Copperfield on the calls for a scope of practice for PAs
Until about five minutes ago, the only ‘scope’ I knew was the one you might insert into a suitably lubed rectum. Indeed, when I heard that all physician associates working in general practice needed scoping, I thought this was colorectal screening gone mad.
But no. This is all about defining role boundaries, so that we know when PAs are working beyond theirs, even though we’re already aware that’s all the time.
The problem is, scope is a slippery concept. Frankly, scope needs scoping. What is a profession’s scope, and who defines it? Jumping on the PA debacle, the BMA has had a go, and now the RCGP, despite wanting us to have nothing to do with PAs, can’t resist having a crack at scoping them, too.
So PAs are moving from a group with no scope, to one which is being scoped to within an inch of its life. But even that’s not enough, as some have called for the GMC to stick their scope in too, even though they’ve said they won’t – and despite the howls of protest at the GMC being involved with PAs in the first place.
Confused yet? I am. Perhaps the concept of ‘scope’ has been retro-engineered to contain the threat that everyone has decided PAs pose to patients and doctors. And what about other health care workers, such as in-house pharmacists, nurse practitioners and paramedics? Are we clear if they have a scope, who has set it and whether it sounds about right? And does the existence of that scope negate the fact that inevitably they sometimes work beyond it – because while they don’t always know what they don’t know, what they do always know is that they are filling gaps that by rights should be occupied by GPs.
Which leads neatly to us. And it’s at this point that the RCGP might regret its unusually decisive stance on PAs. If everyone without a scope, or working beyond scope, has no role in general practice, we GPs can all go home. It’s not just that we’re gonna need a bigger scope. Our job, like the universe, is everything and continues to expand indefinitely. Try scoping that.
I would go on to explain that, also like the universe, our profession will ultimately end in a big freeze or a heat death. But the discipline of astrophysics is, I think, outside the scope of this article. Or is it? Who can say?
Dr Tony Copperfield is a GP in Essex. Read more of his blogs here
My PA is far better than any trainee or any newly qualified and most locums. Based on observation over past five years. Now, scope off.
Have PAs been scapegoated?
Absolutely
Once the RCGP, BMA and GMC have finished scoping them, hopefully they’ll set down Physician Associates National Terms of Service….ie PANTS.
The protectionist attacks on PAs are a disgrace to our profession.
The idea that a medical degree confers super-powers on a GP is absurd.
Like most doctors I flew by the seat of my pants through the first decade of my career, thrown into sink or swim scenarios and learning from mistakes and experience. As a Generalist you can’t possibly know everything, thus we become experts at sorting the wheat from the chaff. The real skill is knowing who needs referring to someone with greater knowledge in a specialist area.
And PAs are essentially the same, albeit one rung down the ladder.
Yes, they need supervision and boundaries, but they grow and develop through experience, until they become confident and expert in their limited field.
Those who are quick to damn PAs’ clinical errors should reflect on their own imperfect record before casting the first stone.
Doctors didn’t want the Partner/Salaried jobs we offered over the last decade, so we either had to close in chaos, fund ruinous (and often unavailable) Locums , or seek a Plan B.
PAs are now part of an MDT that may be imperfect, and even sometimes inferior to the previous model of plentiful GPs, but it has kept General Practice afloat in hugely underdoctored areas.
But now our Leaders, bullied by jealous entitled doctors, seek to condemn and destroy an Allied Profession after they helped save our skins.
They should reminded…..yes, there are good and bad PAs, but equally there are good and bad GPs.
Those of us fortunate to benefit from a brilliant PA know they are worth their weight in gold…..reliable, hard working, loyal……yet currently feeling unwanted and undervalued by a callous GP leadership.
We should be ashamed of ourselves.
Yeah wheel in all the misguided fools happily replacing full qualified Drs with people with less training because they are cheeper. Apparently an experienced PA is better than a new to the practice recently enrolled Dr who was taking part in the on-call rota at the local hospital only a few months ago. And better than thise bloody (expensive) damned bloody locums. According to ‘some bloke’ . Not so quick fellas..a short from the resident satirist suggesting all the focus on PAs might be a little unfair does NOT suddenly mean its ok to ditch your Dr peers. You arent as clever as you tell yourself guys..you got into management – thats all
Cheaper not cheeper. Those not thise. Could PULSE maybe give us the option to edit posts and correct typos?
For what its worth the way I read it he’s saying..why stop at PA’s whats up with all these other folk (pharmacy first anyone?) ..and GPs do we all really always know what we’re doing? Truth is nobody does..including the ‘important’ Drs who don’t need other Drs getting in the way of running their practice. Self evident hey. This isn’t an argument for getting rid of education, training and experience. Unless you want to out yourself as stupid. Go ahead. Be my guest.
Old adage, get on a plane piloted by anyone other than a fully trained pilot at the pointy end? Thought not.
Workforce degradation and reduction in skillsets overall is a massive issue. This leads to worse productivity and outcomes. Yet it increases activity. It looks great for management and looks great for those pushing PA roles – but we measure the wrong things. Measure the wrong things – get the wrong results. Lots of false economies – the person who suffers – the patient.
a b, and you didn’t get into management, that’s all. So accept consequences of your own decisions.
Sandeep, totally agree. Meaningless activity is language of NHSE and PCNs, but not GP surgeries.
Just embarrassing, David Banner.
You are a PA and ICMFP
For PA read any Allied Health Professional. Who of us can honestly say we drill deep into every management plan made by these colleagues? The whole point is that they save us time. A consequence of underfunding primary care and a dearth of “real” doctors. The allied HPs I work with are excellent, but inexperienced. To be safe we have overinvestigation and over-referral. To mitigate these, a GP might as well seen the patient in person. It’s the role which is the problem, not the individuals.
Copperfield your humour column has broken the cardinal rule of comedy….joke as much as you like about Drs, nurses, patients, BMA, Govt etc, but don’t touch PAs…🙄
Anyway next week please take the piss out of urine retention(!!)…..I’m eager to see offence taken that you’re targeting patients with enlarged prostates….it’s no laughing matter 😂
Keep up the good work.
Some Bloke – don’t have enough courage or convictions to use your real name. I’m a locum with 24 years of experience – and I promise your PA isn’t better than me. But you go on making yourself feel better about helping destroy your profession ( and I was a partner for 19 years, so I know all about management – and I would never have gone down this route)
One of our salaried GPs is an ex partner of some time ago. Not famous for useful contribution to managing the surgery. There’s usually a reason why people get out of roles they find challenging. If you are not prepared to put your money where your mouth is, your words won’t have massive effect. Keep up with snide comments from sidelines. I will decide whom I employ and how I use their skills for maximum efficiency
No, Some Bloke, if safety is an issue you don’t get to decide. And as a GP, not on the sidelines, very much on the pitch thank-you, along with the rest of your peers who were all trained to play the game equally well, sometimes better. Peace