Dr Stephen Katona posits an unorthodox method of fighting GP unemployment: why can’t GPs work as physician associates?
It is no secret to any GP that we are in the midst of a severe workforce crisis. GPs cannot find work and practices cannot afford to hire them. The only sustainable long-term solution is, of course, increased investment in general practice and GPs – which the new GP contract goes some way to address. But that does not help the GPs who are currently flailing in a hapless job market, desperately wanting to work.
In the education system, teachers are allowed to work as teaching assistants. A minority of teachers do exercise this right at some point in their career, when they are struggling for work. Which begs the question: can the same be said for out-of-work doctors working as physician associates (PAs)?
Doctors are – by definition – far more qualified than PAs, so it obviously isn’t a question as to whether or not they have the skillset to do the role. Allowing unemployed GPs the opportunity to tide themselves over with PA work could help stop the ever-increasing number of GPs leaving the NHS for private practice or pastures abroad, or just retiring altogether from stress. It could also make it easier for doctors to return to work after a period of ill health or caring for a relative. Would the NHS benefit from retaining more of these doctors? Should employers have the opportunity to choose the health professionals most qualified to look after their patients?
Despite the BMA and RCGP’s positions on opposing and phasing out PAs in general practice, advertisements for PAs persist. So while these jobs do exist, I believe that preventing doctors from having the right to apply for these roles is a form of discrimination. Currently applicants for a PA post must have a PA qualification. Given the additional training doctors receive, why then is a medical degree not also deemed sufficient?
A GP could rightly request to be paid at band 8a rates due to their ability to see undifferentiated patients and receive pay of over £60,000 per year. Yes, this is considerably less than they might receive as a salaried GP, but it beats working in Tesco, and they might end up with less stressful working conditions and less unpaid overtime. Yes, it would also blur lines further between the two professions, but would patients find that acceptable if it raised the competency of those working in physician associate roles?
It would be nice to be able to ask patients their views on the matter. In fact, I have tried! I submitted a petition to the Government, arguing that doctors should have the right to work as PAs. However, it was rejected a week later. The reasoning given was that this was about a matter for which the UK Government or Parliament was not directly responsible.
Funnily enough, I remember Parliament being instrumental in the extension of GMC regulation to include PAs in the first place. Therefore, I don’t think it is entirely unreasonable to suggest that actually, the Government can influence the GMC by introducing new laws or changes to existing legislation, which the GMC must follow. NHS England is now responsible for PA workforce policy (since Health Education England merged with NHSE) and ARRS funding.
I appealed against their decision at the beginning of this year, just after GMC regulation of PAs came into force. I reasoned as above that the Government is able to exert influence over the GMC. But, the petition was rejected again. This time it said that decisions about training requirements for PAs were now a matter for the GMC even though the GMC is merely the statutory regulator for the profession. Given that the NHSE is a public body funded by the Government and overseen by DHSC, I still failed to see how this was not a viable petition request. And that was before the announcement that NHSE was to be dissolved to move control of the NHS back to central government…
There are almost as many institutions that train PAs (33 according to the NHS health careers page) as there are medical schools in the country – that would be 46. I wonder then, how is it justified to not give medical students an automatic PA qualification in addition to their medical degree? This automatic entitlement would not change the standing of either qualification, but it might help future doctors cope with career bottlenecks and burnout.
One might argue that the inclusion of GPs in ARRS funding in the new contract ought to be mentioned, as the current temporary solution. But with the slim eligibility criteria, it doesn’t solve the problem, and it wouldn’t change what at the moment is a lack of a right. I am all too aware that this opinion – further conflating doctors and PAs together – could be unpopular. However, with the unemployment crisis our profession faces, as a temporary measure it might at least aid the plight of doctors unable to find work, and patients unable to find a doctor. It would appear though that we will never have the chance to find out.
Dr Stephen Katona is an out-of-hours GP in Manchester
There might be practicalities, – which cost for medical insurance, – whether Supervisor responsibility still applies. – what GMC subscription, – the possibility of being thought too ‘uppity,’ – regular PA’s displaced. Whether pre- Woke training and accreditation applies, perhaps.
