Physician Associate

[tamzzy]

they are a little more expensive than a hospital resident doctor.

PAs actually get paid horrendously more if you compare the hourly rates than a senior registrar!

Just comparing basic pay with no out of hours work:
PAs are band 8a, so that's £27.5/h for a 37.5 hour work week.
Back when I was a full time ST6+ (ie a senior registrar about to be a consultant) my hourly rate was £23.33.

If the PA works out of hours as well their pay will be considerably more as they are on the AFC contract so 1.3x - 1.5x depending on number of OOH shifts worked (and ofc they do less OOH than a doctor as theirs is a 37.5h week on the AFC contract Vs 48h week for resident doctors)
If the PA chooses to locum an extra shift to match the registrar's 48h, they'd earn a consultant's salary.

 

[adam cool dude]

PAs actually get paid horrendously more if you compare the hourly rates than a senior registrar!

Just comparing basic pay with no out of hours work:
PAs are band 8a, so that's £27.5/h for a 37.5 hour work week.
Back when I was a full time ST6+ (ie a senior registrar about to be a consultant) my hourly rate was £23.33.

If the PA works out of hours as well their pay will be considerably more as they are on the AFC contract so 1.3x - 1.5x depending on number of OOH shifts worked (and ofc they do less OOH than a doctor as theirs is a 37.5h week on the AFC contract Vs 48h week for resident doctors)
If the PA chooses to locum an extra shift to match the registrar's 48h, they'd earn a consultant's salary.

No wonder NHS is on its knees if that is true.

 

[MarcLister]

This is the crux of it for me. I have no problem with them being used to take the workload of "day to day problems" off from more experienced doctors, but there needs to be a) a clear scope of their work b) a clear escalation chain to pass it upto a more senior doctor c) absolute transparency and the ability for a patient to insist on someone more senior.

This is pretty much how I feel. If PAs are needed then let them do jobs appropriate for their medical training. If they've done just 5 years of training to be a PA, how does this compare to a nurse? I would rather see an experienced nurse than a newly qualified PA.

 

[dowie]

Firstly, Lets abandon the 3+2 year theory for PAs -
- although a health or life science degree is recommended, there are no restrictions, and many have gone onto the 2 year course with undergrads completely unrelated
- even if it is a health or life science undergrad, it won't be 3 years of dedicated learning aimed at clinical 'medicine', it'll be something that might overlap at best.

It was an example of an ideal situation and posted as such; BMS undergrads at some universities share medical lectures, anatomy practicals etc.. with MBBS undergrads - and as you know a 5-year medical degree has at least 2 years' worth of similar pre-clinical training too.

AFAIK for Physiologists there is some requirement for a health or life sciences background but for PAs it's perhaps a bit broader and can be mitigated with health-related work experience and my point was that maybe this should be tightened up a bit - narrower requirements and higher standards for the MSc but AFAIK I don't think you can just walk in with a computer science or English literature degree and do a 2-year PA MSc course with no relevant undergrad or alternatively prior healthcare experience as a nurse etc.

Secondly - THERE IS NO GP SHORTAGE. There are plenty of GPs out of work or looking for more work.

There absolutely is, pls don't conflate recruitment issues on your side* with the fact plenty of the population struggle to get an appointment** - the idea of phoning up to schedule something has become almost completely alien in many practices - now it is more a race to the phones at 8am or queue up outside for a same day appointment:
* recruitment issues: https://www.rcgp.org.uk/news/recruitment-issues-workforce-crisis

** shortage of GPs: https://www.rcgp.org.uk/getmedia/36...d600a6/RCGP-Brief_GP-Shortages-in-England.pdf

GP Workforce
Despite an agreement from Government that we need 6,000 extra GPs thenumber of FTE fully qualified GPs has fallen by 5% between September 2015 and 2021 whilst the population is 4% larger and health problems are getting more complex.
There were 45 fully qualified FTE GPs per 100,000 patients in April 2022 compared to 52 in September 2015, when records began.
This means that onaverage, GPs are currently looking after 2,056 patients, which is more than 10%more patients than in 2015.
42% of GPs say that they are planning to quit the profession in the next five years.
80% of GPs expect working in general practice to get worse over the next few years, compared to only 6% who expect it to get better.

