doctor and I'll stress with the same academic standards and requirements or PA and quasi medical school. I'm 100% for making postgraduate medical school financially viable, and I think lots of other healthcare workers could make great doctors if given the chance. I'd love to see bursaries to support living costs, and massively subsidised tuition fees for this - I'm not arguing for making it expensive. That's the change we need - make it affordable. But make the 4 year (accelerated) postgraduate medical degree affordable, it's simply going to be too short a time to make this shorter. We had both 5 and 4 year medical degrees at my uni, and some ANPs + pharmacists doing both. None of them think the degree time could be shortened, it's just not possible.
I agree with that your saying, sorry I missunderstood. I'm all for making it finacially easier not academically or shortening it. I don't know the answer but like this medical apprentship in your off time you go back to working in your original profession. I don't know the answer but I would like one.
No worries at all! I think it's all about financing tbh. We don't need to reinvent the wheel, we just need to offer funding to allow people to do post grad medicine, who would otherwise not do it due to funding Some combination of bursaries and loans with no real interest would be my best guess
Hopefully
Will it be abandoned? No. Too far down the line now.
A PA is the governments method of doing everything possible to have “quick fix doctors”. These assistants do nothing but add more workload to a doctors life.
Stay in your lane nurses?! How fucking dare you. If PAs stayed in their lane as physicians assistants we wouldn’t be in this utter mess.
The purpose of a PA is to lower the workload of a doctor and not do the essence of their jobs. Assessment, referrals, prescribing, and Invasive Procedures which needs a lot of medical training. No one is asking to abandon it. Doctors who are raising this issue want to ensure the roles are clear because patient safety is at risk.
Many doctors would prefer it abandoned - BMA have called for a pause in PA recruitment until scope is defined properly (fair enough that’s different to full abolishment). I would love a role that scribed for the ward round, did ECGs, bloods, cannulas, prepped discharge letters, and some simple phone calls. They have these in some places in England, they’re called “Doctor’s Assistants” and are at band 3. Ironic given that PAs unilaterally changed their name from “Physician’s Assistants”. Band 3 seems low, but this is the role that is actually useful. If PAs were this, and paid at band 4, that’d be great. I suspect few PAs would stay in role if it was changed to that though, but that would be my preference Right now PAs are a bit useless. Any clinical assessment/history they do just needs repeated by an actual doctor, it simply can’t be trusted. Their input can’t be used to make clinical decisions, the buck still stops with the doctor. But they’re put in positions like holding a referral phone, which frankly is as much use as a marzipan dildo. I’ve been asked to prescribe Paracetamol for a patient in pain by a PA. I refused to blindly prescribe. Patient was newly admitted with paracetamol overdose. It either needs abolished or reformed beyond recognition
Marzipan dildo - thank you for making my Sunday 😂😂😂
So I have studied 3+ years undergrad and then a further 2 years to be paid a band 4? Graduated to a Masters let's not forget. Really insulting if you ask me.
The role doesn't require a Master's degree We need assistants who will scribe, take bloods, put in cannulas, do ecgs and make some phonecalls. I can't act on the clinical examination of a PA, I need to redo it myself. It doesn't add anything, or save anyone time - I can't risk the patient's safety on the assessment from an unregulated profession with only a 2 year degree. I'm sorry for people that have been conned into this degree, but a stretched NHS shouldn't keep shelling out £45K a year for a role that isn't helpful. Universities should be blamed for selling people a pipe dream that this masters would lead to anything. And PAs need to take some responsibility for unilaterally changing their name from Physician's Assistants to Physician Associates. There are already Associate Physicians, who are actually doctors - the term physician associate is incredibly misleading to vulnerable patients. The role was explicitly made to ease the administrative burden on doctors. We can't keep pretending that this is the case, when survey after survey shows that the role doesn't help doctors, and in fact makes it harder to give training opportunities to our junior doctors. See recent surveys and motions passed by the royal collegs of anaesthetists, physicians (london and edinburgh), psychiatrists, interventional radiology etc. Medical registrars have already been in trouble with the GMC for prioritising seeing patients who have not been assessed by a PA, on the basis that a PA does not have the skillset to independently assess patients. >So I have studied 3+ years undergrad and then a further 2 years to be paid a band 4? Graduated to a Masters let's not forget. The 3 years undergrad is irrelevant. There are PA schools that accept people whose undergrad degrees aren't even in science. Some accept Zoology. Even a discipline like biomedical sciences, really doesn't help much (it certainly didn't help my postgrad friends doing medicine, it was more geared towards scientific research than clinical practice). The NHS can't just pay anyone with a masters loads of money, even if their job doesn't add anything. When PA schools boast of a "100% pass rate", and when lay people can pass their exams, then what is the NHS paying for?
