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Gold, incentives and meh

Physician associate training places to expand by 220% next year

Education bosses will make a major move to expand the primary care workforce this year by radically boosting the number of physician associate training places.

Pulse has learnt that Health Education England will commission 657 physician associate training places for next year’s intake, an increase of 220%.

As part of his ‘new deal’ for general practice Jeremy Hunt pledged 1,000 physician associates to be working in general practice by 2020 alongside 4,000 other healthcare professionals.

PAs take two years to train and this intake will be ready just in time to meet this target, although GP leaders point out that there is no guarantee that they will end up working in general practice.

Health Education England has undertaken a national drive to expand the number of universities offering the two year postgraduate course in a bid to deliver thousands more PAs to work in the NHS.

Other objectives set out in HEE’s plan for 2016/17 include the roll-out of £20k incentive payments which Pulse revealed are being offered to attract prospective GPs to train in the most under-recruited areas.

And the development of new training hubs for GPs and their staff to share best practice, one of the objectives of the ten-point plan for GP workforce.

A HEE spokesperson told Pulse: 'The physician associate (PA) programme is currently undergoing expansion to meet the Secretary of State’s mandate of achieving 1,000 PAs in primary care by 2020.

'It is being expanded across a number of higher education institutions who are offering the programme as well as supporting planning to increase the number of students. Health Education England is working in partnership with NHS England and other stakeholders to create capacity within the job market.'

But GP leaders warned that the vast majority of PAs take up posts in hospitals and it was essential that the new PA trainees were trained in a general practice setting.

Dr Krishna Kasaraneni, chair of the GPC’s Education, Training and Workforce subcommittee, told Pulse: ‘There will be some GPs in some practices who will be keen on any help and will want PAs, and there will be some who don’t necessarily want to work with PAs.

‘For those who want PAs, who need any kind of resource available, we need to make sure these PAs are trained in a general practice setting.’

But Dr Kasaraneni added that simply introducing these new professions to general practice wouldn’t resolve the ‘huge, huge, shortfalls in GP workforce.’

What is a physician associate?

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In the UK, there are roughly 200 PAs working predominately in hospitals and a newly qualified PA is classed at Band 7, rising to Band 8a with five years’ experience and a relevant master’s degree.

There is currently no formal regulation of PAs, although the DH has confirmed they are looking at introducing prescribing powers for PAs in future, alongside formal regulation.

PA indemnity is typically be funded by their employer, one practice employing two PAs told a Pulse Live event they pay £2,400 for their junior staff member, though speculated this could increase in future.

The NHS began advertising for 200 US physician associates, offering a £50k salary plus benefits as part of a bid to develop the role of PAs while UK professionals were trained. But Pulse revealed last month that only 35 offers had been made, with just 6 candidates for general practice.

Readers' comments (35)

  • Mr Mephisto

    Another stupid politician making another stupid promise that he cannot deliver. Following last years abysmal failure in recruiting Physician Associates form the US what makes Mr Hunt think that he is going to have any more success this time around? Perhaps he may attract some disillusioned GP's if he is offers similar money to locum work with a lot less stress and responsibility.

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  • You promised 5000 GP's Jeremy.

    Not 4000 and 1000 PA's (soon to be 3000 GP's, 1000 pharmacists and 1000 PA's).

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  • There are so many trained doctors from abroad who did not pass plan
    It is worth training these doctors and employing them rather than PA

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  • My wife works as a trainee in a underserved area of Scotland - her health board held a meeting introducing the new PAs, who stated that they could function to the level between FY1-ST7. Needless to say, this didn't ingratiate themselves to the docs. When asked who was responsible for training the PAs, the doctors were told that they were. So as well as being directly responsible for approving all management plans, tests and prescribing, they're also expected to train them. When we don't even get time to teach and supervise our own juniors, why should we invest time in those being primed to cheaply usurp us? And how can you work at the level of an ST7 without ever having prescribed?

