Copperfield on the GPC’s vote to completely ‘phase out’ PAs in general practice
Wow. As in literally, blimey. I mean, I realise that the UK’s most senior medical leaders have advised it IS ‘entirely reasonable’ for doctors to take part in the public debate around assisted dying. But for the GPC to suggest that PAs should be completely phased out seems to me a euthanasic step too far.
It’s amazing how quickly the attitude towards physician associates has transitioned from disquiet, to scoping, to annihilation. And you do start to wonder if all the self-righteous anti-PA tub-thumping carries the risk – deliberate or not – of blinding us to the elephant in the room. Which is – and I realise I’ve mentioned this before, but if the BMA can double down then so can I – that there are plenty of other non-GPs who currently see, and could feasibly screw up, undifferentiated illness.
Sure, they may have more, or different, training to PAs. But, just as I’ve known truly excellent ANPs, paramedics et al, there are some very much at the other end of the spectrum – potentially missing either the serious, or over-managing the trivial, to the extent that I’d avoid them like the plague, even if that’s what I thought I had.
Worse still, being more highly trained than PAs, they may develop an over-confidence which moves the dial the wrong way on the ‘knowing what you don’t know’ awareness scale. Plus they have less oversight than PAs, who in the current febrile climate can’t take a leak without us having to tick it off as a competency.
So there are wider issues here, aren’t there? Such as, who actually is safe to see undifferentiated illness, if not a GP? Which qualifications or experience confer the necessary kitemark? How much support and supervision do they need? Are noctors OK but nonoctors not? Or is this a role so specialised and fraught that it should revert completely back to GPs? If so, how can we cope? Or will the public accept the trade-off of safety for convenience? And so on.
The furore over PAs should have fuelled this broader debate – instead, it’s narrowed into a witch-hunt. And whatever form assisted dying takes, it shouldn’t involve being burnt at the stake.
Dr Tony Copperfield is a GP in Essex.
Spot on Copperfield; calling it out for what it is, a witch-hunt.
Self righteous anti PA tub thumping encapsulates it perfectly
The Physician Associate scapegoating and overt bullying has reached the stage where BMA and RCGP should be reported to GMC for serious breach of their doctors duty. I think all doctors should be concerned about the legal implications of saying publicly, without evidence, that health colleagues cause harm by doing their job. I think Dr Copperfield may be regretting the previous enthusiastic support here- perhaps others may wish to reflect too.
I completely agree with every word. There are lots of ‘clinicians’ who are obviously not fit to see undifferentiated illness as well. Will the witch hunt continue?
Well totally. Absolutely the dumbing down isn’t just about PA’s. PA’s are just the most blatant incarnation. Really so in your face the reaction was inevitable. But sure now this absolutely obvious problem has been acknowledged lets be honest about the other stuff. All about getting other people to cover for an absence of Doctors. All I’m reading in the splurge of righteous indignation above are vested interesting trying to argue several wrongs add up to a convenient right. No. A house of cards is not a comfortable place upon which to base an argument Two wrongs never did make a right
Tony – exactly so, but how can our practices survive now without our “allied Health Professionals”? I oversee 3 of them currently. Well meaning, experienced ANPs and SPs. You have two options don’t you. Discuss every single case in detail, so you might as well have seen the patient yourself, or trust them to get on with it, when you know very well you’d honestly be doing a better job of it in less time. I for one now feel very exposed regards vicarious responsibility. It goes with the territory in GP now. I’m still sleeping at night but that’s only because I have insurance.
Totally agree with you Tony. All “allied healthcare professionals” roles should be reviewed with scope limitation. Only GPs with 10 years training should be seeing undifferentiated patients. UK General practice is all about finding the needle in the haystack which GP training over 10 years trains us to do. As far as “how will we cope without AHCP?” There is currently a crisis in General practice with GPs unable to find work and the reason is clearly in 3.areas: financial, greed and political. No will to fund practices properly by the government and incentivising AHPs at the expense of trained doctors which has caused this workforce crisis. Defunding of practices over the 5 year pcn contract (mainly the gpcs fault who encouraged such a turd of a contract to members) which has put practices under financial pressure. But there is also greed from some partners for whom the lowest common denominator is profit in lieu of care quality. If the will was there, this could all be reverse very easily but I don’t see it happening.
