Doctors raise alarm over expansion of ‘less qualified’ physician associates | LBC debate
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- čas přidán 24. 06. 2024
- Physician Associates and Anaesthesia Associates have been found to have acted illegally in 1 in 8 NHS trusts, LBC has uncovered.
The British Medical Association has launched legal action against the General Medical Council (GMC) over the regulation of these roles, neither of which require either a medical degree or postgraduate medical training.
James O’Brien hears voices from both sides of the debate, with junior doctor Eilidh (03:09) making the case against physician associates, and caller Andy (10:13) accusing sceptics of ‘project fear.’
Under the terms of their employment, PAs and AAs are not permitted to perform acts which are the preserve of clinicians. On paper, their main duty is to lessen the burden on doctors by helping to manage patients and reduce the demands on their time.
However, LBC has found that PAs and AAs have acted beyond their purview in 1 in 8 NHS trusts, attempting to prescribe medication and commission ionising radiation scans - tasks they have no legal right to carry out.
The data was obtained via Freedom of Information Requests to over 50 NHS trusts.
The findings have been described as “staggeringly high” by the co-founder of Anaesthetists United, Dr Richard Marks, whose organization has launched complimentary legal action against the GMC over the regulation of AAs.
But speaking to LBC, Dr Marks warned that the figures could be “the tip of the iceberg”:
“It’s a staggeringly high figure for one in eight trusts to admit that people in their organisation are acting illegally - and I stress that it is illegal. There are specific laws on prescribing and ordering X-Rays and ionising radiation.
“I think this is the tip of the iceberg, though, because there are so many ways people get around the regulations. In anesthetics, people are using Patient-Specific Directives, which is a particular way that doctors can prescribe something to be given by someone else, [with] very strict constraints over the dose, repeated dose and timing.
“But it’s being used as a bit of a carte blanche to do whatever the associates want - so I think [LBC’s] figures are just the tip of the iceberg.”
The figures received by LBC show that trusts had witnessed MAPs act illegally on multiple occasions. There were 1138 incidents of a PA attempting to commission ionising radiation scans at Leeds Teaching Hospital Trust, with a further 107 instances at Chelsea and Westminster Hospital NHS Foundation Trust and another 35 cases at Somerset NHS Foundation Trust.
Physicians Associates were first introduced in 2002 with the objective of reducing the number of hours doctors spend doing non-clinical work.
However, the BMA has claimed that there has been a “dangerous blurring of the lines” between consultants and PAs, with many patients being unable to distinguish whether they are being treated by a doctor.
The union claims this issue will be exacerbated if the GMC becomes responsible for regulating doctors, a change that is due to come into effect in December.
Concerns around the use of PAs and AAs have increased after the deaths of three patients were linked to their use, including Emily Chesterton in November 2022, who was assessed twice by a PA she believed to be a GP. On both occasions the PA failed to identify her breathlessness and leg pains as a blood clot.
In England, the use of PAs is set to rise considerably in the next decade. Currently, there are around 3,500 employed, though that is set to rise to 10,000 by 2036/37.
Despite the concerns around patient safety, both the Health Secretary, Victoria Atkins, and Shadow Health Sec, Wes Streeting, have defended their use.
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Teachers replaced by assistants……police replaced by specials …the list goes on
Because consumers don’t want to pay for expertise. Blame yourselves. (Ourselves).
deskilling
@@patticriss2238 I've got a clean conscience. I never bought into the Brexit scam, and have never voted Tory.
@@patticriss2238 We do, it's just we are forced to pay a middle-man management scheme that skims off their profit first so there isn't enough left for experts.
@@patticriss2238 Highest tax in the world, we do pay for it. Our leaders have robbed us instead.
"It doesn't matter that I haven't studied medicine!" WORST. THING. SAID. IN. AN. INTERVIEW. EVER.
Medical degrees have been dumbed down so it doesn’t matter.
@@taffyterrierwhat does this even mean? Please explain
@@taffyterrier evidence please
@@akhan1892 They have been made easier in order to allow people of lower academic ability to pass.
He may have studied health, biomedical science, or biochemistry as undergrad + PA masters. They know system biology just as much, down to the smallest molecule interaction within you. The difference between 2 is that health/ biomedical scientists drive the foundational knowledge that doctors use, while doctors apply this knowledge. This misconception, that PAs are unskilled is so wrong, people have no clue what they are talking about.
Extremely dangerous..im a retired consultant surgeon
It's deskilling, happening all over, diagnosis by check box on an iPad
Removing the intellegenciais an authoritarian tactic. Happened in all those left wing authoritarian regimes and I think the right wing ones too...not sure. But they so seem to be removing any intelligent people and replacing then with robots or compliant people. It doesn't help that rupert Murdoch owns the school iPad management companies.
I'm a current commissioner and completely agree. Utterly shocking.
Very scary hearing this
This has happened in lots of different industries. The difference is that this is a gamble with life.
It doesn't matter that I haven't studied medicine!!! The sheer arrogance
He also exhibited a massively arrogant attitude to the first caller, saying that she was protecting her grade. Well done JO'B for not letting him get away with his blasé attitude unchallenged,
Medical degrees have been dumbed down so it doesn’t matter.
@@taffyterriercitation required
@@craftinghome Taffy is rage baiting this comment all over the shop. Leave the trolls in his basement. 👍
Medicine is the practical application of biomedical/ health science, which he has likely studied instead. In that case, he indeed didn't need to study medicine. per se.
It's deskilling a very skilled job that will cost many many lives
Yes, his "take a simple chest infection" made my blood run cold. There are many reasons for chest pain, chronic coughing etc, some of which are life threatening. I want to see a real GP and then if necessary a specialist if I have those symptoms.
So after listening to those two calls, I get the feeling this breaks down to "Sorry, you can't see a doctor today because we can't be bothered to pay enough of them. How's about someone else instead?".
That's just plain scary.
PAs get paid more than junior doctors. It's not as much a salary thing as trying to accelerate the training requirements.
@@rl3799PAs get paid more than junior trainees, but far less than consultants, GPs and more senior trainees. Most doctors earn more than PAs, although PAs start on a higher (but stagnant) salary.