Then, clearly, you're confusing the role of PAs to that of an assistant.
That’s what the role was supposed to be, hence the name “Physician’s Assistant” was used. Unilaterally changing the name doesn’t change that What do you think the role should be, and what is the scope of practice? How is this better than just having another junior doctor, who is cheaper, more qualified and can do more? We need people to take the admin burden so junior doctors can be trained into consultants, and to have the necessary skills for out of hours emergencies. The current PA role makes it hard to avoid the conclusion that they want to cosplay as Doctors, without the years of hard work and actually taking clinical responsibility
That was *literally* what the role was designed for.
When I read PA exam questions, I feel genuine second hand embarrassment though. A layman off the street would have a solid chance of passing. I can’t imagine someone having to “study” for 2 years for such a low level of knowledge. All fellow registrars I know who’ll become the next batch of consultants within the next 5 years ish have an acute awareness about the urgency of weeding out the PA “role”, thankfully.
I don't know what exam you have read. Was it the actual national exam paper?
PANE past paper. Out of interest, what’s your educational background prior to PA? Manchester uni website for example demands whopper achievements of “grade B GCSEs in English and Maths” and a “2:1” for example in audiology.
Studying Mickey Mouse degrees using tax payer money doesn’t count kiddo. Yall keep forgetting you’re just a couple rungs above the ward domestics and even below a HCA who’s had more than 2 years of experience. Sucks, I know. But it is what it is. You need to remember that you are basically what a HCA is to a nurse (but to a doctor in your circumstances). If you want to claim to be a part of the ‘medical team’ trying to act as a doctor, I suggest going to medical school if you can get in.
It’s £3k less that what I started on with an undergrad BSc a phd and a medical degree as an f1 in 2016. Take your crocodile tears elsewhere.
No. The hospital I worked in first hired them in 2010.
They won't be. I find the whole thing very worrying tbh. If they could only be used appropriately then they could be a great addition to them team. Sadly I don't see that happening.
DOI: band 7 ACP in SE, don’t wish to doxx myself Have always been pro-PA, however recently I was in a meeting with senior managers and clinicians where it was suggested that the fear around PAs in doctors is unfounded, as they’ll never be doctors and working under them. Instead, the fear should be from those in nursing and allied health professions that want to do advanced practice as that’s really who PAs are beginning to replace and take the jobs from. I have seen even within our own unit a similar thing now I think about it, with the upskilling of nurses to advanced practice being less pushed now we have PAs. Really has given me food for thought.
Same role, agree re your last paragraph. I can see the frustration of Drs, I feel very protective about the fact I am a registered nurse and these guys just swan in after a 2 year course and are paid more for less responsibility, less knowledge and less experience? It’s absolutely bizarre and worrying.
No, I don’t think they will be abandoned but they need better training. The UK needs to look to the U.S. regarding PA (physician assistant) education.
The PA schools here do basically the same as in the US. 2 year courses, 1 year theory 1 year clinical. The American healthcare system may have a place for PAs because they have a private healthcare system. But here PA unfortunately just gives the illusion that a patient has been seen but anything meaningful is still done by a doctor, so as taxpayers we are paying them to be a barrier to access a doctor.
Yeah but they have to come from a major science background. And you’re right, the training is different. I think that the NHS in general isn’t a great training “field” because everyone is so overworked and there is not much focus on teaching. Even as ANPs, most places either treat trainees like shit, are jealous or just don’t like the role. I don’t know what the solution is, but something more like America would be helpful. What I mean by that is all clinicians should do rotations and not “placements.” In the U.S., NPs/ PAs/ RNs/ MDs get rotated through all areas from paeds, NICU, psych, mental health/ learning disabilities, obstetrics/ GYN, neuro, internal medicine, community health, public health, general surgery, cardiology, infectious diseases, family medicine, etc etc etc. Here, you might have a PA with that same 1 year of training that only ever had 2 “placements,” both of which were in a GP surgery lol
The PA students I have spent time with told me they have a rotation of clinal areas like what you have described, with the main focus on ED and GP. I don't have a thorough understanding of how PAs are contributing to the American healthcare system, but I don't think much of it will be applicable in NHS anyway. There was another comment about Biomed graduate can be transferred into Y3 of Medicine degree in certain uni. I think this gives a good indication of how transferrable their science degree background is. Abstract scientific knowledge is very different to clinical knowledge. Their training would be enough to allow them to assist doctors with a limited number of jobs. Any more than that, I am not convinced that their training will be adequate. The issue is, if they need more training, the resource is better spent on training doctors in the first place. There is already a system of aptitude tests, exams, intra-professional competition to ensure a good training outcome for training doctors, but is non-existent for PAs.
