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Letter: ‘GPs need to speak out against the online abuse PAs face’

Letter: ‘GPs need to speak out against the online abuse PAs face’

Dr Shaun Meehan calls on doctors to defend physician associates and other ARRS colleagues after they receive an onslaught of abuse on social media

Dear BMA and the medical profession,

I welcome the Doctors’ Association and RCGP statements, and hope we can now move towards a more mature and positive debate about how physician associates (PAs) can be best used and best supported. Recent comments by my profession towards PAs have been hurtful and potentially very harmful.

I write as a just-retired GP helping to train and mentor PAs in primary and secondary care. I remember my first day as a doctor in 1986 being handed a bleep and told I was working a one in two (meaning I was working a day/night/day/sleep rota). My jobs included all care, bloods and IV treatments for two consultant surgeons’ inpatients, as well as first management of every other day’s emergency admissions.

Things have changed a lot since then with our fellow professionals increasing their skills and their enhanced roles in patient care, taking over many of these jobs. I have had a busy and often challenging career, but not once in 38 years did I blame nurses, consultants, receptionists, GP assistants, ANPs, PAs or patients for my woes. Instead, I often criticised the real reason: the deliberate defunding of the NHS by successive Conservative governments intent on destroying our most precious public service. 

I write to ask that you now consider the appalling social-media scapegoating of PAs nationally that my profession has direct responsibility for encouraging. The BMA needs to reconsider its blind support of doctors who want to destroy those who keep our NHS breathing. These doctors who post venom towards our colleagues should understand that their words cause intense distress and damage our patients as directly as they damage our colleagues. I fear greatly for the mental health of our PAs especially.

As a doctor, I want to apologise to all our professional colleagues who feel abused. I would speak for those doctors and patients who want to thank PAs and our other colleagues for their amazing dedicated care. We could not manage without you. I encourage all doctors to show them support now.

I read with increasing frustration about clinical scenarios that are deemed clear cut, but in my experience they rarely are. I read that PAs have taken jobs from doctors when I know that there are hundreds of vacant doctor posts left unfilled, usually in deprived areas of our country with PAs and ANPs often working in these areas instead, supporting overwhelmed practices who would collapse without them. 

I think it’s time for all doctors who criticise PAs to stop, including the BMA. Your anger should be directed towards the reason, which is 14 years of intentional NHS defunding, especially primary care funding. Stop scapegoating hard-working colleagues – whether PAs, ANPs, paramedics, social prescribers, GP assistants or reception staff. They are essential in a future for our NHS where all contribute their talents.

We are part of the same team, and the BMA should be working harder to encourage that spirit so our patients benefit. Doctor numbers have never been higher, but they now work fewer hours than before, and rightly so. That and an ageing population with newer treatments previously unavailable needs to be managed, but there is no magic doctor tree. This must mean patients seeing whoever is the best person available to do the job.

I, for one, want a PA to see me if I need it, because I know I will be treated professionally and kindly. Let’s treat our PA colleagues professionally and kindly, too.

Yours faithfully,

Dr Shaun Meehan

Dr Shaun Meehan is a retired GP in Merseyside who mentors and tutors PAs and medical students



Please note, only GPs are permitted to add comments to articles

Douglas Callow 2 November, 2023 3:47 pm

well said Shaun

Neeraj Gujral 2 November, 2023 4:15 pm

Why is always the ones who’ve retired who are happy to sit and preach… Especially when their careers aren’t threatened…. Ladder pulled up… I’m OK Jack.

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Mark Green 2 November, 2023 4:23 pm

A retired doctor who teaches PAs thinks they’re a good idea? Right. Well at least you declared your conflicts of interests here.
Can we move on with a proper debate now please?

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Anonymous 3 2 November, 2023 5:50 pm

What a gross misinterpretation of events!
I have not seen any online abuse of PAs and ARRS colleagues at all.

I have simply read valid concerns from doctors with FACTS that back up these concerns.

This is not about individual clinicians. It is about the fact that these clinicians are being placed in positions of responsibility (in place of GPs and Doctors) WITHOUT equivalent training, thus mistakes HAVE been made and patients HAVE died.

As Doctors, we have a duty of care to highlight patient safety concerns, and that is what the BMA and Doctors Association UK have been doing.

This IS as much about protecting PAs and ARRS colleagues who are being expected to work outside their level of competence, as it is about tackling the issues of funding, protecting patients and our profession!

Be careful what you wish for… you might get it. An under-qualified, kind, professional person can kill you despite their best intentions.

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Sharon Meers 2 November, 2023 8:13 pm

I am a Practice Manager with approximately x25 years experience of my profession. It saddens me to see such poor disregard of the PA role. Through my time I have seen the the general practice team flourish from a basic team of nurses and gps to the multidisciplinary team we benefit from today. I for one welcome these new supportive and qualified roles. We can not do this alone, but together sharing our individual and unique specialist areas of expertise.

