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A faulty production line

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)

  • 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.

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