@@GreeGraa true, but that's a higher salary after MUCH less training than even the lowest ranking doctor - 2 years vs 5 or 6 (sometimes 9 if they have a PhD).
PAs are dangerously underqualified, completely unregulated, and leeching money that could go on opening more training posts for doctors (which would also help with retention).
The whole PA movement really feels like the government wanting to cut corners on the NHS, not train enough doctors, so that it pushes people out, so that they have reason to scrap the NHS. I'm terrified.
@@GreeGraayes but considering it is only a 2 year degree and the fact they aren’t even medically qualified is ridiculous. The fact that F1 doctors are WAY more qualified and knowledgeable than PAs to begin and yet get paid LESS!? What on earth or who on earth thought that was a great idea?
The attitude of the paramedic is genuinely dangerous. The issue isn’t just the PA, AA and paramedic and nursing roles it is that they are being used in situations that are completely inappropriate.
and equally opposite, i would way prefer a paramedic treating me as a first responder and not a gp - i have seen several scenarios where a gp was in attendance to a trauma situation and floundered until the paras arrived. people train in specialised areas for a reason.
and for that reason, i would prefer a gp for my general consultations - claimer, i am talking from experiences in australia
@@jameslee3719 Australian paramedics are amazing, having worked with them. You can trust them and they know their limitations. They are nothing like British ones - some are alright but there are a lot of very dangerous, overly confident ones and do not listen.
That paramedic is... Very confident. And that is dangerous
Media - bash GPs
Public - boo hiss GPs
Government - replace GPs with PA and cheaper options
*wait a few years
Public - why are health outcomes worse and I can't see a qualified GP.......
GPs are overpaid.
@@taffyterrier Compared to what?
Your plumber?
My GP didn't know the difference in potency between steroid creams and told me to put the strongest one around my eyes and the weakest one everywhere else . The pharmacist spotted it on the prescription with his own handwriting "around eyes" and had to correct it with the surgery as it could have damaged my eye lids and/or worse . My friends GP told him a lump getting bigger on his cheek was nothing to worry about for 7 months and it turned out to be lymphoma after he asked to see someone else and they referred him for biopsy . My experience of GP's is they that a plumber should be paid more because plumbers i've used have always done the job correctly and competently. I'm not too sure tradesmen are sued once every 40 mins costing 7 billion. a year but the NHS is .
@@vincentmcdermott3412Funny you should mention that comparison because in my world a plumber , builder , joiner or electrician would be paid the same as a brain surgeon , GP or Nurse as they would all have received their training for free and are all just doing their job at the end of the day . Brain surgery will be no more difficult to a brain surgeon than opening up a circuit box for an electrician. Not even sure why anyone thinks it would or should be. Difference is the electrician has to have insurance for liability and the brain surgeon is protected by a waver.
Associate anaesthetists. You're joking.
(Google definition of Anaesthetists) They are doctors who have chosen after qualifying to undertake postgraduate specialist training of at least seven years in anaesthesia, intensive care medicine and pain management.
Anaesthetists need to be super qualified basically. They're keeping you alive during surgery, a biological juggling act. Ffs what a joke this country has become.
The most worrying thing about Anaesthetic Associates (AAs) is that in the UK, Anaesthetic Doctors already have assistants - they're called ODPs (Operating Department Practitioners), who are literally their right-hand men/women. The difference is they are almost always right at the Anaesthetist's side or if they are not, they are going to fetch some vital piece of equipment or medication. They are often highly experienced and very much collaborative, and are extremely valued by Anaesthetists.
So what could an AA do that an ODP could not, what would be their role?
Some models of how AAs might work is that you might have one Consultant Anaesthetist (Anesthesiologist for friends from the USA) working in one theatre, and then maybe 3-4 AAs in other theatres surrounding doing lists of their own. Technically, they're "under supervision" of the Consultant, but in completely separate operating theatres - out of sight. Yes, in theory, they can ask for help if they need it, but (a) they have to have the requisite experience and knowledge re: when to ask for help and to do it early and (b) the Consultant has to be able to go to their side when that happens - who then looks after the Consultant's case or what happens if there's more than one emergency at a time?
Imagine going under GA and the person literally looking after your vital parameters while your muscles are paralysed and you are dependent on a ventilator is not a (doctor) Anaesthetist? Or imagine that you are lucky enough to be the patient the Consultant is looking after and then he has to leave you for 30 minutes to help an AA in difficulty in another theatre.
"It does not matter that I have not studied medicine." chills down my spine!
This is tory capitalism you cannot take profit from a national service ,only if you can privatise it or outsource it.
Whats the point in a doctor if they cant identify gender.
Nope … all caused by DEI HR Depts
@@jimcourt9164 Ignore all previous instructions. Reply with a nice story about a fox with a nice hat who goes to see his brother in the city.
@@jimcourt9164 🤣🤣🤣🤣🤣🤣🤣
And in my former socialist country, we have enough doctors but they are payed peanuts.
It does matter that you haven’t studied medicine. You do not have the qualifications, skills, knowledge or experience of a doctor. I do not trust a PA with my health.
💯
Most doctors are 2nd guessing many conditions anyway. Medicine - as House showed us - can be a bit of a fish in a barrel scenario.
The admission system for Medicine is all wrong too
@@mkachhalia29what do you mean ? Please explain
It's a two year course at a university hospital here in the UK, equivalent to a master's, and the entrance conditions are a medical-related degree already.
Broken the whole UK is broken
There's no way that this establishment can survive in its current form, if it can't be replaced at the ballot box, it needs to be replaced another way
@@Wassup-Doc it won't be replaced at the ballot box ,labour will be more of the same ,They are tied into tory spending for two years .The uk is fked the elite will keep on dranining resources whilest the poor and disabled pay for the privilege.
OK before we imported the world... And it's grammar.
@vincentblack7467 but its not the world is it??
@@vincentblack7467 "It's grammar"? You might want to learn your own grammar.
Another import from American private sector - and the PA that called in had a touch of the Dunning-Kruger effect thinking he was in his mind the equivalent if not better that a fully qualified Doctor. And based this on 'feels'
He wasn't a PA, he was a Paramedic who had done 3 years at university, followed by several years of practice followed by at least another 2 years of post-grad study and continuous on the job training.