If it is really still a PA roke, with no prescribing requirements.
It risks just being asked to do a full GP job on a race to the bottom salary
Sure. Solve an employment crisis by employing GPs in a lower paid role and by default gaining GP level experience and quality care for significantly reduced cost.
Great for employers.
Atrocious for the Profession.
Utterly ridiculous idea – do we have no self respect?
Gis a Job Gis a Job . As Yosser Hughes’s so eloquently put it . My Job finished last August when I was replaced by 2ARRS newly qualified GPs . I was 64 now 65 and loved working as a locum . I had been it the same surgery for 5 years . Helped them through Covid . Filled in when partners left . I did a lot of on call no problem for me with 41 years of experience. . I had seen nearly every emergency and medical problem that exists . Old School GP . I was a full time 10 session GP for 30 years . Closed our practice 10 years ago as it was not sustainable. Worked as a locum and prison GP after that having thought I’d never get another job . Now there is no work for me or my kind . I sort mates out/ point them in the right direction but don’t treat them . I referred myself to eye casualty when my retina detached 2 weeks ago as neither A and E or NHS 111 could help . . I’m still good at this Medicine stuff but there is no work for. Some will retire as do what I want go swimming go cycling fiddle with my motorcycles cook food for my long suffering Wife , holiday with her and hang out in our lovely home . PA …. I could do that . Just let me try !! And breath
What self respecting GP would even consider this? I’m astounded this was written by a doctor. Discount GP rates will fuel ongoing wage stagnation. Fund GP properly and allow GPs to work as GPs.
What a load of nonsense, infuriating and disgusting suggestion. So disappointing to read and disrespectful of the profession. Just stop finding PAs!! Stop this ridiculous ARRS roles and fund roles that are actually meant for GPs!
This is by no means a solution, this is a disaster!!!! Can you imagine after 10 years of training, instead of getting to the top of your profession where you deserve to get the title, respect, better salary you are now simply an underpaid ‘physician associate?!!’ . Are you going to ask a hospital consultant to also work as a PA now?! What a spit in the face. How did this even get published? How did this suggestion even go floating about! Shameful!
No.
There are many struggling to get a GP role and some are working in Tesco or bus drivers. Im sure PA role would definitely help them. Who wouldn’t want 20 minute appointments with patients. They wouldn’t even need supervision and would sign their own scripts. Longer term though would potentially be deskilling as cases would be differentiated. The opportunity and option should definitely be available.
Good idea, but yes they would expect all that is expected of a GP, sad, this profession of medicine practice has been destroyed by some alien force who have fast become a majority in UK in the last two decades, well nearly in everything significant in UK, without the actual
At least the author did not suggest qualified GPs could join a 2 year PA training course and then join the work force. What a ludicrous suggestion. If they do so Why should the employer ever recruit on Salaried GP rates. Solutions from authorities have always been retrospective, they should arrange prospective planning. Medical school training places are increasing, GP training posts are increasing and GMC is bringing in countless international medical graduates into the UK market. It is high time the authorities arranged a proper team to look into providing medical care to UK rather than just reflect actions. I
I have not commented before but this has moved me. This is the worst idea I have ever heard. Horrifying- All that work…all that training, the sacrifices.
Ridiculous & ill-thought-out idea that only aims to get GPs on the cheap
Potty
There are more than practicalities.
I did not go striaght from GP aulification into a GP Partnership or salaried position. I did some locums and completed a post in AE while sitting MRCGP, and then went overseas for a years in Paeds/Obs/GYnae and 18 months as MOSS (sort of staff grade in AE/inpatients), before coming back to look for a permanent job in GP. I would encourage similar, while you can.
Nobody will allow a GP-qualified Doctor to ‘work as a PA’. The GMC, patients, lawyers, courts, will all expect a Doctor to work to the expectations and standards of a GP, not a PA, whatever they are actually paid.
