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GPs ‘do not face huge complexity’, claims former health minister ahead of PA debate

GPs ‘do not face huge complexity’, claims former health minister ahead of PA debate

GPs do not ‘face huge amounts of complexity’ and most of their appointments are ‘incredibly straightforward’, according to a former Conservative health minister.

Speaking to BBC Radio 4 on Friday, Lord Bethell defended upcoming legislation that will bring physician associates (PAs) under GMC regulation, which could be struck down by the House of Lords this evening.

Both the Doctors’ Association UK and the BMA had previously complained about the lack of debate in Parliament.

Discussing the role of PAs on Friday, Lord Bethell said he had not seen ‘any evidence’ of patients being confused about whether they were seeing a doctor or an associate.

‘GPs don’t face huge amounts of complexity. Most interactions are incredibly straightforward. Certainly my own experience over the last 20 years of going to my GP, it really hasn’t required 10 years of training to deal with my small problems,’ he said.

Lord Bethell added: ‘When they are complex, they should be escalated. But there’s a much wider group of people who have professional training who should be respected, celebrated – they shouldn’t be denigrated, they shouldn’t be in any way patronised by other professionals.’

He also suggested that ‘vested interests’ were trying to hamper progress within the NHS workforce.

‘Every time there’s some kind of innovation there are people with vested interests who tried to prevent progress from taking place and this really smacks of that kind of Luddism to me.’

The debate this evening will be on a ‘fatal motion’ brought by former Green Party leader Baroness Bennett, which could see the legislation killed.

Baroness Bennett told BBC Radio 4 that she is not opposed to the PA role or indeed regulating them, but she pointed out that there has been ‘very little parliamentary debate and oversight’.

‘There is concern that PAs may end up replacing doctors, particularly in the most deprived areas and areas where it’s difficult to recruit. And people need security and trust, and this method of doing it is not delivering that,’ she said.

She also pointed out the training gap between GPs and PAs: ‘I think this isn’t a question of status, it’s a question of skills. To be a GP you’ve trained for 10 years.

‘We are now looking at a situation where we are starting to see some cases where people who’ve had an undergraduate science degree and two years of training have been seeing – and the suggestion is that this is absolutely fine – undifferentiated people who walk through the door of a GP surgery.’

On the likelihood of stopping the legislation in the debate tonight, Baroness Bennett said she is not expecting to put the motion to a vote unless there is ‘a real change of heart particularly from the Labour Party, which is not indicating that it’s going to back it’.

The Doctors’ Association UK (DAUK) has written to Labour peers urging them to vote against the legislation.

DAUK co-chair Dr Matt Kneale said they are ‘strongly opposed’ to the order and welcomed the fatal motion by Baroness Bennett.

He added: ‘However, we’re disappointed that Labour has not sought to back the position of putting patient safety first given the very real concerns within the medical profession and among the public about non-doctors.

‘There have been many reported instances of PAs operating beyond their competencies and being linked to patient harm.

‘We need to pause the recruitment and roll-out of PAs immediately until the scope of their roles is addressed by the GMC, the royal colleges and other stakeholders.’

A BMA survey of 19,000 doctors has shown that 72% of doctors do not support the future regulation of PAs and AAs by the GMC. And that 80% of doctors felt that PAs and AAs would be more appropriately named ‘assistants’ than ‘associates’, as they were in the past.

The GMC has said it will add an alphabetical prefix in order to distinguish PA GMC numbers from those of doctors, however the Government has rejected calls to rename PAs.

The BMA has warned the proposed legislation ‘will add further, dangerous confusion’ with patients being left under the impression that they have seen a doctor when they haven’t, and over 10,000 doctors wrote to their MP to urge them to oppose the change.

In July last year, Pulse reported on a GP practice’s decision to stop employing physician associates after an incident of ‘poor quality’ care contributed to the death of a patient.

