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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?

BP diabetes clinic blood pressure PPL

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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  • There definetly is a place for PAs in the NHS. The problem is with the amount of time it will take to set up the service from scratch. The government failed miserably to recruit PAs from the US despite the £50000 salary and relocation costs etc. Now their tactics changes as they announced hundreads of new PA places at different Unis across the country. Two years to qualify and only god knows how many years of supervision before they start pulling their weight ( which for sure, eventually, they will). This is planning a luxury holiday when we cannot put bread on the table.

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  • Please may I point out that although HEE may provide 657 new places, this doesn't mean that they will be filled.

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  • /Can someone tell me can they prescribe independently without the need for the GP to check what they have done or given. I did, several years ago, have a PA but they were not accredited for signing scripts. So in effect I may as well have seen the patient and done the prescribing myself. Unless the are fully accredited for prescribing then having a PA is useless.

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  • Roberta, may I emphasise that no-one is trying to 'diss' PAs as such. Our concern (and many GPs are VERY angry about it)is that the government is constantly demeaning fully qualified GPs, and constantly implying that we can easily be replaced by far less qualified people. All we have to do is cover them for the responsibility of actually prescribing... oh yes, and for their mistakes. Oh, and train them as well. In welcoming PAs we are being invited to commit suicide (while paying for the bullet -- and ensuring we are fully up to date with the paperwork for the gun).
    I have every respect for PAs. I am certain that there is a great place for them in the practice team. But Jeremy Hunt is presumably fully behind the idea that we expensive GPs are actually a waste of space because we can so easily be replaced by all and sundry -- nurse, pharmacists, PAs. What he (and his advisors) haven't realised is that the hardest job in medicine to do well is that of a GP (because it's the sublest and the most wide-ranging); and that one of the hardest things in it is to take absolute responsibility for the decisions that one makes (including being responsible in front of the media).
    The real danger of their behaviour, of course, is that the country will get what it deserves -- and that will be the total collapse of primary care because no-one in their right mind will want to remain as a UK GP, given the responsibility and the vilification.
    And how will PAs take over from GPs if they can't sign for prescriptions, have to get someone else to pay for their indemnity, and can't legally lead the practice?
    So please don't feel that we are getting at PAs - we aren't. We are just extremely angry with those who are pushing us around, yet don't actually know the details of what it is they are trying so assiduously to dislocate.

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  • Is Roberta a Hunt generated computerised troll....posts far too long for a human being.
    Pay peanuts, get monkeys. Here come the monkeeees.

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  • I understand PAs have science degrees as well as two years post grad training. I also have a 'proper science degree'. Which took me three years to do before medical school. It has served no use whatsoever in my work as GP.

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  • Mr Mephisto

    10.26 pm

    Good point.

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  • Mr Mephisto

    My plumber seemed very interested in this scheme until he found out about the salary. He said he would be more than happy fiddling around with someone's plumbing but he could not afford the pay drop. My Bulgarian builder had similar views. He felt that ten years in the building trade qualified him to tackle just about any job. Yet again he said there just wasn't enough money in it for him. Perhaps the government should resurrect the old YTP scheme of the 1980's - perhaps they could round up some candidates from the local job centre.

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  • Many Practice Nurses are baffled by this move because many experienced PN's having been striving for years to get their employer to allow them to advance and prescribe.

    We already have pro-active supportive GP employers, some amazing in " single-handed" practices affording efficient PN/ANP/NP teams. I have seen adverts for one or two GPs using the skills of up to five nurses to work WITH them.

    Then there are the protectionist GPs (in my observation, experience and view. The ones who have a team of six or so GPs but "cannot afford a another nurse", so one miserable nurse is a donkey for what some GP's perceive a nurse actually can do. Many of these GP practices have extraordinary turnover of PN's like chicken fodder.

    Most are mediocre employers and unfortunately can stranglehold a PN career and potential. I know, mine has been trashed by a GP who did not agree prescribing was a nurses role, yet this "experienced" GP did not know his HDL from his LDL at the time.

    Like a GP rightly wrote earlier on here. It take more than academic training to be a good GP or a nurse for that matter, and some nurses like me started out with zero academic points but evolved as much as I could over what now amounts to 20 years of academic modules, often at my own expense and time.

    I really don't see how PA's are going to be in any different situation that we PNs unless the employment structure and support is in place and prevent an entirely different profession such as medicine presiding over the nursing profession. Yes, most of us have patient care at heart and our abilities overlap in many ways but I am so cross that yet another group of "sun-medical" clinician is being encouraged to enter an already diseased network that is not yet assessing and supporting what it already has right under it's nose.

    Just caught me on a bad morning where two more poor controlled diabetics have been seeing the GP for over a year and nothing has been done to support them improve control. It doesn't really take a medical degree to have some insight and action.