GP numbers have fallen while the population has increased and is getting older and sicker.... and that's just the official figures (there are possibly another million+ people here that aren't in the official figures but that data scientists in supermarkets etc.. still need to take into account).

 

[moppy89]

Tricky topic this as nurses seem to get lumped in with the general discussion as nurse practitioners / ANPs also do "doctor"-y roles in primary and secondary care.

The crux of it is that these roles only exist because they allow people to get seen when otherwise they would not/would be waiting much longer. Do you necessarily need a doctor with 10 years training behind them to assess your sprained ankle/cough you've had for a week/sniffly child? In most circumstances, no.

As long as you're suitably qualified and experienced to assess someone and have an awareness of the limits of your knowledge, these minor complaints can be dealt with and spare the more qualified and experienced persons time. The argument should be about the definition of suitable qualification and training.

I work with a lot of very experienced ANPs, due to their background as nurses/paramedics they tend to document with a "show your method" type style as opposed to GPs who seem to almost not bother with documenting (likely due to the insanity of 5-10min appts). I would guess that the more thorough documentation is a defence mechanism because if something goes wrong further down the line, you can bet your ass their decision making will be more scrutinised than a doctor's

 

[tres]

There absolutely is, pls don't conflate recruitment issues on your side* with the fact plenty of the population struggle to get an appointment** - the idea of phoning up to schedule something has become almost completely alien in many practices - now it is more a race to the phones at 8am or queue up outside for a same day appointment:
* recruitment issues: https://www.rcgp.org.uk/news/recruitment-issues-workforce-crisis

** shortage of GPs: https://www.rcgp.org.uk/getmedia/36...d600a6/RCGP-Brief_GP-Shortages-in-England.pdf

Unsure if you truly mean not enough GPs, or not enough GP appointments.

Did you read your quoted sources?

1) "Of the 49% who were currently applying for or considering work as a GP in the UK, 86% had struggled to find an appropriate role. On average, they had applied for around 13 jobs each. It’s absolutely staggering that there are not enough GP roles available when existing GPs are being pushed to breaking point. It’s especially worrying to see stark regional disparities in our findings, with GPs struggling hardest to find roles in areas that have higher levels of deprivation – potentially further entrenching health inequalities.  "

This demonstrates my point, plenty of GPs, not enough jobs. There is no GP shortage.

2) You have quoted a 2022 article.

This is not a "recruitment issue on my side". I personally know 10+ GPs that either can't find work, or enough work. We advertised for a new GP and got 28 applicants.

Here is some more up to date information.

Exclusive: Half of GP trainees about to qualify still looking for work, RCGP survey finds

Half of the GP trainees qualifying this summer are still looking for work, with over one third struggling to find an ‘appropriate role’.

www.pulsetoday.co.uk

GPs struggling to find jobs while patients are ‘crying out’ for appointments, says College

New research from the RCGP find six out of 10 job seeking GPs are struggling to find vacancies.

www.rcgp.org.uk

Over 80% of locum GPs struggle to find work, finds BMA survey - BMA media centre - BMA

BMA Press release

www.bma.org.uk

Some GPs struggling to find work, says union

Locum doctors in England have told the British Medical Association shifts are hard to find at practices.

www.bbc.co.uk

'I’m a trained GP, but I can’t get a job': the absurd new crisis in the NHS

Doctors say they are ‘sitting at home’ unable to work because surgeries are employing pharmacists and physios instead. Sarah Graham reports

inews.co.uk

Thousands of new GPs could be unemployed this summer, warns BMA

Thousands of newly qualified GPs could be unemployed this August due to a 'nearly non-existent' job market in some areas, the BMA has warned.

www.pulsetoday.co.uk

Out-of-work GPs fear losing their licence to practise, GP leaders warn

GPs who are struggling to find work fear they could lose their licence to practise, GP leaders have warned.

www.gponline.com

Four-fifths of locum GPs can't find work

Locum survey: four in five locum doctors cannot find work, while a third have already planned to leave the NHS, the BMA has found.

www.personneltoday.com

Four in five locum GPs in England unable to find work, BMA study finds

Government funding model blamed as more than half of GP locums surveyed said they were considering career change

www.theguardian.com

I agree there are not enough GP appointments. But there are plenty of GPs, just not enough jobs, partly due to the issues in the OP.