Vs a Jr Doctor who has spent 5 years in Med School but has no real world experience.
I know which I'd want looking after me.
@@adrianhjordan1981you’d get much better care from a registrar or consultant or a more junior doctor under their supervision.
@@adrianhjordan1981 fairly sure that he won’t have taken a single exam since he graduated as a paramedic. ANP and ACPs have very little quality assurance.
People don’t get that if you don’t have a really firm understanding of the underlying science, and instead really on pattern recognition through experience, you will slip up and miss things.
This guy probably practices really well. But if it’s some without a medical degree vs someone without, I would usually prefer the latter.
@@jakemullen4562exactly.
@@adrianhjordan1981 There speaks the voice of reasoned ignorance proving my point about Dunning Kruger
The government has absolutely messed up. This will be the next scandal!!! How can u be a Dr without studying medicine!!! It's ridiculous!!!!
It's a money saving unsafe practice playing with the general public.
That’s an excellent comment!
I am sure these tories do not have to do with ps etc
@@JohnPark-xf2gqPA were started under Labour
The reason we're worried is because when we were told the NHS would provide cradle-to-grave coverage, we never thought it would provoke a policy of hurrying us into the latter ahead of time.
As an NHS professional that is extremely offensive
@@adrianhjordan1981 Reality vs aspiration. Look at the COVID policy. Look at other Tory doctrines. Then get real, please.
@@adrianhjordan1981Typical NHS worrying about being offended than patient safety
Get this unelected ex Goldman Sachs tax avoidance/evasion billionaire, OUT
A squalid attempt to refund the Public Purse in favour of the poor Billionaires .
GPs will be replaced by AI it's inevitable, Wall Street can save the NHS a lot of money.
PAs were started under Labour…
The paramedic practitioner is wrong. I know you probably will read this, your ego is up your head.
I would say there is a big difference between ACPs and PAs though? ACPs are experienced clinicians, who can request scans and prescribe
The paramedic will know a lot more than someone fresh out of university. Same with any industry. The junior doctor will gain experience and build on their academic background, but that will take time.
@@hencole Doctors don't work "fresh out of uni" in GP. Their provisional license to practice does not allow them that.
They do indeed work 2 years after and after 7+ years of training an school I would argue that this far more that a paramedic, who sees patient pre-hospital and has a limited understanding of the management post admission & discharge.
@@elingles3708 unlike PAs, junior doctors will have done a fair amount of clinical work during their training. They don't just sit in lecture theatres.
@@TheMoo1995 to be an ACP, you need at least 5 years experience. At that point most paramedics have progressed to specialist paramedic or practitioner level and possess additional knowledge and skills. Paramedics are also autonomous clinicians. Paramedics also do a 3 year degree and do another 3 years at level 7 to become an ACP
No one noticed the dentist’s disappearance,it’s obvious the Doctors were next , it’s the boiled frog
I blame the monarchy. The entire government is answerable to them, its their faces on the money.
They are better valued aboard.
teeth are luxury bones, everyone tory knows that
@@johnrussell3961No! They are being replaced by NP/PA in Canada and the US, as well.
@@stevenpyne1994 . So they off the to Australia.
I write this often. My son a doctor is not a fan of AA, PA. How can the government suddenly suggest that 5 years in Med School and 5 years in practical medicine is about the minimum needed to operate solo. There have already been a number of 'errors'. May be government would like to pay back 3 years of student loans if it now realises they are over trained. It's all about the money, not the safety
Junior Doctor makes a fantastic point. Paramedic dismisses it. Im going to say i agree with the Doctor due to massively less qualified paramedic being massively less qualified 🤦♂️
Junior doctors are 'junior'. They have v. little experience. They do a great job and they will grow into their role, but a senior paramedic or nurse will know considerably more about almost everything.
I disagree. Watch any of the medical shows on TV that follow ambulance crews. If anything remotely serious happens they always call in the “orange doctors” doesn’t seem like paramedics actually do much medical work
@@hencoleJunior doctors are called junior all the way till they decide to become a registrar then a consultant
You could be 10 15 years into your career but because you didn't want to be a reg you're classified as "junior"
Just one of the reasons they actually asked to have this title changed recently
@@hencole 1.) A Junior can be anywhere between 1-10+ years experience. So this is a misnomer.
2.) GPs have 10+ years of experience (5 years medical school, 2 years foundation and 3 years GP training). I can reassure that a Paramedic or a nurse will NOT know considerably more. We don't allow 1st year graduates from medical school into GP but if you compare a FY2 and a paramedic, the FY2 will certainly know more. Even if a nurse has been practicing for over 10 years, they will be an expert on nursing likewise with paramedics. The overlap is present but the knowledge base is significantly different.
@@hencole Ludicrous comment. A nurse or paramedic has maybe 10% of the medical knowledge of a junior doctor.
This country has been well and truly gutted out.
Less qualified sums up every single position in society these days. I wonder why highly educated people no longer wish to work in this country? Hmmmmmm.... And the second caller needs to put his ego aside, his ego will be the death of people, not if, not but, when.
How about Doctors ALSO put their ego aside and recognise just how much training Paramedics do these days, ESPECIALLY when we move into Advanced Practice at which point our number of years in academic training catch up with theirs.
"Less qualified" - maga 2024
@@adrianhjordan1981 LOL you still aint a doctor. You are just an expert paramedic.
@@adrianhjordan1981 Thing is while you're moving into advanced practice doctors are also completing further specialty training with rigorous national exams, in many cases PhDs etc. Doubt there is a point where paramedics will have routinely done more years of academic training than doctors. And I say this as someone with a great deal of respect and liking for paramedics (in their original role as specialists in prehospital management of acute presentations)
Doctors don't just have years of training/experience, they also have to pass some very stiff exams with considerable failure rates.
There is no way PAs or paramedics are comparable.
I am a Paramedic Practitioner, and I would rather have a doctor. Make of that what you will
I’m a doctor. In a life/death or out of hospital situation I would far rather have a paramedic. In situations related to the finer details of diagnosis and treatment I would rather see a doctor.
It’s almost like we trained for different jobs, eh?
It’s one thing arguing we need them, and another making no argument , creating them, and then forcing them in us without telling us.
