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GPs buried under trusts' workload dump

Chris Deane

  • Physician associates may be given prescribing powers, says DH

    Chris Deane's comment 29 Sep 2015 8:01am

    Just a quick comment from a PAs perspective. I have been working in general practice for nearly 9years now and I work exactly the same list as our GPs.

    My indemnity is through the MPS and I pay the same as a GP and am held clinically responsible for my decisions. Yes I have to knock on a GPs door to get a script signed but this is not as much of a big deal as people are making out.

    I have my own patient base that prefer to only see me and are quite insistent on seeing me over some of the GPs. We are not replacement GPs, how could we be with the breadth and depth of experience that a GP has? However there are now two of us in my practice and the workload that we take on is equivalent to that of a GP each. Our practice has high ratings on NHS choices and we work all day from 8am-6pm apart from an hour off for lunch. We do not just do 3hr surgeries AM and PM and we work to 10min appointments.

    We are part of the solution, not the problem. general practice still needs more GPs and people are correct that the government needs to address why GPs are leaving but until (if) that is sorted we need people to help address the ever increasing demand for appointments. patient education could go a long way to reducing the pressure on GPs rather then people feeling they need to see a GP for every sniffle or mild cough.

    If we work together then hopefully we can help each other and make work enjoyable and not the chore it has become for many

  • GPs shouldn't dismiss physician associates - my practice couldn't do without them

    Chris Deane's comment 12 Jun 2015 9:33am

    I think that there has to be a compromise between saving money and still providing a service. Everyone knows that the government feels it messed up with the change of the GP contract leading to incomes rising at the time and many opting out of OOH and that has in part led to the problems that we now face.

    As mentioned previously PAs are not the answer to everything but to be used in general practice within their remit and training they can be effective. PAs are not expected to be fresh out of training and working the same as GPs. I have spent the last 8 years going on further training and courses and gaining experience to work at the level that I do now and you are correct in thinking that a newly qualified PA would not work to that level, much as a GP reg would not in the first few years (obviously GP registrars are more highly trained than PAs when they enter GP land).

    For many, the PA salary of starting at 35-40k is still a hell of a lot of money compared to other jobs available and if you get well paid for a job that you love (most PAs fund the training themselves and do not get any support) and have put in the effort to qualify then it is an attractive prospect

  • GPs shouldn't dismiss physician associates - my practice couldn't do without them

    Chris Deane's comment 11 Jun 2015 10:49am

    ? 9:21

    really? medical students on their first GP placement have nothing to learn at all from someone who has been working in general practice for 8yrs? Wow. You must have different medical students than us then. I had to be examined by the medical school prior to teaching and have to go on all of the updates required by the medical school the same as the GPs. The medical students we see have a lot to learn from nurses, Drs and most clinicians. I am not training GP registrars here but students on the 4yr courses.

    I am sure being a GP you have never been taught anything by anyone other than a Dr as a student??

    Absolutely embarrassing - what a bigoted comment, well done Dr Anonymous

    FYI: my course was a 3yr Msc and I have trained and worked in hospitals.

  • Physician associates ‘can do GPs' work more cheaply’

    Chris Deane's comment 08 Jun 2015 6:45pm

    I have copied and pasted my reply to one of the other articles published recently so apologies if some of it is not relevant to the comments posted here but it may answer some of the questions posed. There are plenty more comments on the artice ' GPs shouldn't dismiss physicians associates'

    Please excuse me if any of this does not make much sense but as I only have "half a brain cell" it may just be nonsense for you all, although I will try my best.

    I am Chris, the PA mentioned in the above article and I thought that I would try and answer a few of the appropriate questions.

    People (many with two or even three brain cells) seem to want to be PAs as they have decided they want a career working in medicine after already completing their first degree. Some are those who feel their current roles (nurses, paramedics etc) do not satisfy their needs or goals. Others may be those who have not managed to get into medical school, but they seem to be in the minority. I think a lot of people are attracted to it as it does not entail another several years study after they have already completed their BSc.

    There are a few questions about wages as well. Looking at the jobs advertised, starting salary seems to be easily achievable at £35k and increases from there tithe mid £50's for some I believe. I do not want to discuss my salary other than to say that I am very happy with it.

    My surgeries run the same as every GP in our practice. My patients are not screened at all and I have 10min apts and also undertake telephone triage, home visits and teach medical students. The only things that I do not really do are the items mentioned in the article. The way I work may be influenced by the fact that I have been qualified for 8yrs and have worked in general practice for all of that time.