 

[tres]

It was an example of an ideal situation and posted as such; BMS undergrads at some universities share medical lectures, anatomy practicals etc.. with MBBS undergrads - and as you know a 5-year medical degree has at least 2 years' worth of similar pre-clinical training too.

AFAIK for Physiologists there is some requirement for a health or life sciences background but for PAs it's perhaps a bit broader and can be mitigated with health-related work experience and my point was that maybe this should be tightened up a bit - narrower requirements and higher standards for the MSc but AFAIK I don't think you can just walk in with a computer science or English literature degree and do a 2-year PA MSc course with no relevant undergrad or alternatively prior healthcare experience as a nurse etc.

It all depends on the undergrad subject, which is my point - I agree, if they do biomed, they will overlap with the pre-clinical curriculum.
My point is that you can get on a PA course with ANY BA/BSc. Degrees in computer science, English literature and human resources have been used to get into PA studies.

 

[Raymond Lin]

It all depends on the undergrad subject, which is my point - I agree, if they do biomed, they will overlap with the pre-clinical curriculum.
My point is that you can get on a PA course with ANY BA/BSc. Degrees in computer science, English literature and human resources have been used to get into PA studies.

Geez....that sounds like a gravy train I need to get myself on! 100% pass rate you say? With similar salary to a junior doctor?

Where do I sign up? lol

 

[tres]

Geez....that sounds like a gravy train I need to get myself on! 100% pass rate you say? With similar salary to a junior doctor?

Where do I sign up? lol

Most are band 7 - £46,148 to £52,809 a year
Some are band 8 - starting at £53,755

The GMC's argument is doctors will eventually outearn a PA.
Despite the fact it takes something like 15 years after starting work as a doctor to cumulatively catch up to a PA and overtake them!

 

[Minstadave]

Experience so far has been very poor.

The PA students we've had to train have been absolutely dismal, lack the knowledge that most lay people have, let alone med students.

The referrals from PAs are absolutely shocking, doing baby checks without a clue what is normal. RCGP stepping in and stopping them seeing children has been amazing.

Would never employ one, they're absolutely shockingly poor value. What we really need is a true assistant role that increases efficiency, not some expensive doctor cosplayers.

 

[dowie]

Unsure if you truly mean not enough GPs, or not enough GP appointments.

Did you read your quoted sources?

Did you?

In particular, the bit from the Royal College of GPs states that we need more GPs:

Despite an agreement from Government that we need 6,000 extra GPs the number of FTE fully qualified GPs has fallen by 5% between September 2015 and 2021 whilst the population is 4% larger and health problems are getting more complex.

You're claiming there is no shortage but again the Royal College of GPs and the UK government agree that 6000 extra GPs are needed and that the number of fully qualified GPs has fallen by 6%.

The population has increased and gotten older and the number of FTE GPs has fallen, there's perhaps a mismatch between FTE roles and GPs willing to work full-time (maybe women don't wish too) or indeed retired GPs in rural areas vs GP trainees searching for a positon etc..

You've done a scatter bomb of links but that includes all sorts of things like trainee GPs etc.. which doesn't necessarily refute what I said and I'm quoting directly from the Royal College of GPs - why would they think that GPs retiring is a significant problem if there is such a plentiful supply of replacements - in reality some of that is a more complicated recruitment issue and a mismatch of roles in areas, expectation of working practices etc..not enough training opportunities and no doubt the employment of PAs hasn't helped either.

 

[Minstadave]

Did you?

In particular, the bit from the Royal College of GPs stating that we need more GPs:



You're claiming there is no shortage but again the Royal College of GPs and the UK government agree that 6000 extra GPs are needed and that the number of fully qualified GPs has fallen by 6%.

