Charlotte
@Cray_tweets1
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Employment lawyer in litigation. Interested in politics, policy and the NHS. MA (Cantab)
London, England
Joined November 2023
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According to this, I could theoretically become a GP partner in 5 years, starting from scratch.
This is quicker than an actual doctor who has just graduated from medical school would be able to (if they can even get a training place).
How this can possibly be right?
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I have today learned that there are ACPs & ACCPs working in EM & ICU in *exactly* the same roles as doctors but being paid more for less hours.
I’m not convinced this is lawful, but even if it is, how is this fair and why have doctors accepted it?
@Cray_tweets1
2/2 This is one big reason doctors (appropriately IMHO) get really angry about this. ACPs just starting working are generally paid more for less hours (40 vs 56/wk) than registrars on the same tier. They also aren't forced to move hospital every 6-12 months.
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@timricketts_
@amateuradam
Hate to be a broken record but the fact that a newly qualified doctor earns less than a newly qualified physician associate is still something I cannot fathom.
It led me down a rabbit hole to try and understand what on earth is going on in the NHS and I’m still here 😭
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Of everything I’ve seen, this might be one of the most jaw-dropping.
8 weeks of actual in-person training and assessment to become a physician associate?
8 weeks!!
This is what happens when regulation is non-existent.
Surely the GMC can’t possibly sign off on this?
Not concerned about the Wild West that is current UK medical workforce planning?
Don’t know what the problem is… 8 whole weeks of in-person training and assessment. A medical degree is so boring and long after all.
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This job is open to ‘newly qualified’ PAs who will then ‘work on the junior medical rota’.
If this is safe for patients, why do Drs have to do 5/6 yr regulated degrees in medicine?
You don’t have to work in the NHS to see that this situation is nonsensical.
PA job applications from May 23
Duties:
‘The successful applicants will work on the junior medical rota in the relevant department’
I can respect them for being honest and up front.
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I work in law & I don’t understand this.
If a nurse can be trained to work autonomously performing complicated surgery, is there anything stopping them being informally trained to do the job of a medically trained surgeon?
Where is the line drawn? Is there is line anymore?
.
@theRCN
position statement on nurses as Surgical Care Practitioners:
Autonomous practitioners working at an advanced level of practice.
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The idea that a Training Programme Director doesn’t even need to be a medical doctor is astounding to me.
Given its importance, imo this role should be undertaken by a practising doctor on the Specialist/GP register and regulated by the GMC.
A GP Training Programme Director should be a GP.
It should not be a nurse who isn't even a doctor and hasn't got a medical degree.
How can you be in charge of training a profession you aren't part of?
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@Doc_IonaCollins
@jobbinggasman
@RCObsGyn
@parthaskar
@iDrSunny
@HelenRSalisbury
@carolvorders
@natalieben
@djnicholl
@doctor_oxford
@Dr_BellaR
@Dr_Done_
@Xeon4f145d96s1
@DrLindaDykes
@mmamas1973
This is crazy.
So theoretically after my degree I could have gone and done a PA course, worked in GP and begun seeing undifferentiated/undiagnosed patients with v light touch supervision yrs before a Dr would be allowed to do the same?
How can anyone argue this is ok?
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Do GPs need to be Drs anymore?
“Our PA Partner is working towards parity over a period of yrs, a period… which we strongly hope will see the regulatory changes progress enough for her to become an independent clinician, a status for which it’s clear she’s more than capable”
BJGPLife: Physician Associates in general practice: A positive perspective
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@BJGPjournal
I don’t see how this position is sustainable? Either a med degree plus foundation and GP training is required to be a GP or it isn’t? As a patient, I don’t see how the PA course plus informal unregulated/unstandardised postgrad training can really be deemed equivalent to this?
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Serious question, if this role can be done without a medical degree or postgrad psychiatry specialty training, then why do we require doctors to do those things?
Imagine waiting 2 years for a mental health assessment then being diagnosed by a PA with NO mental health experience after a 2 yr course .
The people of Wakefield deserve better
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It is *totally* unacceptable that Junior Drs have to spend their precious time, often for months on end, asking to be paid correctly and have issues resolved.
Paying employees correctly is a basic requirement of all employers, let alone the largest employer in Europe.