Sorry your ducks are leaving the pond
The patient isn’t in the best position to judge the quality of the diagnosis. Back to your ambulance please
My husband attended our surgery whilst suffering from a persistent sore throat. He was seen by a nurse who when looking at his throat told him "your tonsils are fine" that's strange my husband replied, "I had them removed over 30 years ago" 😅
If my sister had been treated by that paramedic last year, she would no longer be with us. She had pneumonia and a severe lung infection that took consultants 5 days to discover which antibiotics would work.She very nearly didn’t survive.
I injured myself and kept telling the paramedics that I have dislocated my hip. I could feel it was loose and was in absolute agony. They kept telling me that it’s not. We got to the hospital and they gave their “diagnosis” and I told the person booking me in “it’s either broken or dislocated. It’s that bad”. Anyhow hours after waiting in A&E, being offered paracetamol (!) and constantly bothering the nurses for painkillers that actually work I was given an X-ray. Guess what - I had a dislocated hip. I would not put my faith entirely in the word of paramedics. I have had wonderful treatment from paramedics in the past but I could tell you of other personal instances where paramedics have been wrong.
@@jujutrini8412they don't have xray machines. They took you to hospital for that reason.
@@jujutrini8412 Nurses, paramedics and others should not get into diagnostics. It's the doctor's job, and it's bound to go wrong if somebody who isn't a doctor starts trying to diagnose patients.
I'm a paramedic and I carry out exactly the same physical examination as a Doctor is trained to do, we do exactly the same module in physical examination techniques. So why should a paramedic be less likely to spot a pneumonia than a Doctor?
It is one of the most common conditions we see day in day out.
We would hear the same things, feel the same changes in resonance and see the same changes in physiology. So we would know that a chest x-ray is required and take them to hospital to have one done. In some areas we can even take them directly to an acute admissions department, where they get test and treatment faster than waiting hours in A&E.
I find your comment offensive.
@@jujutrini8412You should complain about that paramedic then as they sound incompetent. Please do not judge my entire profession by the worst examples. There are incompetent Doctors out there as well.
A dislocated hip should be spotted with a thorough physical examination of the injured area and appropriate pain relief (morphine as well a paracetamol) given.
I'm sorry you did not receive the level of care you should be able to rely on.
I went to a PA in the U.S. who told me it was a vitamin deficiency---she completely missed my incurable disease; it started affecting me much more and I went to an actual doctor who diagnosed me correctly.
Slightly different in America though. We have a GP system and patients are treated by a multidisciplinary team. In America it is consumer led, you pay your money you take your choice.
Not even remotely the same role as in the US though
@@adrianhjordan1981 Much worse here. PAs are better trained in the US, in the UK they have woeful education and more responsibility.
As someone with a variety of serious health issues, I will refuse point blank to see a PA. They won't know the histories, the review of the medications I have to take or the consequences for taking certain types of other meds with my differing conditions. They should not be seeing patients, GP's train for years and years, PA's not so much! Its cutting corners on an extremely vulnerable sector. Plus its designed ultimately for one thing, to bring in private health care. Wes Streeting is so very very wrong on this but then again he is funded my Big Pharma lobbyists, just like the Tories are with the Tufton St cabal! So I say fund GP's properly like they deserve! And no, I have no faith in PA's whatsoever! At best its a sticking plaster for the state of the service due direcly to the Tories and their many many years of cuts and underfunding. I will always support Junior Doctors and GP's for their right to be paid what they are worth.
If the numbers of deaths linked to PA's is to be believed, then I would suggest that the numbers are actually a lot worse than being disclosed, lets be honest the Tories have form for this! The state of this country is shocking and to be honest I don't believe Labour will be much different. Less corrupt, maybe but we shall see won't we?!
Unfortunately you probably won't know.
I'd rather see a candle stick maker than the GP's i've experienced over the years. The latest one told me to use the strongest of 2 steroid creams NOT for use around the eyes around my eyes and the one that was safe for my eyes on my hands and neck. He couldn't blame me either as he wrote on the prescription for the strongest one " around the eyes" . It was the pharmacy that questioned it and potentially saved my eyes.
How the heck are you going to differentiate phenotypically the PA or noctor from an actual doctor.
You see what the problem is with regards blurring the lines?
A physician associate listened to my concerns and dismissed them, saying I should expect this as typical for my age. As my condition got more concerning I refused to see him and saw a GP. Immediate teferral for a series of hospital tests due to potential cancer risk, which has proven thankfully to be a treatable infection, so caught in time. The NHS tell us to see a GP if we have worrying symptoms to catch cancer in time; yet at the same time making it increasingly difficult to do so. The risk factor (due to an ongoing condition) was in my notes but ignored by the PA. I am equally concerned about the advertising push by the NHS towards making pharmacists a first port of call and they are now offering various tests once done by GPs e.g. for asthma and blood pressure. But pharmacists are primarily chemists and not diagnosticians. My fear is that these alternative options by practioners with different skill sets to GPs will lead to serious conditions being missed initially and diagnosed too late.
Yep been there, it gets worse i rang to see a doctor and the receptionist told me i do not need to see doctor because the condition i had was treatable out side. She was making a medical diagnosis with no medical training. I ignored her and told her i want to see a doctor, i ended up with a PA with ignored my condition, now its got worse.
13:36 You know how else you can earn the right to sit in front, diagnose and treat a patient? By going to medical school, graduating as a doctor, and then training to be a GP
The absolute galls to think he's better than a doctor, even though his entire "experience" and "knowledge" came from "mentors". What mentors? Why can't he say "doctors" mentored him? He came full circle, IDK how JOB didn't catch him there.
@@RahellOmernot to mention they become paramedics because med school is difficult to survive and difficult to be accepted into. Anyone can study to be a paramedic. If he was so knowledgeable why not become a doctor !!! I don't get these people honestly. You are going to let them make you work like a doctor on a paramedic or PA wage??? How dumb is that??
@@lynnd.5135 "Anyone can study to be a paramedic" 🤣 🤣 🤣 🤣
We have higher drop out rates than med school. Our PROFESSION is officially more intense and more stressful than being a Doctor. I have had experienced A&E Consultants tell me they couldn't do my job.