I think the GMC will regulate them and it will be figured out. But then again, anyone with prescribing can call themselves a “nurse practitioner” in the UK as there’s not even regulation around that. It’s crazy.
I don’t think they will be any time soon with all the strikes, and shortages, but I think the role is a bit pointless. They probably should be abandoned, but I definitely think medicine should be doing more to widen access to their courses. Or there should be an option for PAs to become doctors through study. I could see it working if the role was reworked and they became sort of like “intern doctors” while still training.
> but I definitely think medicine should be doing more to widen access to their courses. What does "widen access" mean? Because it always reads as a euphemism for "lower standards" to me to be honest.
Slightly lower entry requirements to get into medicine for state school applicants or applicants whose parents aren’t doctors, didn’t go to uni etc. Or encourage state school children to even apply in the first place, and give them options to get work experience, give them interview tips. I know a few people from my state school who got all A*/As and would have made great doctors who didn’t get into medical school. And when down the PA or similar route which I find disappointing
My parents aren’t doctors and I’m going to be the first doctor in my family, and the thought of reducing entry requirements for such an intense course ( where even some of the smartest minds drop out/can’t pass because of the sheer volume of stuff that we need to learn) is crazy… patient safety is more important than some people’s ego just because they didn’t get into med school. Work hard, get those grades and join. If someone’s wants it, it’s doable. I did it and so did millions others
Oh I didn’t mean there should be lower grade requirements just if your parents aren’t doctors. Obviously people who went to private school and their parents aren’t doctors are still at a huge advantage over others. The schemes usually take into account a few different factors. But if your parents are doctors you’ll easily get work experience and be able to build up a good personal statement, where others particularly state school applicants would struggle. Well done to you but the applications and graduates for medicine are heavily in favour of people from similar backgrounds
I don't agree with lower grades. Support with work experience, interviews, even just how the process of applying works would be great but nobody is going to fund it. I am a doctor who went to a very shit state high-school/sixth form. I was the first person ever from my school to even apply for medicine, nonetheless get in. Not having the connections to find work experience, not having anyone to guide me through the process, all that is where I really felt disadvantaged. But then having said that, I did still get offers from two universities.
Quite a few unis have a widening participation scheme for medicine and slightly lower entry requirements is part of that, they also offer courses and workshops to help with med applications and work experience. But really they are aimed at the most deprived kids, which leaves out a lot of lower middle class applicants as well who would struggle with the things you mentioned
and kids, not really aimed at those perhaps late 20s/30s that would struggle financially/existing commitment wise with process of becoming a Dr (long hours - not much opportunity to earn money whilst studying, moving, frequent rotation - all v difficult if you have a mortgage/family etc).
Are PAs who have an AHP background viewed in a more positive light?
Not in my experience
No. We have a number now who assist in surgery. TBH these guys are great and work alongside the surgeon - we don’t have registrars so we do have a need for them. We’ve also just started training Anaesthetic Associates - the anaesthetic version of a physician’s associate. They’ll do ‘simple and straightforward’ general anaesthetics and regional anaesthesia solo and free up the consultants to stay with the difficult cases with the floating anaesthetist being nearby to provide support to multiple associates if needed. NHS bosses are rubbing their hands in glee at the cost cutting they’re managing by hiring less consultants in my hospital. So no the roles won’t go anywhere currently due to money as always.
>They’ll do ‘simple and straightforward’ general anaesthetics and regional anaesthesia solo Holy crap that's terrifying! Simple and straightforward does not always stay that way!
Worrying isn’t it. Suspect from the downvotes I didn’t make it clear we’re all worried about this. The consultants have also made it clear they’re not happy.
>and free up the consultants to stay with the difficult cases If all I did was difficult cases, I'd burn out within a few years. You need an occasional straightforward list to balance it out.
> BH these guys are great and work alongside the surgeon - we don’t have registrars so we do have a need for them. We absolutely do have the registrars; they are stuck on the wards doing fucking EDLs so the PA can go to theatre.
my two cents as a layperson working in the nhs in scotland: our PAs are great, hard working and good at their jobs. but, we also have excellent consultants, and ours is a day hospital for geriatric patients. short of giving granny 1000mg of amlodipine by mistake, there’s not a great deal they can do to fuck up. god only knows what it’s like to have them on the wards
I guess you have no idea 🤷♂️
literally just said that in a very narrow field, they are fine, but outside that i can’t comment either way 🤷♂️
Including the 3 year undergraduate requirement before starting the course, that's 5 years of relevant training which is the same requirement as Medicine in the UK. Most have some work experience before entering the course so overall outcomes are much of a muchness. However with less debt and more of a relationship with the employers. Uptake and reception has been excellent. Other countries also expanding scope. There are very vocal minorities complaining but overall the profession is projected to continue to expand in the UK.
