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The cheapening of our health system is everyone’s business

The cheapening of our health system is everyone’s business

Editor Jaimie Kaffash says everyone – including physician associates – should come together to challenge the lowering of healthcare standards

When deciding what to write about for my editorial this week, all roads seem to be leading to physician associates.

I am at risk of repeating myself, so please forgive me – but it does seem as though the message isn’t getting through. Just this week, shadow health secretary Wes Streeting was once again engaging in a bit-of-bothing, comparing the online bullying of PAs with the deep structural problems being caused by replacing doctors with less qualified professionals.  Just to hammer the point I made last week, bullying of PAs in unacceptable – but it is a tiny issue compared with what is happening in the health service.

You may have noticed that we have featured a few nominally secondary care stories in the past week: for example, the row involving the Royal College of Physicians, and the BMA calling for an inquiry into the use of PAs on doctors’ rotas.

The reason for this is two-fold. First, is the practical explanation; the use of PAs and similar staff in secondary care has workload implications for GPs. More patients won’t get the support they need and will be bounced back to primary care.

The second is that the issues surrounding PAs in primary and secondary care are pretty much the same. There are slight differences – for example, the difference in pay between hospital trainees and PAs, and it is far more obvious when these HCPs are put on a hospital rota than when patients are triaged to them in a GP practice.

But in general, it boils down to one thing: they are being used because they are cheaper than trained doctors. And this has exercised and united the profession in a way I haven’t seen since perhaps the Dr Hadiza Bawa-Garba case.

GPs and specialists are united in this common cause. We have seen how standards of care have become the boiling frog, with the temperature being raised slowly over time until we find an unsafe health system where referrals are being rejected, waiting lists are years long, GPs are overwhelmed amid everything else.

But this replacement of doctors with PAs is a scandal. Not because we are seeing a spike in avoidable deaths or the like (yet).  It is a scandal because it is an acknowledgement that lower standards of care are a literal price worth paying for a cheaper service.

It is incumbent on primary and secondary care doctors to stand together on this (yes, without crossing a line into bullying). And it may be a forlorn hope, but I would like PAs to support the cause too. Because this isn’t about how intelligent they are, or whether they are failed doctors (they are not). It is not even about whether they can add anything to the healthcare system – I’m sure they can.

This is about a government that is doing healthcare on the cheap, and it will be everyone who suffers.

Jaimie Kaffash is editor of Pulse. Follow him on X (formerly Twitter) @jkaffash or email him at



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

Neil Kerfoot 20 March, 2024 6:10 pm

Well said

So the bird flew away 20 March, 2024 6:29 pm

Up until recently, the social experiment of the NHS has been tremendous value for the population’s health/social/mental wellbeing and security. The NHS also now has the additional huge value of population level data. Being occasionally cynical, I think this Govt are trying to cheapen the costs of the NHS (eg cheaper HCPs, as you say) while simultaneously they (and probably the next Govt) will sell the NHS data value to infotech, biotech and pharma R&D for £billions over the next decade.

Whether the money the Govt receives will be ploughed back for the public good (or off-shored in hedge funds) is anybody’s guess. Why this isn’t being fiercely debated on MSM is a feature of the increasingly unrepresentative version of kleptocratic democracy that we have sadly got used to.

So the bird flew away 20 March, 2024 6:36 pm

#sellingenglandbythepound #genesis

Andrew Buist 20 March, 2024 7:26 pm

You’re absolutely right Jaimie – what’s happening here is a cheapening of the NHS with the replacement of GPs with PAs on a scale we’ve not seen before. Nothing against PAs, I do believe they could have a role in primary healthcare – but starving practices of core funding, while enabling PAs via GMC and providing funding with strings means many practices desperate to maintain their services with go for it. I think this is part of UK gov plan to drive a 2-tier healthcare system as more affluent patients will eventually reject this type care and go private for both primary and secondary care thereby undermining the NHS. It’s worrying that a change of government may not change this direction

David Church 20 March, 2024 9:24 pm

Well said indeed, Jaimie and Andrew;
and to the Bird who Flew, the second paragraph :
Well, the money could not go into the NHS without openly admitting that Government was selling personal data it had no right to sell; Therefore it is more likley to be hidden as it goes into Ministers’ back pockets, in a corrupt political system which we will need a completely fresh sort of Government to sort out!

David Marshall 20 March, 2024 11:15 pm

Bottom line is this. Government think Primary Care can be done on the cheap. GPs are too qualified, too high-powered for the role, and mostly, too expensive. Somebody here posted that the best “first encounter” is in fact with a highly experience medic. Counter-intuitive perhaps, but on reflection, I think correct. And that person is a GP.

Kristofer Holte 21 March, 2024 6:55 am

PAs currently get paid more than all but the most senior registrars. They are not cheaper

Mr Marvellous 21 March, 2024 10:17 am

Really good column.

“Cheapening” of the healthcare system is exactly what this is. Bums on seats, dumbing down, quantity rather than quality. It is indeed bad for all of us.

Dave Haddock 22 March, 2024 5:23 am

Cheapening of the NHS would be great news if true
We are paying far too much tax as it is, and for a service that is increasingly unavailable in any reasonable time-frame.
The growth in private alternatives is good news for doctors – more opportunity to escape the abusive clutches of the ghastly NHS.

Dave Haddock 22 March, 2024 5:26 am

ps. Elsewhere Puls is reporting “98% vote for strikes” and “overwhelming”support by juniors for strikes.
This is blatantly misleading and factually incorrect..
There are around 70,000 junior doctors, around 30,000 voted for strikes – that’s less than half.
Shamefully misleading reporting.

Bernie Hunt 22 March, 2024 2:09 pm

Thank you for an excellent article.
Learned professionals being replaced by skilled workers in GP/ hosp/ uic. They aren’t cheaper, as cost of upskilling aph paid for by NHS and salaries start above senior reg band, without the benefit of it being a learned professional.
Skills and final salary both below a consultant/ GP, so savings and reduced quality of patient care guaranteed by the plan, as per NHSE/ DOH plan .
The 111 plan is the same story, but here the patients are often vulnerable elderly, who can die quickly when wrong decision made due down regulating of workforce skill.
View the elderly as economically inactive drains on a countries resources and current NHSE/ DOH plan at least makes sense to capitalists.
Please get this issue as main NHS issue on the public agenda for the election.Ask Itv/ C4 to doa documentary.
The public needs to know what is happening to their system. This downgrade in staff skill is adding to a&E waits. It could all be modelled, but NHSE makes DOH demanded policy changes and no adverse effects are looked for…
There would be public outcry if pilot associates were proposed

Monica Stevens 22 March, 2024 4:44 pm

It isn’t even cheaper.,%2443%20per%20patient%20per%20month.

In America they are realising that PAs and nurse practitioners cost more than care given by a GP, because they order more tests and refer more patients. Extra costs for a worse quality service. Watch the video, it is illuminating and relevant.

Mahesh Kamdar 31 March, 2024 8:13 pm

How come our leaders did not see this coming?
Or were they silenced by the money coming to them. Look at the example of RCP getting paid to train PAs and producing all good reports. The heads of all of them at RCP should hang low I with shame.