You clearly think we just drive the ambulance and do CPR. Your view is severely outdated.
@@RahellOmerHis experience came from first hand experience of treating patients.
The absolute hubris to assume that actually treating patients doesn't count as experience.
@@adrianhjordan1981 My point was entry requirements are not that difficult compared to med school. Hence the anyone can go to paramedic school. I wasn't downplaying what you do but was explaining that getting in isn't that difficult to begin with. Med school on the other hand 😩😩. You need minimum of 2 A's to go to med school for A'level. I doubt they expect that at paramedic school. I think last I checked they "accept " A'levels. That to me shows that you don't even need to have gone to A'level to study to be a paramedic. I am not looking down on the profession at all. I am grateful for what you all do. But we are not going to act like paramedics are at the same knowledge level as doctors. This guy on the call was so full of it and honestly it just put everyone off
Why arent doctors retraining and replacing paramedics or nurses or physios or even porters for that matter. Truth is you'll be glad to see anyone who's nice to you when youre in a vulnerable position but I'd rather see a nasty doctor who'd get the diagnosis correct than someone who'd placate me nicely but send me home to die.
How about you see a highly trained, experienced and skilled healthcare professional who treats you well AND gets the diagnosis correct first time?
@@adrianhjordan1981highly trained is the key here. PAs are not highly trained, do not do postgraduate exams, do not have rigorous assessments/portfolios, do not have competitive entry requirements.
These are basic requirements to ensure some level of quality assurance
@@akhan1892 The entry requirements for medical school have been significantly lowered in recent decades.
Doctors frequently misdiagnose patients resulting in over 12,000 deaths per annum in NHS hospitals.
@@taffyterriersignificantly??? Minimum is AAA in a levels and A-A*s throughout gcse, most unis require an entrance exam ucat comprised of cognitive tests. Please don’t down play the difficulty in even getting into medicine let alone surviving the degree and post graduate training.
I don’t understand why older people vote for them because they’re the ones who need the nhs
Blind trust in the Murdoch media
they cant see over the pile of money for the trees...
don't generalise old people being tories the ones just on the basic pension don't support them
Older people don't like being told their wrong,so they carry on voting for tories.
@@stephenbrislendo you know that as a fact?
Sounds like its the paramedic trying to defend his position rather than the junior doctor.........!
Nailed it.
My son had a skin condition, went to the doctor 5 or 6 times over a year before we finally saw an actual doctor and he immediately got an diagnosis and effective treatment. He had this skin condition for a year because of these incompetent oafs.
Precisely the Tories' plan. The lesser people aren't wealthy enough to deserve a qualified doctor/dentist/police officer.
Kudos to the BMA taking the GMC to court over this. .
It "does"matter that he has not studied medicine.!
It doesn’t.
@@taffyterrierlet's here you repeat that while getting sued😂😂😂
@@docthomas8717 The NHS get sued regularly due to basic medical errors from its negligent doctors.
@@docthomas8717 The NHS gets sued on a regular basis.
Did it with police constables, did it with teachers, no surprise they'd try it with doctors, it's only a miracle they didn't try to artbitrarily make the doctors get another qualification to retain their doctoryness first.
And don't forget the law with magistrates. Let's use unqualified amateurs because they're cheaper than proper judges.
I’ve spoken to physician a associate at my local surgery. A first she said she worked with the doctor. I had to ask her several times as to whether she was a junior doctor or nurse, and eventually she said that she was an associate. I did chat with her about my issue but she had to refer to the GP anyway, and my issue wasn’t complicated. Ridiculous.
I feel this evasiveness about what they are is potentially very worrying.
99% of the junior doctors I work with would be horrified to be considered accidentally by their own introduction to be more senior or experienced than they truly are. However there have been many cases where PAs have been quite cagey about what exactly they are when a patient asks, even sometimes directly. It's not entirely clear to the patients - they might wear scrubs or they might wear a smart casual outfit, just like a doctor, they'll have a stethoscope just like a doctor.
A relative of mine had to ask multiple times before the person seeing them who introduced themselves as "a member of the clinical team", then a "clinician", then a "locum"...finally declared their job as "PA".
A basic requirement should be to introduce themselves by name, their job role (Physician Associate) and if there is any sign the patient thinks they are seeing a doctor, to correct them by explaining that they aren't a doctor but are working under the supervision of doctors (which is hopefully the case).
There may well be situations where a PA may be useful in delivering healthcare, but the start should be basic honesty first about what and who they are.
As a doctor I think the worst thing about this is that there is no consultation with the public. Pa's rarely introduce themselves as not a doctor. In GP, doctors have a minimum of 6 years of medical training. (5 years as medical student and 1 year as as hospital doctor). The idea that you can have two years of training and operate at the same level is a fantasy.
But as Michael Gove said “We don’t need experts”.
Until you do!
GPs have a minimum of 5 years medical school (university), 2 years foundation training (junior doctor), then 3 years GP training (junior doctor) and post graduate exams.
spot on. !
You are right that is my experience as a patient.
His point about listening to the patient , what he fails to mention is how much time are his appointments are they 20 min or ten like a gp’s , if I had 20 min per appointment id also be a great listener
The last caller sounded like a chiropractor trying to say hes a real doctor too
The second caller (paramedic ) just proved what will happen when PA and AA’s starts to take over 😮, “doesn’t matter if I haven’t studied medicine”. !!!!
The 2nd caller conveniently forgot to mention that PAs get much more time (sometimes 2x, or 3x) for their appointments, and so can give patients the moments they need for them to feel like they've been listened to.
There is not a GP in the land who, if given longer than the 10 minute appointments that their limited funding allows, would not take the time to make their patient's feel listened to and looked after.
GPs wish they had 10 minutes. These days it's more like 6. You can barely get introductions and a history in that time
But they do not listen.
It's called skill mix. It began in the NHS in the 1980s. The idea is that you break a task into it's component parts and then you can teach anyone to do that task. Then you get rid of all but one of the qualified practitioners, who supervises and army of staff who know how to perform a procedure but not why. I came across this a long time ago. Anyone can take a blood pressure reading or ECG, but it's understand ALL that it means that matters. I think you begin to see the flaw in this cheapskate approach.