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  • I work as an ANP/Prescriber with a background in ED/Pre Hospital & Primary care. This knowledge built up over 20+ years in the military and NHS service. They are offering PA £50k and the training pipeline is 2 years compared with my 5years uni + 1yr full time medical trg in the military (+ numerous ALS/Trauma training etc). Why would they not just create a better training pipeline from NP/PP to become advanced level clinicians in Primary Care? Oh and offer a better salary instead of expecting Adv Practitioner output for basic nursing pay!

    As a sideline re insurance. As an ANP/Prescriber my insurance this year was several thousand pounds + £2.5k excess per claim. The insurance industry isn't behind supporting Advanced Practice and I feel this would prevent some Part-Time clinicians working as it isn't financially viable. All the hurdles are what makes us clinicians think about other options!

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  • This could be another 111 type fiasco. A colossal white elephant, that provides a few benefits but also some problems.

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  • Well, this is the future...get cheap labour. There is no money left and things can only get worse for doctors. We are possibly the only country in the world where salaries for doctors is going down every year. My experience of friends from India is that 10 years ago doctors were paid approximately 10 times more here in UK. Since then average salary of a doctor has increased 3 times in India. Here, our salaries are going down every year. They are training more and more doctors in Middle East/Asia. Doctors who earn well are respected there. Here, we are working in extremely stressful conditions. 10 minute consultations, risk of litigation, less & less money, CQC, Appraisal etc etc. It is a global world & I have a feeling that we are going a see a massive exodus of doctors to Oz, Canada & even Asia. At the end of the day we all want a good income & better lifestyle. Government is aware of what's happening, so they are getting PAs ready for future. In the coming years, GP work would be taken over by PAs.

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  • Let me enlighten you naysayers regarding the PA profession/education. The two year training is on a post graduate level. PA students have obtained a 4 year science degree prior to admission to the programme. During those two years they are undergoing ninety weeks of study which combines the theoretical and scientific basis of medicine with clinical experience. They then take a national exam and must undergo a re-certification assessment every 6 years and well as maintain CPD hours. They have worked hard for their degree, love what they do and deserve some respect

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  • Can GP partners apply? Suspect monthly drawing will be similar

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  • Why not just employ 3rd year medical students? With all of their fantastic skills and knowledge I'm sure that they can easily replace any GP.
    :-)

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  • Physicians Assistants need to step up to the plate. They should be responsible for their own decisions (a doctor should not be responsible for the decisions of a PA) and pay their own insurance etc. Do not accept responsibility for them. It may be a wise career move for a GP to "re-train: as a PA. You have much less responsibility, lower overheads and the pay can't be much worse than what GPs already get?

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  • Mr Mephisto

    11.03 am

    From a GP perspective we can clearly see what GP's will in for. I do not question the training, the skills,or motivation of these individuals. I do however know how our politicians and NHS employers think. Any GP's left in the game at this stage will be asked to be responsible for all clinical decisions that these individuals make. GP's will be the fall guys and it will be their backsides and careers on the line when things go wrong - if there any GP's left in the UK at this point in time. The job certainly seems a lot more attractive than being a GP - similar money with a guarantee of protected learning time, study leave, and holidays without the stress or worry of finding a locum. All that plus limited clinical responsibility. It seems like a win win situation. Where do you get an application form?

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  • Anonymous | Sessional/Locum GP24 Feb 2016 10:58am

    Well, this is the future...get cheap labour. There is no money left and things can only get worse for doctors. ------ There IS money, but they don't want to spend it training new GPs, or making their workload better for them, or offsetting some of the medico-legal costs, etc. Instead they can spend it training new MOCKTORS.

    As for the OHP saying PAs have training? a science degree, means diddly-squat in preforming the same role as a GP. I could have a science degree in Geography, wtf does it have to do with medicine

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  • Their essentially staffing the NHS with inadequately qualified staff to the detriment of the patient. We need real doctors!

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  • Surgeiries should refuse to employ PA's.

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  • So 2 years of training and they will be able to undertake duties similar to a GP ! Sounds ridiculous doesnt it ? A GP has to undergo an absolute MINIMUM of 10 years training including medical school in order to perform general practice duties . We make decisions LARGELY dependent on clinical skills and acumen honed by training and exams .I think they are seriously underestimating the amount of skill and training needed to carry out GP type work !