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Gus Hiddink 2 November, 2023 8:50 pm

You are retired. You TRAIN PAs. Talk about a conflict of interest.

I have worked with PAs and some are acting way beyond their scope and it was genuinely concerning to see and that’s working with them on ED. I would hate to think how it could be seeing undifferentiated patients in GP if not well supported. It is an unregulated role and effectively being used to replace GPs in some cases. RCGP even had a PA Locum agency sponsor the conference! How utterly insane.

Don’t you DARE apologise on the behalf of me or the profession for the genuine concerns we have. This is a disgraceful gaslighting article.

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Anony Mouse 2 November, 2023 11:59 pm

I am in agreement with Shaun. We should embrace the concept of working with fellow clinicians. He apologised personally and on behalf of doctors who are supportive of PAs, not all doctors. He trains PAs and medical students so I see no conflict of interest there.
Gaslighting is becoming a very overused term – having a different perspective to one’s own is not gaslighting.

Anonymous 3 November, 2023 6:07 am

Views of retired GP who has already become detached from reality. PAs need to be regulated, supervised, supported and their responsibilities limited.

Some Bloke 3 November, 2023 6:41 am

Well said.
PA s need to be supported and supervised, like trainee Drs.
Pity GPs who fear competition from PAs for jobs. When all “easy” jobs are gone, or not offered to GPs, they would have to grow up and own some responsibility. Imagine the stress of that!

John Graham Munro 3 November, 2023 10:04 am

For years I signed my referral letters off as a Locum G.P.——–then suddenly almost overnight the P.C.T. deemed I should be a G.P .Associate

Interesting—–or not

Ikenna Ogbu 3 November, 2023 10:45 am

Interesting point of view.

1. It’s worth the DOI that Shaun’s progeny is a PA, so I can see why he might adopt this POV.

2. While I disagree with abuse directed at any individual as that’s not appropriate, it is a no-brainer that an unregulated profession whose background is an unaccredited, condensed version of medical science should not be allowed to practice unsupervised as this is understatedly unsafe.

3. PAs DO NOT have the breadth of training to independently consult undifferentiated patients. That is a slap to the face of the rigour and validity that GP training has established in the last 60 years.

4. PAs may have a role in primary care, but it is certainly not as independently consulting HCPs. If anyone wants to become a GP, the pathway is via medical school, foundation training, and subsequent GP training. The need for a second tier of healthcare professionals is artificial.

5. This is no disrespect to PAs who have obviously worked hard on a pathway that’s been created to as a way to continue to fill a leaking bucket. These people are only rightly choosing a pathway that seems accessible and promises career protection. However, patient safety should remain paramount to whatever we do as healthcare professionals and the current model of PA implementation in primary care is a recipe for disaster.

Guido Faux 3 November, 2023 10:51 am

Surprised to see a comment suggesting the level of supervision required for a PA is comparable to a GP Registrar with a minimum of four years post grad clinical experience.
Unfortunately that is probably a widely held assumption.
Regulation of PAs, detailing requirements for their supervision cannot come soon enough.

Karl Bennett 3 November, 2023 2:06 pm

As someone who is similarly appalled by the prejudice manifested against PAs Dr Shaun Meehan’s letter is a breath of fresh air.

Mark Bloomfield 3 November, 2023 2:33 pm

Actually Shaun, the rot started under New Labour in 1997. Summary overnight abolishment of GP Fundholding, later replaced by the failed Practice Based Commissioning when the error was realised. GPFH was by no means perfect, but it was gradually & incrementally allowing the development of unique LOCAL solutions to LOCAL problems. PBC was too ‘one size fits all’ and required too many disparate practices to cooperate. Then there were ISTCs and NPfIT programmes, PFI hospitals, commercialisation of DoH under Ken Anderson. BOTH political parties are culpable.

General Practice is a mess because there are too few incentives to attract more bright young doctors who will make quick, ACCURATE diagnoses / assessment of need and THEN assign patients to the correct secondary support team. It needs putting DOCTORS back in firm charge, not this woolly, leadership weak ‘multidisciplinary team’. We need to restore the clinical hierarchy.

PAs are being wholly unfairly supported and promoted on an ideological basis. Within the system. Feted and celebrated, encouraged and given opportunities Junior Doctors are being denied. Even paid better! The criticism is hitting hard because it’s accurate. PAs are effectively cheating their way into ‘seeing patients’ and every single one of them knows it’s morally wrong.