The NHS is setting out measures to improve the working lives of postgraduate doctors.
These include improving payroll accuracy, reducing admin burden and enhancing choice and flexibility with rotas.
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@iDrSunny
Aside from that, is it even appropriate for someone who is not actually statutorily regulated to have such a wide possible scope of practice? How has it been allowed to get to this point? It’s unbelievable to me that someone can perform these things without being regulated.
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@DrANChekroud
PAs, who are *still* unregulated, are intubating newborn babies?
What parent would ever in a million years consent to this if they knew?
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@IncogAssociate
@DocShivSharma
@Doctors_Vote
@Xeon4f145d96s1
@MichelePaduano
@TomStocks1982
@Doc_IonaCollins
@DocAnonX
@DrPhilBanfield
Just no. Show me any other professional qualification where people are examined by someone not in that profession who doesn’t have the same qualification.
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@JoOgidi
Sympathy? She’s a Cambridge educated barrister in one of the most important positions of public office at a time when the NHS is facing an existential crisis. If she’s not good enough for the job she shouldn’t be it in.
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This is a really good point.
Let’s say a newly qualified PA works in a GP for short period and then decides to train as a Dr. Will they be allowed to continue working as a PA in GP (as a locum) whilst also working for example as a non-GP Dr in training (something Drs can’t do)?
A fun brain teaser for you.
Imagine a medical professional who has dual registration with the GMC, both as a doctor and a PA.
Let’s call him “medical model Max”
Max has just qualified as a FY1 doctor. He decides to continue working the paeds registrar rota as a PA.
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Going to push back on this.
Where all else has failed, sometimes the only option is to turn to the legal system. And the beauty of this approach is that it cannot be ignored.
As for the motivations of lawyers, do we say it must be a ‘good time’ to be a Dr when people are sick?
Gosh. Doctors taking legal action against their regulator, who in return will take the traditional approach and spend same doctors money without limit on their own legal team. Good time to be a lawyer.
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@LittlePersonDoc
@RoshanaMN
This.
What on earth is happening in medicine in this country? Is this actually happening?
As a lawyer reading this, I have to tell you, it’s truly mind-boggling.
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@IncogAssociate
This is disingenuous.
I am curious how Drs making mistakes is a good argument for an unregulated role requiring significantly less medical education / exams /postgraduate training? And no recourse available to a regulator in the event of misconduct.
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@TomStocks1982
@wesstreeting
I’m don’t see how this can possibly be justified.
I seriously hope Labour address this asap because it is not sustainable and at some point I predict they will have no choice but to do so.
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@Ask_foradoctor
If PAs aren’t aware of all the possible diagnoses how can they usefully see undifferentiated / undiagnosed patients in GP? Surely the likelihood of getting it wrong and the patient returning for another appointment (or worse) is significantly higher than for an actual GP?
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There is an opportunity cost to training MAPs instead of Drs. Just because we can doesn’t mean we should.
“If a MAP should never be in a position where they’re expected to perform a particular task unsupervised, does it make practical or economic sense to train them to do it?”
'Are there limits on what people should be allowed to do in the medical or surgical field when they’re not a doctor and not training to be one?'
(Yes - including not taking out gallbladders)
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@Xeon4f145d96s1
I have been following this issue for a while on Twitter now and it’s the first time this has come to my attention.
Bizarrely and contrary to the narrative I don’t think there is any group that has suffered such a loss of professional self esteem as doctors.
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@IncogAssociate
@Xeon4f145d96s1
@RCPhysicians
@FPARCP
@gmcuk
I’m not sure whether you are misunderstanding this deliberately or not… but it’s really not elitist. It’s actually the opposite.
Everyone needs to be held to the same standards if they want to work in the role of a doctor ie a medical degree and then post grad training/exams.
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@jamie_wallis
@DrSteveTaylor
Yes - I mean equity partner in a GP practice.
Have you read the fine print? It says someone in months 0-12 would only need support similar to GP registrar???
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@profjimspeaks
@iDrSunny
I saw 1st hand as a trainee in clin neg that even cons Drs make mistakes.
Not sure that the ideal solution is an unregulated role with a fraction of formal medical training which is inexplicably allowed to anaesthetise, operate on & treat undiagnosed/undifferentiated pts?