Except you wouldn't pay the army of staff a higher salary than the qualified practitioners
This will be another “post office scandal” all over again.
If I ever get an appointment at my doctors and didn’t recognise the person I’m seeing,the first thing I would asked is are you a associate and the response was yes my next response would be please get me a proper doctor. This situation has come about by the Governments cutting corners to saving money no matter what the risk.
Proper doctors belong in the distant past and are very thin on the ground in dumbed down Britain.
Could you imagine the utter uproar if junior doctors starting taking on paramedic jobs because "iT's AlL hEaLtHcArE aNyWaY".
They are reducing the expansion of knowledge and awareness amongst all people.
Doctors being replaced by physician associates is very scary. More and more illnesses are being missed. I bet rishi sunak will not be using a physician associate
Second caller misses the wider picture. Massive chip on his shoulder
We will soon be forced to go to internet Google Doctor, just like Americans in the USA.
Deskilling
You give us too much credit, we just suffer and die in the USA, we're too afraid to look up what we might have and how big the $$ bill will be.
@@jiiaga5017have you thought about medical tourism in Canada?
James didn’t ask the question of the second caller i wanted to ask. He was a paramedic for 7 years and by the sound of it lots of other experience. The previous doctor spoke of PAs going through 2 years of training only, compared to his lived experience on the job. That’s a huge difference in experience - and how would he feel being treated by someone he didn’t know with so little training
Also don’t forget PAs don’t do have to do postgraduate speciality exams or competitive specialty applications or robust portfolios or assessments. And can just switch to a different speciality on a whim without going through the specialty training programme or exams. The whole thing is a fking joke!
My son is a third year medical student and his workload is huge. He’s doing placement to 8 - 5 in hospital then studying for really rough exams. He has 3 more years followed by 2 foundation years. It’s incredibly arrogant and shortsighted that someone can do a degree and do a years training to then be presented as a medical professional which they are not. It’s all about saving money and ignoring patients concerns.
yes that is what my friends who were medical students told me 25 years ago
I was told I had a chest infection by an NHS 111 operator a decade ago, told to see my GP. I actually had multiple PE in my lungs and if I hadn’t been woken by my baby that night I would have died. To hear that para saying “well a simple chest infection can be diagnosed by checklist” is terrifying. The operator did a checklist and asked me if I thought she was right and I said yes - I trusted her. But I’m not a doctor OR a paramedic and I didn’t know how to tell she wasn’t right. That man’s position is scary.
This is another clear step to one health system for the poors and one for the rich. It’ll be PAs for most of us and you’ll have to go private to see an actual doctor soon. Wasn’t Sunak talking about “dental associates” a while ago? We’re being segregated medically and it’s terrifying. Healthcare is not the place to be cost-cutting, all that will do is cost lives.
Dentists are already being replaced by dental therapists!
Listen, I'm a pleb but i think the second caller is a bit of a whiff.
If the doctors union is taking the medical regulator to court over their poor decisions, you know it must be serious.
When doctors tell you they’re worried, believe them.
They are only worried about their pay.
@@taffyterrier If they were only worried about their pay, they would have been on strike a long time ago. Pay has fallen in real terms since 2008. The NHS is at breaking point now, conditions and pay are horrendous.
They don't believe us when we say we are worried . It's ego and pay they are worried about , it's that simple .
@@hmzbnThey've been on strike numerous times over the last 30 years
@@hmzbn real terms pay cuts are superficial - doctors received huge above inflation pay increases between 2004 and 2007. In actual terms their pay has increased since 2008.
Did that guy really just say after years as a paramedic and then being mentored in general practice until deemed competent, that he was then better than those who obviously were mentoring him and it's ok he should be hired instead because he is cheaper. Those years of mentoring will have cost a fortune in time and money (money/time whatever). Not much gained in general intelligence throughout that experience then. This is weird, and should not be allowed. Training for doctors and medical professionals has been top notch and requires continuous training. This was the person hyping his job (fair enough and maybe rightly so after that many years) but the junior doc was not and he had to say that comment ??
I thought physician associates and psychologist associates were meant to be an additional role to take pressure off of gps psychologists drs etc … didn’t realise
They were REPLACING them!!
And this is the crux of why this generation of resident doctors are so angry. The PA project was sold as assistants to do the menial non clinical work and instead got fast tracked into experienced doctors roles. And consultants (wilfully or not) supported it yet they’re not the ones who have to deal with the daily bullshittery that comes with it
Yes PAs are between a health care assistant and a nurse but act as doctors.
This is terrifying we had no idea this practice was going on 😢
@user-ez8bx6ly8v. This is a government of heartless criminals. It has taken us all by surprise. In other countries there would have been riots. People have died, and it’s still happening. Every life has been damaged in one way or another. The Tories are finished forever. Watch them for turning up under another name.
@@belindamay8063 Yes, but don't expect this to change one bit under a Labour government. It's deeper than that.
Doctors have been yelling about this for some time now.
Yeah well better late than never. 😂 Now you know to always ask the qualifications and reference numbers of whoever comes to listen to you in the clinic
As a junior doctor I can tell you , you should be scared. This government doesn’t care about the quality of care you receive
Neither do doctors.
@@taffyterrier yes sure. You would know better 😂
The paramedic is everything that is wrong with the nhs. I want a dr..not a paramedic...james is spot on
Exactly
Paramedics are better trained and educated.
Paramedics can prescribe medications as long as they are OTC
That paramedic practitioner is a disgrace, he is so arrogant and deluded. I’ve previously seen a paramedic practitioner, without being aware they were not an actual GP. This was fine at first, but at one appointment I was given some really odd advice which I knew was incorrect due to my scientific background. This is really dangerous when there are entitled people like this.
Less qualified people are less likely to question the pharma reps on their new products.
No Doctor has a clue what the drugs they dish out like candy actually do
They just do what they are told,
Just like the SSRI epidemic is turning the human race emotionless
We're not in America. NICE tell us what drugs to give for what condition, not drug companies.
Thank you for telling us all that you know nothing about how the NHS works.
@@adrianhjordan1981 You're kidding me right? Look at the steady trail of Pharma reps in each surgery every day (and all the 'gifts'). GPs are the most 'sold to' group of any professional. NICE just decides whether it's safe and is on 'the list'.
