PAs: a symptom of NHS leadership groupthink and echo chambers

Reflecting on the discourse surrounding PAs, Dr Seema Haider asks towards whom we should actually be directing our anger

The physician associate debacle shows little sign of abating. It has, understandably, generated a vociferous reaction on all sides, creating hostile divisions within teams. None of this is conducive to good patient care. But for those whose intention it is to dismantle the NHS by stealth, it is proving an effective strategy.

It also gave us an insight into the modus operandi of the Tory Government, demonstrating the perils of cheap cost cutting tactics and how a refusal to adequately fund a service can bring even the sixth largest employer in the world to its knees. There has been a failure to safeguard patients because of penny-pinching strategies, alongside a ruthless squeeze of the remaining NHS staff, attempting to extract every last bit of service provision from them (in return for some vacuous clapping). These are the hallmarks of 14 years of Conservative rule. 

From its inception, the plan for diversifying the medical workforce was poorly fleshed out. This is a catastrophic failure of NHS strategists and policy makers who should have known better. This strategy needed meticulous planning, forethought and risk calculation; it had none of these. There was no consideration given to the time required to train PAs, or what their remit would be. Now PAs are left feeling under attack and in fear of having their livelihood threatened.

The PA debate represents a significant event with far-reaching consequences and one that has played games with the lives of patients and the livelihoods of NHS staff. It is galling to think that if a clinician made a mistake of equivalent magnitude, they would be expected to apologise, take ownership, and face the wrath of the GMC. Yet there is no such accountability in NHS leadership. Mistakes are made and forgotten for those in power, as they then rotate to new positions of power (just with new titles and roles). This malignant infrastructure continues and the same problems manifest because, fundamentally, nothing has changed in the culture and ethos of the organisation. The rest of the profession watches on in utter disbelief while years of frustration and anger reaches fever pitch.

These events also highlight the inherent issues within hierarchies, showcasing how leadership structures are meticulously crafted to create groups of selected individuals; some of whom are consumed with the pursuit of power. This cronyism silences the grassroots perspective, creating a poisonous echo chamber which is so disconnected from reality, and can have devastating consequences for patient care. I understand that sometimes you can inherit a mess and that, of course, there are some individuals who genuinely wish to enact meaningful change. However, these individuals’ voices can be lost in a toxic groupthink system.

The problem remains that the higher you go in leadership, the more you are pulled away from the frontline. Like with anything you don’t do regularly, you will deskill and lose valuable insights. The logical solution to this, is to listen to your colleagues at the coalface; it is here you will find the truth.

When I speak to GPs or read social media posts from the grassroots, I am astounded by the incisive analyses and strategic acumen of these individuals. They can dissect legitimate issues within a healthcare policy instantaneously. Yet when I imagine an NHS executive board sitting there strategising, I am bewildered that they seem unable to see the same glaring issues. Of course, while these grassroot GPs could be anomalies, untapped strategic geniuses, I believe that they simply possess a wisdom that comes from lived experience rooted in the here and now. In a fast-changing NHS climate this is the representation required for effective policy change. Personally, if I was planning policy, I would substitute Lord Darzi (Lord Voldemort in some circles) for an 8-session GP from Basildon any day. No offence to Lord Darzi, Wikipedia tells me he has a fascinating life story (and that randomly he hangs out with Elton John), but we need primary care experts advising about primary care.

This is not a swipe at individuals, or a blame and shame campaign which is rarely helpful. Leadership is not all bad or all good. There is nuance and we can hold multiple truths about organisations and individuals. But there is a problem and it is an infrastructure and culture issue which needs a total overhaul. I am hoping that Labour can deliver this and it’s not just a case of calling up your mates from last time.

As new doctors join the NHS at what is a politically turbulent time, I cannot help but feel sad. They have been robbed of the unadulterated excitement about their future career. A vocation once celebrated for its job security, is now tainted by the prospect of unemployment. Labour are now left with the herculean task of restoring safety and stability to the NHS.

My message to Labour is simple: after 14 years of misinformation and minimising, we are now proficient at recognising when we are being misled. Please fund the NHS adequately, listen to its staff and gift the NHS a joined-up IT system that doesn’t malfunction every time it is switched on.

Dr Seema Haider is a GP Partner in Havering and a freelance writer with an interest in coaching for equity & transformation. You can find her on X (formerly Twitter) @SeemaHaider1