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Folashade Henry 3 November, 2023 2:35 pm

I think it must be very difficult for PA’s seeing the uptick in outcry against what they perceive as their role in primary care, and though I think we should never be abusive of healthcare colleagues, we didn’t nip the scope of PA practice in the bud when we should have and now it’s out of control. They should not be independently seeing undifferentiated patients in primary care – it completely undermines the need for GP training and it is unsafe.
We can be kind and supportive of PA’s while being adamant that GP’s are not interchangeable with them and their scope of practice needs to be limited and regulated.

David OHagan 3 November, 2023 3:10 pm

This letter highlights the difficulties we all face in trying to improve patient care, NHS, and the roles of doctors within it.
Instead of acknowledging the important patient safety concerns raised by multiple doctors, or addressing concerns around training and employing doctors in fair and reasonable contracts, this letter generates a spectre of ‘criticism ‘ and ‘bullyng’, published to connect with controversy.

An insubstantial spectre, as almost every single concern I have seen expressed about PAs has been prefaced by an expression of support for a group of people who are being bullied, and gaslighted into roles many of which are unsuitable, are poorly supervised and are exploitative precisely by the same senior managers and some GPs (sadly) who claim to be on their side. There will almost certainly be a few personal and unpleasant comments in each direction, such is the nature of the internet and social media.

There are many ways to train doctors, and medical training has probably become too long and manipulative. It is inappropriate to expect experienced specialists such as GPs in training to move half way across the country at 2 weeks notice. The whims of the training coordinators now far outstrip the benefits of centralised coordination of training.

Much of the problem with PAs is about the politics of their introduction, and the poor training that they are receiving. The fact that there are really good PAs despite this shows that this could be a future valued role. The ‘bad’ PA however is the one who has misinterpreted their training. They may be overconfident, or just trying to overcompensate, they may actually have been seriously misled, by the very ‘trainers’ and supervisors so keen to defend the role so uncritically.

The debate about this role, which despite its origins in the USA following Vietnam, is still very new here and has significant differences to face in our NHS compared to the ‘wild west’ of commercial medicine elsewhere. It is important for everyone involved to engage with the argument rationally.
This attempt by Pulse to generate controversy, by promoting this slightly misdirected letter is predictable, but hopefully will bring about some light as well as heat.

Mr Marvellous 3 November, 2023 9:49 pm

Well my family will be seeing a GP when they need medical care. Privately if necessary.

James Cuthbertson 4 November, 2023 12:21 pm

What are some examples of this abuse?

I don’t go on twitter

Because for me the biggest problems with having non doctors doing clinical work is that they always have the opportunity to bounce difficult patients to doctors and take away all the easy consults so your clinic ends up being 90% heartsink vs 20%

This makes the job of a GP shit

a S 5 November, 2023 1:52 am

Locum PA’s on 90k ? What was the point of training 10 years to earn 90 k as a salaried GP. Looks like they are getting all the remurination without the accountablity. Maybe I need to re-train to be a PA.

Not on your Nelly 5 November, 2023 9:49 am

WorkIng current GP. Have never and would never employ a PA. Would never see or let any of my friends or family see a PA with two years training who doesn’t know what he /she doesn’t know. Most Retired GPs are out of touch and the roae tinted glasses come on very quickly.

John Graham Munro 5 November, 2023 2:16 pm

I was once described as ”a bit out of date”———–but I can still recognise an ill patient when I see one

Decorum Est 7 November, 2023 12:26 am

Shaun, you have a valid point but it’s not improved by your failure to disclose a vested interest?
Why should ‘socially committed’ & ‘high achievers’ get poorer working conditions than folk with lesser qualifications? You haven’t explained that! That the former cadre are treated in a shoddier fashion, makes no sense (why go to the trouble of achievement, when 1/2 achievement will give a better life style?

Andy McGrogan 7 November, 2023 1:06 pm

What a peculiar article.

Ex-Dr Shaun Meehan decries “the deliberate defunding of the NHS by successive Conservative governments intent on destroying our most precious public service” yet doesn’t seem to realise that PAs were a role introduced in the UK by a Conservative looking to defund further by offering a cheap knock-off of a GP in primary care.

PAs are the answer to a question that no-one was asked.

If the number FTE GPs is falling then a logical thing to do is invest into improving the working conditions of GPs, not make diluted GP copies. That just accelerates the decline.

The Tories must be crying with laughter at their dinner parties over how easily they’ve recruited all these typically-socialist old GPs to come on social media and virtue signal about how we should all just let this happen because otherwise we’re just being big meanies to the people who’ve already done the training.

It must have been nice to enjoy a 38-year career without worrying about job security in future as multiple different professions increase the scope of their jobs into your core work, while you have no-where to expand the scope of your own work. I suspect that as this doesn’t affect his own future directly anymore he’s not considered what primary care might look like in 10 years on its current trajectory.

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