This is like saying we do not care about having salaries for GPs cut in half, because we do not wish to be respected for the 10 years training to get to that stage, and want to remain paid a fraction of what hospital doctors get.
Maybe work in hospital jobs for a while, but even there, please make sure you are paid adequately, or hospital doctors will also be forced down to minimum wage workers!
Why are we always so quick to race to the bottom?
I might quit my salaried job and apply to become the cleaner. Or perhaps I’ll just stop doing my admin at 7pm and clean the premises instead for a couple of hours, then the surgery won’t need a cleaner anymore. 2 birds 1 stone.
”Just because you could Doesn’t mean you should’
It is a no from Me
I am with do we not have any self respect.
Terrible, terrible idea – thank goodness your petition was not allowed.
Pay PA rates and get a GP – why bother advertising for any GP posts again – let’s get a third pay cut for GP’s. Partners would bite your hand off, no doubt.
Would have me running to Australia even quicker if I weren’t in my 50’s
PAs are trained to be PAs with different skills just like nurses. It is disrespectful to demean their status just as we should not demean the status of nurses suggesting doctors can take their jobs- imagine the outcry from our nursing colleagues. The truth is there are very few PA vacancies at present as all employers await the outcome of Leng review- it can’t come soon enough. There are hundreds of student PAs who are desperate to help our NHS just about to qualify. We must move our NHS from a 99% reactive service to a preventive and reactive service. Doctors are trained to be reactive but the skills of so many others will be needed to prevent illness. This needs to be in teams of clinicians including doctors, nurses, PAs and others.The need and work ahead is huge. There will be work enough for all in primary care and doctors should be less arrogant about their status or they will lose the trust of our public and certainly govt who make funding decisions.
Yeah, nice holiday…thanks for asking.
Dr Katona playing devil’s advocate, or just a political naif?
Must congratulate Shaun Meehan though for having balls of steel always choosing to be on the wrong side of the PA debate (any COI?)……Unlike the centuries old betrusted roles of doctors and nurses (evidenced in histories and literature), PAs are a recent invention, manufactured without due diligence, and so it falls to GPs’ to critically question whether they should be in the NHS at all, replacing GPs.
Their political role, it appears to me, is to cause distraction from the fundamental issue of NHS funding..
No!!
It seems like you are trying to open a door to a scenario where practices get a GP for significantly less pay. Whilst that might be attractive to the partners it won’t benefit the employees and I can’t imagine it benefits the profession in the long run.
April 1st has come very late this year
I disagree with aspects of the above comments. The employment of GPs via the PA / PCN route with NO REDUCTION in salary or terms is simply a vehicle to allow unemployed GPs to gain their rightful place within the Primary Care Team. Contrary to the comments of the above , we in our practice would not employ them on a reduced rate but top up the salary to that required to the recognised GP rates. They would be treated as GPs. The evidence for this is the same scenario, as we have never despite the ease of doing so during the PCN farce, never reduced our GP locums’ rates and maintained these at the higher rate minimum £95 to £110 per hour throughout this PCN debacle( soon to be neighbourhood fiasco) or replaced the GP role with other unsuitable roles although some ARRs do have their place. When you have PCN CDs, ICBs and the government trying to destroy the fabric of Primary Care via persistent untested and sometimes dangerous interventions from managers , many who have never stepped foot to work in a GP practice , then novel solutions are sometimes required to defend our position as GPs within the NHS.
Is this serious?! I thinks its offensive that this has even made it into an article.
I come from Liverpool so always fight for those who are unjustly treated( so bird etc..) Did you know my team won Premier League this week with amazing people working together to achieve.…maybe an example for us all!
Shaun, they’re not being unjustly treated. They’re being rightly and justly treated to proper critique by GPs, who have longstanding professional, legal and ethical responsibilities to their own patients. This debate and critique should have occurred by the (inept) colleges, GMC, Govt committees etc prior to political increase in PA numbers. I feel sorry for the many individual PAs affected by this fiasco.
Well done to Liverpool, though.