Emily Chesterton died in November 2022 after suffering a pulmonary embolism. She had made an appointment at the Vale Practice in Crouch End, in North London, after feeling unwell for a few weeks and reported calf pain and feeling breathless, and saw a physician associate at the practice.



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

John Graham Munro 26 February, 2024 6:04 pm

All one needs to be a G.P. is common sense——just like P.As——end of debate

Reply moderated
Patrick Young 26 February, 2024 6:12 pm

Another posh

Patrick Young 26 February, 2024 6:13 pm

Another posh boy

Patrick Young 26 February, 2024 6:14 pm

Another posh boy arts graduate

Not on your Nelly 26 February, 2024 6:15 pm

The Lord is sadly like most people who haven’t a clue what goes in a GP surgery (most members of the public and many fellow secondary care “colleagues”)…..we don’t stand a chance really

Patrick Young 26 February, 2024 6:16 pm

Pimped for Matthew Hancock

Peter McEvedy 26 February, 2024 6:21 pm

And all you need to be a Health minister is to be sired by a Hereditary Lord, fail to win a Commons seat in two elections, but go to the House of Lords becuse your father was there. And an ability to ‘misplace’ a phone so that messages wanted for a judicial review could not be found as well as a variety of other allegations which can be found on Wikipedia. I suggest his knowledge of Primary Care is limited.

David Church 26 February, 2024 6:38 pm

Well, I think he is right here. The issue is not complex at all. NHS GPs face annihilation by the Government’s privatisation plans, unless we can persuade the general population that NHS is actually a Good Thing, and a further Tory Government is not, so we need to get our patients voting for NHS care with their polling papers, or just leave UK for ever as civilised society breaks down completely.

Nick Mann 26 February, 2024 6:41 pm

James ‘experts for Govey’ Bethell, who needs doctors anyway? There are now hundreds of formal and informal examples of PAs blurring their roles and titles with those of doctors. It’s dangerous. Bethell should know all about “vested interests”: he was, with Hancock and Gove, well vested in arranging £1bn of VIP contracts for Covid. Not a credible witness, hasn’t done his homework, and only too happy to prevent proper Parliamentary scrutiny.

SUBHASH BHATT 26 February, 2024 6:44 pm

You see what is booked. You don’t know till you see patient if it is straightforward or complex.

So the bird flew away 26 February, 2024 6:54 pm

Myself, I’d like to know what the good Lord’s views are on how to sit the right way around on the toilet if he’s figured it out yet.
Maybe he could also solve the puzzling issue of the length of a piece of string….

Keith M Laycock 26 February, 2024 7:15 pm

Arrogance personified. The unbelievable expected to be believed.

Have look at this Hereditary Peer’s and 5th Baron of Bethell’s C.V. on Wikipedia.

George Forrest 26 February, 2024 7:22 pm
Reply moderated
Dr Jeffries 26 February, 2024 7:23 pm

Any wonder healthcare in the UK is shite.
Dr Munro have you ever thought of taking up golf or bird watching in your retirement rather than writing ill informed provocative rubbish?

Patrick Mackle 26 February, 2024 7:25 pm

Sadly, the plan always was blur the roles. Leaders or the PA movement, for example as in the link above, explain this ambition to camera.

Mark Feldman 26 February, 2024 7:28 pm

Unconscious incompetence!

James Mather 26 February, 2024 8:54 pm

There’s a storm comin.

FRANCIS CAMPBELL 26 February, 2024 8:56 pm

The Munro guy ain’t a doctor

Prometheus Unbound 26 February, 2024 9:03 pm

This lord bethel..