    And they WILL have to pay higher indemnity fees very soon , if they are going to work to a level that is purported . Everyone knows how risky modern general practice work is .

    The GP Partners who take on these PA 's better get ready to supervise them closely because you are effectively getting clinicians with less clinical training than even a GP registrar at ST1 Level.

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  • Once again, I have to post a counter attack regarding these understandably concerned GPs. Well, I am an American trained PA, undergraduate BS in Physiology from UC Berkeley and trained at Drexel University Medical College in Philadelphia. I have been practicing as a PA for 34 years and 4 years of that clinical work was in several progressive UK practices, where I was seen as a very valuable team member and given significant responsibility. I have to be revalidated by written exam every 6 (recently changed to 10) years and acquire 100 hours of Continuing Education every 2 years. Look folks,here are bad GPs as well (I have worked with a few) as bad PAs, but this is not a reason to dismiss the concept, out of hand. A concept which may well keep the NHS alive and kicking. I say this with genuine respect and concern because coming from the US system, I greatly admire the NHS model and have fought over here for an overhaul of the US healthcare system for years. And as far as training goes, American Family Practice doctors train for longer (eight years of Uni and then a 3 year residency) than GPs so does that make UK GPs inferior in competency? I think not. One of my Brit colleagues ( a PA trained at St. Georges) had a PHD in Biochemistry from Oxford, but tired of trying to obtain grants for research so she redirected her efforts into clinical medicine and became a PA. I went to a top tier university ;so please stop "dissing" PAs as "inferiorly trained"...this all sounds like the same conversation we PAs had about 30 years ago when the profession first took off in the US. We are not here to replace, but to help. Thanks.

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  • Dear Roberta
    You obviously have a lot of experience and no-one is doubting your intelligence or academic abilities. The trouble is- that does not maketh a good GP.
    Regarding training of American doctors, they do an undergraduate degree which isn't necessarily relevant to medical training so their clinical traiming I'd actually only 4 years compared to our 5.

    Out if interest what are your indemnity fees and who pays them? I am pretty certain the higher the PA to GP ratio, the higher the indemnity fees will be moving forward.

    You statement - this concept may save the NHS - says it all. I'm sorry but I have got to the point where I am far more interested in saving my beloved profession than saving the NHS. And its about time we had an honest debate about it under this Tory government who are determined to run both the NHS and GPs into the ground.

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  • Thanks for the commentary Shaba...I actually agree with much of what you have said regarding "running the NHS into the ground" and certainly we would agree on many of the current Tory government schemes! I support more GPs and increased funding for them. However, I feel there is room for many types of providers to work as a team for the benefit of the patient. I also understand your concern for your profession. But the very successful PA profession in the States has not encroached on the sanctity of the doctor...we are "dependent " providers, legally, despite being able to work solo (which I frequently do.)

    FYI, our indemnity costs in the US are even higher than in the UK due to the ease of malpractice lawsuits ( we are famous for this!!). My employer (and I occasionally work locums as well- then the agency covers my malpractice )pays for this ,but I generate far more income for the practice so it compensates for the cost. I am "in demand" by doctors, for a reason. Much of what I do cuts down on the "aggravation" factor suffered by the doctors. Particularly a good triage system. I totally agree that the true competent practice of medicine is learned through actual "hands on" experience and I (even at my advanced age!) learned much from the GPs I worked along side of.
    GPs might have a better go at controlling how PAs are trained and utilized if they bought into the concept and became more active in developing guidelines and protocols. I had to leave my last UK practice just outside of London due to visa issues when I divorced, but they made it clear that my experience and usefulness as a provider was missed and they, in fact, hired 2 new PAs to take over my position when I left. All I am saying, is that some of this "mythology" regarding what PAs are and what they really do needs to be dispelled. The problems between GPs and the NHS has very little to do with PAs...it's a bit of a "scapegoating" methinks.

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  • There has been a deafening silence from the Royal Colleges about Physician Associates and risk when they are usually the first to berate the profession on standards.We fully appreciate that JH thinks anybody can do our job because he has no idea what we do.I believe GP's should not offer them any posts unless all indemnity funded by the Government but I suspect these costs are going to be astronomical.

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