The doctor won’t see you now

Photo by smallbox on Unsplash

“It’s a scandal worse than the Post Office Horizon debacle,” says the retired consultant radiologist who contacted me, urging West Country Voices to look into the use of Physician Associates in the NHS.

Plenty of us think we know what’s going on in the NHS. We’ve seen the charts detailing the systematic underfunding. We’ve read about the non-existent new hospitals. Some of us have clocked that the government included all the billions wasted on useless PPE made by mates, and failed test, track and trace, in the headline figures to convince us that the NHS got its Brexit dividend. The brain drain/talent drain has been commented on – the billions spent re-hiring staff, who once worked in the NHS, through private agencies at multiples of the original cost.

And we’re all getting used to comment like these:

‘You can’t get to see a GP anymore’.

‘I’ve had my hospital appointment cancelled five times now. No staff.’

‘I’ve given up and gone private.’

But what if I told you that something even worse was going on, beyond the systematic underfunding and the refusal to pay staff properly, driving them into the private sector?

As The Observer reported, there are trained GPs unable to find work. Weird, huh?

What if I also told you that the government, far from delivering on a promise to deliver 6,000 more doctors, is actually quietly replacing GPs with non-medics and directing funding so that it is uneconomic to hire fully-qualified doctors.

According to The Observer, more than half of appointments are now covered by non-GP staff. In many cases, that’s fine. Many of us will have had a great service from a nurse practitioner, for example, when our issues were simple and straightforward. We probably think that’s a very sensible solution to easing the GP’s workload. We happily leave the appointments to people whom we feel need them more than us.

We don’t for a moment think there’s anything sinister or mercenary about this. We trust our local practice and we want to believe that we will be treated in the best way possible for our condition. And we don’t like to cause a fuss.

But what if we thought we were seeing a GP and we weren’t? What if we were seeing a Physician Associate?

A what?

Health Education England (HHE) defines the Physician Associate as:

“a healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision.”

Physician Associates (PA) are currently UNREGULATED.

The plans for the General Medical Council to regulate PAs are likely to be ineffective as there is no accepted Scope of Practice for them. This leaves patients at the mercy of local employers as to what the PAs are allowed to do.

The Physician Associates Voluntary Register is just that: voluntary and toothless.

Hmm. What could possibly go wrong?

What are their qualifications? They must have:

  • a relevant degree (for example bioscience or healthcare-related) and
  • a postgraduate diploma, which takes two years of full-time study to complete.

To qualify as a junior doctor you need to complete four to six years at medical school  yet, magically, a two year MSc will give you as much knowledge as five years in medical school.

But, for healthcare providers, they’re quicker to train, and easier to recruit.

While less skilled than recently qualified doctors, they are, perversely, paid more!

Under the Additional Roles Reimbursement Scheme (ARRS) the NHS is financially incentivising the deployment of PAs in general practice, but not more GPs.

As one doctor wrote:

“Spoke to a local GP partner (West Midlands.) – the ARRS (aka GP replacement scheme) has been an absolute godsend for them. Apparently, they are ‘no longer obliged by NHS England’ to employ doctors; Primary Care Network (PCN) pays clinical staff wages and their income has rocketed to £250k/yr as a result. Now tell me the profession hasn’t shafted itself. Our own ladder-pullers are complicit in the current GP employment crisis.”

And this:

“GP acquaintance told me that PA students are a godsend, as the surgery gets £100 a day for having them and as ‘the best way to train them is to just let them get on with seeing patients’ this is money for very little effort.”

And, of course, they can work wonders for the old waiting lists and Mr Sunak’s headlines!

PAs are not just being used in GP surgeries. A freedom of information request revealed that PAs had covered 726 medical shifts in Cornwall’s hospitals in a six-month period. That’s four shifts a day in which patients were being seen by an unregulated individual, whose actions are, supposedly, supervised by a specialist doctor.

One has to be seriously ill to be admitted to an NHS hospital and yet PAs are replacing doctors for their care not just in the West Country, but in the National Institute for Neurology and Neurosurgery, part of University College Hospital London:

We asked NHS medical consultant, Dr Dan Goyal, what he felt about their use in GP and hospital situations: his response was sobering:

“The NHS using PAs to replace actual clinicians is absolutely scandalous. I can’t believe it is even happening in the UK in 2024. And really, the only reason such a patient risk nightmare is permitted is because of the desire of some NHS Executives to meet their targets.

“NHS Managers are measured against waiting lists and waiting times but, generally speaking, not against patient outcomes. It is a sad reality that some managers and executives have no issues with taking shortcuts to cut the waiting lists and please their bosses, regardless of what that means for patient outcomes.

“Using unqualified personnel to carry out clinical duties is just another in a long list of extreme healthcare rationing measures taken by NHS leadership. Instead, they should be honest with the public and explain why they can’t get the same level and quality of care they had 14 years ago.”

You or I might feel able to challenge the person we see to confirm whether or not they are in fact a doctor. We might feel able to challenge their diagnoses, question their advice, pick up on prescriptions which are contra-indicated because of other medication or conditions, demand to see a fully-qualified physician or clinician. But what if you are too ill? Or not so confident or well-informed? What if you don’t have a champion by your side? What then?

Dr Goyal reminds us that 14 years ago there were no waiting lists over 18 weeks, no 12 hour A&E waits, no waiting an hour for an urgent ambulance, over 90 per cent of cancer patients started treated within two months, and everyone could see their GP within two days.

And no, it’s not Covid or Ukraine that’s to blame: it’s the Conservative government and their private healthcare donors and agenda.

However as yet the Labour front bench has not condemned the physician associate scandal, nor addressed how they would ensure patients were not inappropriately cared for by staff who are not doctors.

If this de-skilling of the NHS concerns you, please consider signing this petition.

Please note that this is not an attack on physician associates as individuals or as a profession.

In a future article, we will look at the growing use of Surgical Care Practitioners (SCPs).