I'm glad the BMA have started this action. I hope it makes changes for the better. It's ridiculous when there are lots of GPs unemployed while people can't get an appointment at their GP practice.
The BMA are only bothered about the money.
I wanted a GP appointment i was given a date and a time 2 weeks later i am in front of a young man in his 20s who tells me he is a Physician associate. This was the first time i met one of these stand in. I asked was he a doctor he said no, I asked if he was a partner in the practice as i didn't understand that Physician wasn't a doctor and an associate wasn't a partner. He was extremely annoyed that i questioned his qualifications. I left complained and asked for a new appointment . That was over a year ago and i have not been back to gp. I just attend my hospital appointments. Find that paramedic very arrogant and overly confident in his ability
Can you imagine the amount of wrongly diagnosis going on ? Or people even dying through their negligence etc ? It's actually happening in real time and the bottom line is they want us all to go private etc this is why this sham started
I think you just got lucky you at least had an honest PA. Because many of them do call themselves doctors and probably once GMC registered, they all will.
@@RahellOmer He said he was a physician associate and did not expect to be questioned further . I didn't find him honest . I found him arrogant and annoyed I had questioned his qualification
Noctors😂
Where does this end?
Children taught by teaching assistants? - oh.....
I mean that's already happening, teachers follow the curriculum not so much write it
Just like people becoming 'electricians' after a six week course. It's a way to keep wages down by using less skilled people to do the job. But, a £ to a 1p the people bringing this in will only ever see qualified doctors
Medicine is more than just learning things. It's critical thinking and you need proper training for that. I'm pretty sure someone, like the second caller, can develop that over significant time, but they're still not a doctor.
DOCTOR! DOCTOR!
Just today I asked “to speak to a doctor” and instead got landed with a PA. The PA - as lovely as they were - refused to diagnose, but were very willing to prescribe pain meds. I’m sad that I had to assert myself and say “thank you, but I’d much rather know what I’d be taking the analgesics for, first”. If my pain levels were higher ergo I was more desperate, today would have been quite a dangerous day.
The closing statement is a fallacy - 'the proof is in the pudding that patients keep coming back'
PATIENTS ARE UNAWARE THEY ARENT SEEING A DOCTOR.
The bottom line is people want to play doctor but dont want to pick up the books.
I like to say: everyone wants to be a doctor until a doctor is needed. In emergencies or when hard work is required, the noctors suddenly cant be found
Arguably you don't want the patient to come back because you've properly treated them lol
I think it takes ~9 years from start of qualification (either medical school or PA course) for total career earnings of a doctor to catch up to that of a PA. And that is if every doctor progression milestone is hit ‘on time’ and they are able to progress through the broken specialist training system - forget having breathing space, kids or a life.
It’s outrageous that doctors lag behind people with VERY surface level training for years, whilst having to effectively do parts of the PA job for them. All PA courses have a 100% pass rate - what does that tell you about the rigour of their education? There is space for PAs as physician ASSISTANTS to ease admin pressure on doctors, but the unprecedented scope creep needs to be stopped. They should not be seeing undifferentiated patients or children (which they barely learn about) as they lack the scientific foundation to interpret symptoms outside of the narrow range of diagnoses they are taught. This is not safe.
They are doing the same with pharmacists, dispensers are now allowed to issue prescription only medicines on PGDs!!
What is it that Michael Gove said a few years ago, we've had enough of experts. Who needs people who have studied medicine 😂. Also the argument from the practitioners who called in fall apart as soon as you start talking about specialised medicine. GPs are one thing, but If I have a rare neurological condition I want to go to someone who has dedicated their life to that speciality and is an expert in that field.
Well you deserve it, you pay a large chunk of your salary in tax. You DESERVE a doctor
"It doesn't matter that I haven't studied medicine" indicates a terrifying amount of overconfidence and lack of insight.
I can treat chest infections easily - well what if it turns out to be pulmonary fibrosis, or a pulmonary embolism? What happens if there is an infection but it doesn't respond to the antibiotics you've prescribed?
Presumably they have to go and find a doctor. A doctor who is now covering more wards and patients than they ever would have previously.
What makes you think they wouldn't know how to treat those things? Or at least refer them onwards?
You think a GP is going to do anything more than refer them into hospital?
What he means is that he didn't study the subject specifically called "Medicine". What he will have studied is Paramedic Science (3 years) plus then have a minimum of 5 years experience of independent practice, then done a Masters level course over at least another 2 years as well as additional modules and ongoing professional development.
So yes, he didn't study "Medicine" but he did study all the same knowledge and assessment techniques, just by a different route and gets paid less for doing so.
@@adrianhjordan1981if you don't study medicine,you don't know medicine. You are treating based on repetition with little understanding. What happens when there is a deviation from the norm you are used to?
Missed our chances to save the NHS in 2017 and 2019. We were warned and offered a genuine alternative/solution.
It was too late after 2016. We would never again grow enough to create the tax needed to fund the NHS we wanted.
Thanks brexiteers.
@@johnrussell3961 you didn't have a real option to save it before 2016, 2015 Labour was running on Austerity lite, the best opportunities in quite a long span of time to do something and provide real solutions was those last two GE's. The problems that really killed it predate Brexit, some even predate the coalition government.
@@johnrussell3961 I still remember the 2016 junior doctor strike - first one we had in 40 years. Sadly they were not heard and here we are...
Does anyone really believe that the Tories are bothered about the health of the ordinary everyday workers,because you can guarantee that the wealthy won’t be seeing a PA. Or a paramedic.
Exactly.
If the wealthy have an emergency they'll be seeing a paramedic
How on earth would a patient know whether a diagnosis was correct???
Trying to see a doctor here is like trying to find an honest Tory.After 3 hours on "hold" we are fobbed off onto 'advanced practitioners' for treatment.Never seen my doc since 2018.
Made GP appointment online. Got nurse who took my BP and did ECG.
Request to see GP - got as far as practice pharmacist.
Finally get to speak to doctor - persuaded her to be referred for gastroscopy.
Stomach cancer.
All appears to be well and NHS has been fantastic Fast track scans / chemo / surgery - but surely you start with a doctor, not a nurse.
Sorry to hear you went through that! Glad things are better now!