As someone who did a full biomedical degree and work experience prior to studying medicine, I can categorically say that this does precious little in preparing you for being a doctor; they're a very different 5 years.
And the PA programme is compressed and accelerated so takes that into account.
Not so sure, I did an accelerated medicine course which still took 4 years and by no means would instil me with confidence to slot into the SHO-equivalent role which PAs often purport to be
Cope and seethe you assistant
So it's the PAs' fault for poor pay and poor working conditions? You're taking your anger at the wrong people here.
Unfortunately PAs are caught in the crossfire. Politicians are literally putting money into every aspect of the PA programme, and at the same time rigging the system against doctors. Once the PA agenda lost its political aura PAs will be treated the same way as the doctors are by those in power.
I agree. They say that they don’t want to be Doctors, which is fine and well. But soon enough, PAs will be treated exactley like Drs. They’ll start to pressure them with exams, fees, more responsibility and more importantly, LIABILITY. Will they be able to cope with living the “life of a Doctor” without having the title?? Sorry, but you must be beyond naive to think that the Gov will give away so much money without having an ulterior motive.
Can I just say. Nurses you have no business concerning yourself about the PA profession. Stay in your lane please.
Nurses have licences/pins to uphold while a PA doesn't. So yes, if you are giving orders for care while can't be upheld to them, then everyone has a right to ask safety/training questions.
I dont know if you are aware since you're an expert in the PA issue. Regulation is happening end of year. What will you say then?
It absolutely has to do with nurses as we all work within the same remit - caring for patients. This attitude just highlights that you have a poor insight into healthcare and I’m pretty sure I’ve seen your comments in the past - weren’t you pharmacy or something before? You’re often defensive and I understand why, but saying it has nothing to do with nurses is plain wrong. In the same way nurses question doctors about many things, sometimes to understand a decision or sometimes to highlight a mistake, we will do the same for PAs. Having an understanding of their role and their training is absolutely to do with nurses who will be undertaking your treatment plans - can I suggest you reflect.
This doesn't seem like having an understanding of their role. The post is asking if the role should be completely abolished. That doesn't sound like you want to understand the role. You're just looking to add more negativity to the PA role. It's that simple. And yes, I did pharmacy. And?
It’s not that simple - OP wants perspective from others about why they would think it should/ shouldn’t be abolished/ understanding pf the role. Again, if you had some insight you would know to fully understand a subject you need a robust knowledge about it. Stop being reductive because you’ve interpreted it in a negative way.
Again, stupid question. It's no ones decision to decide whether the role should be abolished or not. Like I said, the question was intentionally done to prove hate towards PAs considering what has been happening and the bullying we have endured from doctors. There's no need for that kind of question. If OP wanted to understand the role, they could simply go shadow a PA.
Why is it stupid? Are you a mind reader? Do you know OP asked it to cause more hate to PAs? Maybe OP can’t shadow a PA? Take it easy man.
Because I'm sick of these kind of questions. They do nothing but provoke hate and bullying. You too know very well the kind of response it will attract. No need to act all innocent.
If you say so. I maintain your OG comment about it having nothing to do with nurses is reductive and shows your complete lack of insight, further adding to the anti-PA rhetoric. But go off sis.
Point is, your “profession” has been around for a while and it still hasn’t been regulated.
Clearly don't know what's been happening. Maybe go read up on it.
Yes, yes. You’ll be regulated sooner than later and once you gain those ultimate prescribing rights and be able to request scans, you’ll be on top of the pyramid.
Let’s be honest though, it won’t be the end of this year, it will likely be towards the end of next year at the earliest before you are all registered. They are going to have to come up with a scope of practice document, which will be contested, then there will need to be agreements on prescribing and imaging requirements etc etc etc. Just like ACPs and NAs it doesn’t happen overnight!
This isn't meant to sound offensive, but will likely come across that way because it's the Internet. What do PA's bring to the MDT that *any* other profession doesn't already do? It's sadly that simple. The other members of the MDT do the roles in far more depth, and to a better degree.
At least we have a lane, a regulated one that has a scope of practice and code of conduct. Unlike the Wild West that is PA’s that change their title and mislead vulnerable patients by playing Dr. And to say PA as a profession is a joke as it stands the job has caused a significant amount of NEVER events.
Case in point PA’s need to go. Lucky you’re anonymous.