In July 2021, Bethell was placed under investigation by the House of Lords Commissioner for Standards over a “complaint regarding Lord Bethell sponsoring a pass for Gina Coladangelo”, who was a lobbyist and lover of the then Health secretary Matt Hancock.[9]

In August 2021, it was revealed that Bethell had replaced his mobile phone earlier that year and not transferred data from his previous phone, meaning that it could not be searched for messages related to an £85m contract with Abingdon Health that was subject to judicial review.[10] In November 2021 he stated in a witness statement that three prior explanations he had given for why he could not access his messages – that he lost his phone, that his phone was defective and that he had given it to a relative – were incorrect and that he had deleted them because he incorrectly thought they were backed up.[11]

Turn out The Lights 26 February, 2024 9:08 pm

When is a sprain not a sprain when it is a dot missed by. A PA.If Gp isn’t complex PAs will not need a scapegoat/supervisor.Let them be independent and carry the can.Thought not.JUST ANOTHER WAY TO INCREASE OUR WORK LOAD WITH MORE NOCTORS.

Prometheus Unbound 26 February, 2024 9:08 pm

So he admits he makes defective statements.
Is that what other people call lying? I would not know as I am not qualified to say that.

Turn out The Lights 26 February, 2024 9:08 pm


Prometheus Unbound 26 February, 2024 9:38 pm

Lord bethel has a degree in history politics so know everything about science.
Maybe we should go back to barber surgeons.
And green grocers can return to being pharmacists
We don’t need dentists either as any car mechanic can pull teeth

Prometheus Unbound 26 February, 2024 9:54 pm

If I was his private gp I would dump him as a patient, for being so rude

Cornelia Junghans Minton 27 February, 2024 7:38 am

This comment might be on a par with Philip Hammond’s ignorant comment: “I reject the idea that there are vast numbers of people facing dire poverty in this country. I don’t accept the UN rapporteur’s report at all. I think that’s a nonsense. Look around you; that’s not what we see in this country.” When you have been pampered all your life, work with the cabinet of millionaires and never stray far from your posh environment or the subsidised canteen you might well think UTIs and ingrown toe nails is all we deal with.

A B 27 February, 2024 7:46 am

Its almost as if the UK is now run by some weird reincarnation of the spirits of the people in charge of pre-revolutionary France. If he related to Marie Antoinette? You can almost hear him whisper under his breath ‘let them eat cake’ as winds up. Yeah this is our country and this man and his friends own the place

C Ovid 27 February, 2024 10:14 am

His folly was to suggest that having good health means that no-one else seeing the GP is complex. Lucky him. It is inevitable that his GP’s skills will be tested in due course. Perhaps he will have a borderline PSA or weight loss with a normocytic anaemia, or a sudden drop in eGFR without reason. He’ll have time to reconsider his arrogance then.

C Ovid 27 February, 2024 10:18 am

…or what about being seen in ED for 30 hours, “encouraged” to sign his own dchge and then wandering into his GP surgery on the way home with unaddressed symptoms, no understanding of his condition and no dchge summary! Hang on, that doesn’t happen in Harley Street …. Unless you are acutely unwell…. so perhaps it might.

Dave Haddock 27 February, 2024 10:18 am

Labour’s Shadow Minister Primary Care and Public Health is Preet Kaur Gill; she has made similar claims in public.
It’s not a Tory thing, it’s a widespread belief. And with a lot of widespread beliefs, there is at bottom a small nugget of truth.
Whilst GP patients are increasingly complex; more ill, more drugs, less support from specialists – there are some GP colleagues who are skilled at avoiding anything resembling a difficult decision. We all know someone.

Dave Haddock 27 February, 2024 10:19 am

Labour’s Shadow Minister Primary Care and Public Health is Preet Kaur Gill; she has made similar claims in public.
It’s not a Tory thing, it’s a widespread belief. And with a lot of widespread beliefs, there is at bottom a small nugget of truth.
Whilst GP patients are increasingly complex; more ill, more drugs, less support from specialists – there are some GP colleagues who are skilled at avoiding anything resembling a difficult decision. We all know someone.

Truth Finder 27 February, 2024 10:35 am

Shocking revelation about a dirty politician above. Absolutely clueless.