    Many of the points raised by people stating that we are a cheaper alternative obviously have some merit, we would be fools not to see that but it does not mean the role is useless and should be discarded. Rather than moan about us it would be better to see how a practice can use us effectively to ease the workloads on GPs and ensure that they then have the time they need to spend with those seriously ill. I really believe that you do not need the years of in depth training and studying that GPs have in order to be able to deal with 75% of general practice consultations. GPs are a hugely skilled and intelligent workforce, we do not need to be wasting their time dealing with minor illnesses and many of the things that a PA can see. The crucial part of PA training is knowing when to get help and to not be afraid to ask for it. Yes nurses can do a similar job in some aspects but take years to train up after they have done their nursing qualifications and still often think along the nursing model rather than the medical one which takes time and does not always work in the time constraints of general practice. I am not saying ANPs are rubbish, I have met many excellent ones that well deserve their role and they do have their place but PAs work differently.

    Asking if a GP would be happy for me to see and treat their families is an interesting question. For me the answer is yes, I have several patients that are GPs and see me happily themselves and I also look after their families.mperhoas they too have half a brain cell?

    It is always going to be an interesting debate, look back in time and all of this has already been covered when nurses wanted to stop many historical nursing tasks and become ANPs and nurse consultants etc etc and now they are an entrenched part of the NHS.

    Discussion about a subject is good. Inflammatory comments about how many brain cells people have are puerile and do not add anything constructive to the debate! Let's at least keep it civil shall we?

    I am always happy to discuss things and if anyone would like to speak to me about the role then feel free. I will go out on a limb and say you can email me at cdeane@nhs.net if you want to.

    Thanks,

    Chris

  • CCG to recruit physician associates from USA to address GP shortages

    Chris Deane's comment 08 Jun 2015 5:54pm

    There are many more comments and some answers to these questions on the artice 'GPs shouldn't dismiss PAs'

    I am a PA and have tried to shed some more light on the role in the comments at the end of that article. It is nice to have a discussion about things but it would be nicer if we could all work together to help the NHS and general practice in any way we can

  • GPs shouldn't dismiss physician associates - my practice couldn't do without them

    Chris Deane's comment 08 Jun 2015 5:28pm

    A few more interesting points raised and also some not so constructive ones.

    @ 3:16 have you actually read any of the information about ANPs and PAs or did you just decide to fire off a derogatory comment? NO-ONE, I repeat NO-ONE is saying that ANPs and PAs can replace GPs, how could they with all of the breadth and depth of training that a GP has?! What is being said is that the roles can help alleviate the ever increasing pressure GPs face with the demands on general practice and the increasing elderly population coupled with the lack of people being able to manage self limiting illnesses at home. Surely you do not need all of a GPs 10+yrs of training to deal with minor illnesses, hypertension and a whole host of other things that can be managed by someone else, it is just a waste of highly qualified Drs at a time when there is a shortage of them. Perhaps if there were more of these roles in practice then you could concentrate on having longer appointments for those complex patients in need of your time rather than rushing trying to see them in 10mins adding to your stress and theirs?

    @ 10:11: Thank you very much for your supportive comment, it is nice to know that some people can see the possible benefits

    @ 7:21: Yes pharmacists could (and do) have an excellent role in general practice. In our area the pharmacists already do many med reviews and b/p check etc and then contact us for an apt or advice if needed. this cuts down on a lot of the admin time in general practice and if we can encourage more patients to use the minor ailments scheme then that would be great. I print off the prescriptions needed and then knock on a GPs door to get them signed or have a discussion if needs be.

    @ 12:48: This may well change for us in the future, currently we have to take the exam (yes an MCQ) and do 40hrs of CPD a year, that is our form of revalidation. As mentioned we are not Drs so we should not be held to the same revalidation as Drs but something more suitable to our job descriptions. Also if you find that being a GP is a bit too taxing then feel free to not earn the money paid to GPs (not enough in my opinion, genuinely, not just ass-kissing here) and become a PA at £35-50k a year

    @ 8:27: You may well be right but that is something that needs to be addressed at a higher level. PAs and ANPs are not causing this but GPs will never be replaced as they are too highly skilled. What may happen, in my opinion, is that GPs may be asked to take on more specialised roles/ GPWSPIs as the NHS continues to move pts from secondary to primary care

  • GPs shouldn't dismiss physician associates - my practice couldn't do without them

    Chris Deane's comment 06 Jun 2015 2:04pm

    Good points raised again however I have to disagree that there is no difference between and medical and nursing model. That has been discussed ad nauseam for years and there are clear differences between the two. That is not to say that NPs and ANPs are not trained in a medical model for that extra qualification, by the very nature of the ANP and NP role, they have to be otherwise they would not transition from managing cases already diagnosed to making their own diagnoses.