Deeply secret and classified, the Tory “Manual of Stratagems for Concluding Terms of Office” (aka Book of Evil) states s6.66 that “before leaving office, plant devices that are set to explode under new Govt and cause division in targets”. Hence ARRS originally only for PAs, not GPs.
Re feeling the heat, I hope by now some of the previous Govt ministers and senior NHSE managers who defunded and broke the NHS are descending the 7 circles and having their feet toasted by Old Nick, and others are enjoying the hot tub of a bubbling cauldron…
Every health professional has a role and as long as allied clinicians are adequately supported and supervised then they are as valued and safe as any other clinicians including GPs.
We are all human and at risk of making a mistake. Sometimes we do it right but the outcome can still go wrong. Who could avoid treating a pseudomonus Infection with ciprofloxacin successfully but still have the patient tear their achilles 4 weeks later.
We need more funding to employ our GP colleagues looking for work, and need to open up partnership opportunities while making the burden of being a partner less onerous, so they agree to join.
Let’s do that without wrongly persecuting PA colleagues who can do a great job, but are not GPs, but clearly have a valuable role.
Two separate issues are being conflated here: whether it is acceptable to blame and bully PAs for the way they have been deployed in the NHS, versus whether it is safe for them to see undifferentiated illness in primary care.
The venom aimed at PAs as a profession is wrong, as is generalising about how they practise, because of a few cocksure idiots (which profession doesn’t have those?). I believe that PAs can work safely in a hospital team, where they are appropriately supervised. I remain to be convinced that the same is true in primary care, given the undifferentiated nature of our work. Sorting the truly sick from the trivial is very, very difficult. After 25 years in medicine, including a decade of training focused largely on diagnostic skills, I don’t always get it right. It is not a criticism of PAs to question whether their training is adequate for them to work safely in general practice.
Most danger to patients these days clearly comes from shambles that is our acute services. How their doctors work- I would not accept that in my surgery from ANP, PA, ECP.
I am fairly relaxed about my PA continuing to work as before RCGP nonsense guidance. Like mental health paranoia. As if when we refer there’s even a chance patients will see a psychiatrist
“Or is this a role so specialised and fraught that it should revert completely back to GPs? “–Yes Copperfield, you’ve hit the nail right on the head! A lot of supposed consultations done by noctors or similar actually had GP input all the way from history, examination, diagnosis and management. All the noctors did was the notes entry so on paper it looks like the non GP did the consultation.
A PA asked me the other day why I forgot to send an MSU for a simple Cystitis. I am still lost for words.
Rcgp “blended learning” not fit for purpose; recent graduates seem frightened by or uninterested in patients, having spent too much time with a computer and too little with poorly people.
Transition to independent Practice always hard, but present crop seem particularly unprepared and even uninterested.
Sensible piece. I think part of the problem arose from PAs in secondary care being employed on better terms than junior doctors. If this hadn’t happened then I don’t think the debate would have exploded.
I don’t think so. It’s not a witch hunt. it’s pointing out tat 2 years of training don’t qualify you to manage undifferentiated patients. Frankly I don’t think anyone but GPs should be. It’s what our job actually is. Straight forward minor illneses; ANPs particularly ones with urgent care, miu training, ED training is good. Paramedics home visits to make plan with GP. Pharmacists to do medication reviews and related eg medication management like shared care meds. IE DOING THE JOBS THEIR TRAINING PREPARED THEM FOR. Rest of its ours and should be. The fact we are overwhelmed doesn’t change the fact that this is our remit, the work only we are trained for. Do you remember how we did all that generalist training including pharmacology medical school and then generalised post grad training rotating through specialities. Frankly GPs could do with more training through a fuller range of specialties not handing our work over to people who haven’t done any of this training.
And to those above who say it’s a witch hunt. Grow up. You’ve so lost far of the sight of what safe practice is or maybe you did far too much of the hand holding empathy training bit you forgot the important substantive bit.