More funded GP posts is more important than more GPs currently. We're churning out GPs with no job to go into.

 

[Goodie]

Aren’t PA’s still paid at a b7 at a start going upto 8b? so to put into context the cost saving in salary compared to a fully qualified doctor is not huge.

B7 - £46k to £53k
B8a- £54k to £60k
B8b - £62k to £72k

edit* I realise this is a workforce issue rather than pay issue but think it worth highlighting all the same.

 

[Minstadave]

Aren’t PA’s still paid at a b7 at a start going upto 8b? so to put into context the cost saving in salary compared to a fully qualified doctor is not huge.

B7 - £46k to £53k
B8a- £54k to £60k
B8b - £62k to £72k

edit* I realise this is a workforce issue rather than pay issue but think it worth highlighting all the same.

Yes, makes absolutely no sense.

Nurse practitioners don't make much sense financially either. Paid to train and then go onto a 7 or 8 in an SHO role.

Both PAs and ANPs don't work a 40hr week for that money too whereas 40hrs is the starting point for doctors.

 

[tamzzy]

Aren’t PA’s still paid at a b7 at a start going upto 8b? so to put into context the cost saving in salary compared to a fully qualified doctor is not huge.

PAs actually get paid horrendously more if you compare the hourly rates than a senior registrar!

Just comparing basic pay with no out of hours work:
PAs are band 8a, so that's £27.5/h for a 37.5 hour work week.
Back when I was a full time ST6+ (ie a senior registrar about to be a consultant) my hourly rate was £23.33.

If the PA works out of hours as well their pay will be considerably more as they are on the AFC contract so 1.3x - 1.5x depending on number of OOH shifts worked (and ofc they do less OOH than a doctor as theirs is a 37.5h week on the AFC contract Vs 48h week for resident doctors)
If the PA chooses to locum an extra shift to match the registrar's 48h, they'd earn a consultant's salary.

^

TBH, I know the BMA moves at a galacial pace, but I'm quite surprised the BMA hasn't yet jumped at this pay disparity lol

 

[heeeed]

there is definitely a shortage of GPs overall. The fact that we have lots of GPs finishing training without jobs doesn't mean that we have enough for the actual work in primary care at a safe manageable level. It simply reflects that practices cant afford to employ more due to the woeful drop in funding practices have seen over the last few years. I would love to employ more doctors and take some of my workload off me, but when I took a 17% paycut last year its pretty hard to swallow an investment in new staff. It's actually these days often hard to even consider replacing those who move on. That situation isn't going to change any time soon with the mess around NI also. until the government invest in general practice and regain some trust from the profession that they wont pull the rug from under them again then nothing will change

 

[tres]

Did you?

In particular, the bit from the Royal College of GPs states that we need more GPs:



You're claiming there is no shortage but again the Royal College of GPs and the UK government agree that 6000 extra GPs are needed and that the number of fully qualified GPs has fallen by 6%.

The population has increased and gotten older and the number of FTE GPs has fallen, there's perhaps a mismatch between FTE roles and GPs willing to work full-time (maybe women don't wish too) or indeed retired GPs in rural areas vs GP trainees searching for a positon etc..

You've done a scatter bomb of links but that includes all sorts of things like trainee GPs etc.. which doesn't necessarily refute what I said and I'm quoting directly from the Royal College of GPs - why would they think that GPs retiring is a significant problem if there is such a plentiful supply of replacements - in reality some of that is a more complicated recruitment issue and a mismatch of roles in areas, expectation of working practices etc..not enough training opportunities and no doubt the employment of PAs hasn't helped either.

That article is almost 2.5 years old.

My resources talk about CCT'ing GPs, not trainee GPs.

FTE GPs falling = not enough jobs. Not enough primary care funding. Too many lesser trained staff, e.g. PAs.

 

[Raumarik]

If they are using these PA, they need to ensure there is very clear ID / uniform so people do not mistake them for more qualified clinicians IMHO.