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  • If you start linking up the dots I believe these new proposals are just part of a much larger agenda which encompasses GPs and their diminishing role alongside the DWP

    I have pasted below the contents of an open letter written by a very brave GP. the link is also pasted below the contents. Please circulate

    I believe this GP has some valuable insights which directly relate to these current plans outlined in this post:


    Jobs on Prescription

    The Government’s latest proposal to turn GP surgeries into Jobcentre Plus must be treated with extreme caution. The Islington GP surgeries that have agreed to pilot this scheme have, perhaps unwittingly, crossed another boundary which plays into the wider agenda of blurring functions and roles of public servants. Hidden behind the deception of “joined up” services lies a de-professionalisation and lowering of standards the public can expect. Merging of functions and budgets will also provide richer pickings for corporate takeover which is the intended endpoint. Meanwhile respected public employees like GPs will be used to set the precedent.

    My experience of patients who have had benefits stopped has not been encouraging. Most have gone on to appeal the decision and won. Many were clearly not fit for work and their accounts of the assessment often beggared belief. One patient sticks in the mind. A 62 years old man with severe Parkinson’s disease who despite medication was struggling to function requiring help to dress and wash himself, walking with the classic shuffling gait and experincing disabling tremors in his arms. He was summoned for a work capability assessment. To my shock he was deemed fit to work. Others have been driven to relapse of chronic mental health disorders and the desperation of relying on food banks. The DWP and its outsourcing partners are interested in one thing alone and that is to reduce the spend on benefits. The impact on those refused benefits that then go on to suffer extreme financial hardship, psychical and mental harm as a result of ludicrous decisions are the collateral damage the government is quite happy to inflict.

    As a general practioner I am well aware of the financial and bureaucratic burdens deliberately places on practices struggling to provide safe high quality care with diminishing budgets and staffing vacancies. It can seem tempting when government offers alternative financial opportunities for cash strapped practices to grab them only later to realise how temporary and damaging the deals have been and for what purpose they were offered up. Much of what I am tasked to do with my patients neither serves their best interest nor clinical priority. Limited time and resource is constantly being diverted to activity which has no significant health benefit for patients but has income attached.

    The Jobs on Prescription schemes will damage the doctor patient relationship particularly for people with mental distress and physical disabilities. The GP will be seen as an agent for the DWP with a potential conflict of interest in advising patients into job focused interviews. No doubt in time the role will be given to less qualified staff with perhaps less ethical objection. Bonus payments for getting people off benefits could speed up the achievement of the government goal to reduce the benefits bill. The constant focus on benefits and work add further psychological burden to people eroding self-worth and esteem. The threat of “conditionality” implying you either engage or face sanction hanging heavily over claimants. The subliminal message is that the patient is to blame by choosing not to comply so whatever happens they bought it on themselves.

    Doctors need to remember their duty to do no harm. Patients pressured into employment schemes or put off seeking medical care from doctors they no longer trust may come to harm. This is against our ethical duty and should be rejected for what it is a draconian attempt to deny basic financial safety net for sick and disabled people.

    http://dpac.uk.net/2016/02/a-letter-from-a-gp-about-jobs-on-prescription-donoharm/

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  • Unfortunately,like Donald Trump over here,the few GPs who have used this commentary space to insult and degrade PAs (and myself personally)rather than actually dialogue, demonstrate their ignorance of so many aspects of what the PA profession is and what we do. There is no need to reinvent the wheel,PAs have been successful over here for 50 years and many studies have shown patients get great care comparable to any family practice provider. Again the difference is the years of experience. And I would argue that a "science" degree is irrelevant to the practice of medicine. Understanding disease (believe it or not) is necessary to appropriate recognition and treatment. And no, I am not a monkey nor a bot. I am one of the original PAs that came over to B'ham in 2005 to help establish that PA program. Please be civil in this forum (it's one of the attractions of living in the UK) Thanks

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  • Do not touch with a barge pole. I would sooner have an FY2 - not prepared to babysit people with no medical training.

    A two year "postgrad" degree is no way comparable to five years undergrad plus five years post grad. Unless you're saying they're incredibly advanced learners - twice as advanced as medical students with better grades - there are no short cuts in medicine.

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  • Buy shares in companies that make money out of medical negligence claims...the future is bright for these folk

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  • "Roberta Rich | Salaried GP25 Feb 2016 4:26pm"

    You are evidently NOT a salaried GP. Why are you posting as one?
    How many others on here post with a lable suggesting they are a Dr when in fact they aren't.

    You can sign up and post here and pretend to be anything you like, and if you say something that doesn't fit with the PULSE adjenda your comment gets deleted. Depressing times for medicine in the UK indeed.

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  • Given that the HMG scheme attracted 2 from the US, this should mean we get 7 next year?

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