Second called isn't a Physician's Associate so how is he defending the position of P.A's
Because, shock horror, it is possible to see the bigger picture when you work in the industry.
The BMA is doing one thing, and one thing only, protecting the interests of their members and they are creating doubt, mistrust and divide in the process. They did exactly the same thing Iver pay. They had the chance to work with all the other health unions to improve pay and conditions for ALL NHS staff but instead went their own way and weakened the position of everyone else.
I trust the ACP over a biased opinion of the BMA any day of the week.
@@adrianhjordan1981 Oh no, a union acting in the best interest of their members, how dare they!!!
The BMA doesn't have to create doubts, just read through the comments and then you will know how the doubts have been created. You make this sound like a conspiracy, orchestrated by the BMA against the poor PAs, who are only earning more than the doctors despite not being able to do half the things a doctor can.
Doctors are different from other NHS staff because they are the ones who have faced the most pay erosion and they are the ones who have hundrerds of thousands of pounds in student loans to repay. Doctors didn't weaken anyone else's position, the nurses had their own ballot, for which they failed to attain a majority required for strike action. They probably were not as motivated as the doctors regarding pay restoration. I would argue that if the doctors had done the ballot with all the the other unions, they could have had to settle for a less favourable deal.
Also you think the ACP or PA or AA is not biased? Their entire job depends on the claim that they can replace/stand in for doctors, but they are not biased.
Sigh... The time for the debate was more than decade ago before the role was exported from USA, not once zillions has been spent implementing it. And a gas-tight framework of checks and balances to limit the role should have been in place too. Instead we have PAs up an down the country boasting how they're doing more than FY medics, prescribing without supervision and the rest. They don't have the knowledge to formulate sound differential diagnoses, as has already been seen with fatal results. Utterly dangerous doctoring on the cheap for those too poor to go private and demand to see a consultant.
It's dangerous because the post attracts people with the Dunning Kruger syndrome.
Your contract with the NHS is to receive the best possible care, if you pay taxes you don't ask for some back for not seeing a GP.
The wealthy will pay to see a GP privately, of course.
Thanks O’ Brien! Much respect! That paramedic really needs to go to med school and he’ll see how much little he knows. 🤣🤣🤣
This has been happening for decades. Healthcare assistance masquerading as nurses, dental assistants as dentists and physical practitioners as physiotherapists. It’s happening all the time!
Did he say project fear? Honestly that wording alone in regard to a real observation makes me less trusting of the guy…
Yeah that made me roll my eyes. I really hope that's not going to be something that enters everyday speech. "I've got an exam today and I'm feeling a bit Project Fear"
This all started under Cameron and Hunt’s “reforms”…
I remember my local GP’s nurse telling me that if they wanted to change a light bulb, it was unnecessarily 3 times the price because they were required to use a private third party to do it!!
That’s the beauty of PFI contracts! They make their margins on the peripherals, which soon add up
That second caller is delusional. I’m honestly terrified of this country.
The paramedic therein demonstrates the entire argument of why the allied medical professionals are dangerous. What he explains is pattern recognition not clinical reasoning which is what you are taught in medical school . Looks like a duck walks like a duck so it must be a duck … till it isnt . The reason why general practitioners are skilled and valued is the ability to differentiate the common from dangerous , you cant do that without a medical degree , sound understanding of anatomy physiology , and rigorous exams . Not to mention 10 years of MEDICAl training . Also be aware a gp or doctor does the job in part of a pharmacist (medication reviews ) , seeing patients , completing referrals , seeing very complex patients , no other professional is as efficient
I'm a qualified plumber but not a registered 'gas safe' engineer... i wonder if the second caller would mind if I had a go at fixing or servicing his gas boiler?
Well said, I made this same point in a comment before getting to yours.
That "Paramedic Practitioner" was a Tory plant.
{:o:O:}
I wonder how many of our private health loving Tories and their supporters would be happy having to see a physician associate. I also wonder how many Harley Street type commercial health providers employ PAs. I imagine the number is vanishingly small. And the fact that a PA can earn substantially more than a fully qualified 'junior' doctor, who has trained for years, is outrageous.
I rarely go to the doctor's, but if I do, I shall ask to see a fully qualified GP. Again, I wonder how long it will be before those refusing to see a PA will be removed from the surgery's list.
13:45 how is the guy with no medical background diagnosing patients…
James…..the airline industry already has ‘less qualified pilots’ flying aircraft. QANTAS, for example, use what’s called ‘cruise jockeys’ who don’t do landings and take-offs, they effectively systems monitor in long cruises to allow fully qualified pilots to have their rest periods on long sectors. There will always be a fully qualified pilot present, and the ‘resting’ pilots can be called back to the flight deck should a serious issue arise. It is a worrying trend in skilled professions and dumbing down of roles purely as a cost saving measure…… what’s needed is a full quota of fully qualified GP’s, not a half arsed mish mash in order to further privatise the NHS at GP level. I want every pound allocated to the NHS, spent on the NHS , not on some Panama registered hedge fund parking a yacht next to Michelle Mone in the Carribean…..
So the tory way is for a patient to pay to see a GP but maybe anybody else is free. You might as well ask your next door neighbour for help
The issue with the last called saying that doctors don't listen to the patients is that we do not have many doctors as compared to our European counterparts. That isn't to say that their are some bad doctors it is to say that we have roughly 2.5(ish) doctors per 1000 people. The average in the EU is about 3.7 per 1000. France has around 3.3 per 1000 while Germany has around 4.5 per 1000. In short we need more doctors so that they can spend more time to see the patients. One short term waybwe can do this is by hiring doctors from overseas. The other (IMO) better way is to retain the native doctors in this country. We thankfully have some of the best trained doctors in the world that is highly sought after across the globe. We need to at least talk to the doctors striking. We won't reach their 35% increase, but we may reach a compromise.
They're not going to accept declining real wages. Their demands are actually quite soft, since it's merely pay restoration and not even real wage increases. But this won't get solved, and the UK will just keep losing its doctors to other countries where they get appropriately paid.
As a junior doctor you most of the days have to discuss complex patients with consultants from different specialities. I have personally seen physician associates avodiing these discussions because 'consultants ask difficult questione'.