David Turner 27 February, 2024 11:34 am

I suspect this character is made up, and a pilot for a new comedy sketch.
I just refuse to believe a real person would spout such utter crap.

David Turner 27 February, 2024 11:37 am

Thinking about it maybe the next time this idiot takes a flight he would be happy for the plane to be piloted by a pilot assistant, who has had less half the amount training of a pilot
After all flying a jumbo jet can’t be that hard can it?

Dr No 27 February, 2024 11:43 am

Actually I don’t believe he believes this. (Just like Lee Anderson isn’t racist but is happy to be considered so). His intervention is part of the concerted propaganda against GPs by this government. We are being de-funded, sidelined, and ridiculed. We are not part of the future of Primary care. Thanks God I’m out of it at the end of this year.

David Wright 27 February, 2024 1:38 pm

The government may be wanting to sideline GPs but the public do not. They want what they used to have and what was taken for granted even 10 years ago – timely consultation with an experienced GP. I am now retired, but when I was working (35 years as NHS GP) I used to say that private general practice could never work because the NHS GP service was so good. This is now no longer the case, so perhaps now is the time for you all to set up your own private practices?

Darren Tymens 28 February, 2024 11:29 am

Lord Bethell is demonstrating a deliberate a wilful ignorance that is typical of the culture of the modern political class.
Rather than engage with reality, it is best to just deny it and not talk about it.
Another contract imposition looms. It is clear the current government are morally and intellectually bankrupt. It seems pretty clear that NHSE also suffers the same problem – they are in a mess with no idea bnow to solve it apart from destroy general practice (for seemingly obscure and totally mad reasons) and throw as much money as they can get from the Treasury at secondary care.
We have one chance left: that a change in government brings in a more rational group of people who are willing to ignore NHSE and take a fresh look at the real problems (one of which is NHSE itself).
If that doesn’t happen, the NHS is doomed – and we have to look at other options, outside of the NHS.

Farrah Azam 28 February, 2024 4:32 pm

“there’s a much wider group of people who have professional training who should be respected, celebrated – they shouldn’t be denigrated, they shouldn’t be in any way patronised by other professionals.” i wonder if lack of insight is classed as a small problem?

Keith M Laycock 28 February, 2024 5:40 pm

Re Francis Campbell’s comment: – “The Munro guy ain’t a doctor” – Is that facially true or just an opinion – as in, how could Munro make such a comment if he was a Doctor?

Zack Magkrachi 28 February, 2024 6:08 pm

What we are witnessing here is the final outcome of a plan laid down by Maggie all those years ago. First came the miners….capitalism gone rogue.

Anthony Gould 29 February, 2024 7:24 pm

The level and quality of decision making by GPs is often very high
Using less qualified and less experienced allied health care professionals adds risk and will likely ensure more patients will be unnecessarily referred to secondary care at financial and service capacity costs which exceed their clinical effectiveness and downgrade safety in hospital acute medical care
Just wait for the research to come once this bunch of self serving political party has sailed into oblivion having salted the ground for the NHS and for the country

John Campbell 5 March, 2024 2:19 pm

Gross, crass ignorance – sadly typical of this present Government’s approach to healthcare. Saving the NHS is going to require a complete change of approach. Lord Bethell appears entirely ignorant in respect of what GPs contribute on a day to day basis – I’d be delighted if he would join me for a clinical session. I have no political allegiance but this Government and it’s predecessors have, self evidently, wrecked every public service in the UK – health. police, councils, education, social care. To save the NHS we need a radically different approach to thinking, planning, funding, and delivering health and social care – and one that starts with basic respect for the primary care team and for GPs who are seeing 1.2 million patients every single day. Without their input, the NHS would not survive for more than 3 days. The clear direction of travel is to undermine General Practice – taking it in a similar direction to Dentistry (and look at the shambles they have created there…..)
Professor John Campbell MBE MD FRCGP , Exeter