    I 100% agree that any of these roles are not suitable to replace a GP in its entirety and they never will be. What these roles do do is help fill the workforce gaps that are there. Yes nurses should be utilised alongside PAs and any other allied health professionals that can help in the crisis that the NHS faces. It is all well and good saying we need more GPs but the VTS programme seems to be about 40% low in its number of trainees needed to just keep up with current demand, not even taking into account the thousands of GPs looking to retire in the next few years and those that will qualify and then go off on maternity leave and come back part time only.

    Everyone is quick to slate new and existing roles when they try to change things but no one is coming up with an actual solution other than to say reduce GPs workload, give them more money and holidays so that more graduates will be attracted to the profession. The crux of the matter is that we need a solution NOW not in 5-10yrs. We need to all work together to achieve this, yes nurses can help tremendously but there are still not enough to go round and we will just end up in the same cycle where everyone will be complaining that 'unqualified' HCAs are now doing too many traditional nursing roles.

    PAs (and NPs and ANPs) are a part of the solution that general practice needs now unless someone can come up with a workable solution rather than pipe dreams of employing thousands more GPs when they simply do not exist and are not even in training in the numbers needed. We need to all work together, have some give and take and keep the NHS going and yes that will mean compromises along the way unless we want to be privatised and pay thiusands for our treatment as is the case in the USA

  • GPs shouldn't dismiss physician associates - my practice couldn't do without them

    Chris Deane's comment 05 Jun 2015 9:56pm

    Sorry, should say 'perhaps' above rather than whatever autocorrect thinks mperhoas is!

  • GPs shouldn't dismiss physician associates - my practice couldn't do without them

    Chris Deane's comment 05 Jun 2015 9:46pm

    Please excuse me if any of this does not make much sense but as I only have "half a brain cell" it may just be nonsense for you all, although I will try my best.

    I am Chris, the PA mentioned in the above article and I thought that I would try and answer a few of the appropriate questions.

    People (many with two or even three brain cells) seem to want to be PAs as they have decided they want a career working in medicine after already completing their first degree. Some are those who feel their current roles (nurses, paramedics etc) do not satisfy their needs or goals. Others may be those who have not managed to get into medical school, but they seem to be in the minority. I think a lot of people are attracted to it as it does not entail another several years study after they have already completed their BSc.

    There are a few questions about wages as well. Looking at the jobs advertised, starting salary seems to be easily achievable at £35k and increases from there tithe mid £50's for some I believe. I do not want to discuss my salary other than to say that I am very happy with it.

    My surgeries run the same as every GP in our practice. My patients are not screened at all and I have 10min apts and also undertake telephone triage, home visits and teach medical students. The only things that I do not really do are the items mentioned in the article. The way I work may be influenced by the fact that I have been qualified for 8yrs and have worked in general practice for all of that time.

    Many of the points raised by people stating that we are a cheaper alternative obviously have some merit, we would be fools not to see that but it does not mean the role is useless and should be discarded. Rather than moan about us it would be better to see how a practice can use us effectively to ease the workloads on GPs and ensure that they then have the time they need to spend with those seriously ill. I really believe that you do not need the years of in depth training and studying that GPs have in order to be able to deal with 75% of general practice consultations. GPs are a hugely skilled and intelligent workforce, we do not need to be wasting their time dealing with minor illnesses and many of the things that a PA can see. The crucial part of PA training is knowing when to get help and to not be afraid to ask for it. Yes nurses can do a similar job in some aspects but take years to train up after they have done their nursing qualifications and still often think along the nursing model rather than the medical one which takes time and does not always work in the time constraints of general practice. I am not saying ANPs are rubbish, I have met many excellent ones that well deserve their role and they do have their place but PAs work differently.

    Asking if a GP would be happy for me to see and treat their families is an interesting question. For me the answer is yes, I have several patients that are GPs and see me happily themselves and I also look after their families.mperhoas they too have half a brain cell?

    It is always going to be an interesting debate, look back in time and all of this has already been covered when nurses wanted to stop many historical nursing tasks and become ANPs and nurse consultants etc etc and now they are an entrenched part of the NHS.

    Discussion about a subject is good. Inflammatory comments about how many brain cells people have are puerile and do not add anything constructive to the debate! Let's at least keep it civil shall we?

    I am always happy to discuss things and if anyone would like to speak to me about the role then feel free. I will go out on a limb and say you can email me at cdeane@nhs.net if you want to.

    Thanks,

    Chris