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@gmcuk
Are PAs/AAs classed as medical professionals now? This seems to equate PAs/AAs with doctors. I worry that this will be misleading for many patients.
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@jobbinggasman
@RCObsGyn
@parthaskar
@iDrSunny
@HelenRSalisbury
@carolvorders
@natalieben
@djnicholl
@doctor_oxford
@Dr_BellaR
@Dr_Done_
@Xeon4f145d96s1
@DrLindaDykes
@mmamas1973
This can’t be real…. this is the most litigated area of clinical negligence.
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@ItsnotrightUK
Really? This literally makes no sense and is seriously concerning. Why should doctors not be allowed to apply to fill these shifts?
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@SecretPhysician
@DrPastry
@john_brittenden
@DrEilidhMaria
Bloody hell. Why are the doctors in positions of power going along with this? Do they not care? Are they that weak-willed? It’s baffling.
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@deborahgoshko
@DrEilidhMaria
This is very concerning indeed. What happens if there is a mistake? There are very good reasons that these things are so tightly regulated.
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@Dr_Done_
The concept of someone unregulated intubating a newborn baby is in itself *totally* unacceptable.
That they may not even be sufficiently qualified is incomprehensible.
What on earth is going on in the NHS?
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@DrPastry
@ASiTofficial
@RCSEd
@RCSnews
@gmcuk
@OrthopodReg
Sorry… what? How? This role is still not even regulated. Do patients know that a PA operating on them in not regulated so cannot be disciplined in the event of misconduct? This is truly mind-blowing stuff.
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A success story for who? It’s all very well that individual members of staff are doing a good job, but that’s completely missing the point.
People should be able to raise valid and legitimate concerns about large scale changes to delivery of healthcare in the NHS.
4/4 There's ample work and training opportunities for everyone while keeping patient safety at the heart of what we do. Ours is a success story that we encourage everyone to embrace and emulate.
@StGeorgesTrust
@ASiTofficial
@SWLNHS
@BAUSurology
@FPARCP
@NHSEngland
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@UMAPsUK
1/ Drs owe a duty of care first and foremost to their patients.
2/ A PA is *still* an unregulated role, with no regulator for patients or employers to report to if necessary.
3/ The BMA represents Drs. Drs supervise PAs so are collectively best placed to determine safe SoP.
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@jamie_wallis
@DrSteveTaylor
Looking from the outside it appears completely nonsensical.
The idea that it would be safe for me to do a 2 year PA degree and then work in a GP with ‘GP registrar’ level support is just preposterous.
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@Sunraged
@caroll_ste87889
@GMB
@susannareid100
@edballs
What about the fact that the patient thought she was seeing a Dr (did she give informed consent?), and was given an appointment with a PA twice in relation to the same issue, instead of a doctor.
It’s horrific.
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Have we reached the point that the consensus is that you don’t have to have a regulated degree in medicine and postgrad training & exams to entirely step into the shoes of a senior doctor?
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@VishwajeetP4t3l
@Jillyphys
@JanetEastham
What do you mean ‘if it was intentional’? Are you suggesting someone can ‘accidentally’ prescribe a controlled drug? Come on now.
It shouldn’t even be happened once, let alone 22 times in 7 months!
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@andycatherall1
@LeanneHPatrick
@Statsjamiefact
This is the argument that it’s better to see anyone than no one.
I don’t accept that.
We have thousands of Drs who want to train as specialists but can’t and also who are leaving the country every year. We have unemployed GPs despite patients waiting weeks to see one.
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@DocShivSharma
@Doctors_Vote
@Xeon4f145d96s1
@MichelePaduano
@TomStocks1982
@Doc_IonaCollins
@DocAnonX
@DrPhilBanfield
How can you be an examiner for a practical exam you’ve never even had to pass? Why are any doctors enabling this?
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@timricketts_
I know! I’m angry for you too.
I have been following this pay issue for a while now but it’s the first time this pay differential with ACPs/ACCPs doing exactly the same role as some Drs has come to my attention! I’ve seen so much about PAs not nothing about this.
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@DrEilidhMaria
This is a really good point. The criticism largely is and should be of the role & its implementation by the various govt institutions involved, not of the people working in it. It’s clearly very difficult & uncomfortable though.
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@Bonivorlewis
@Adam_Skeen
@DrInsurgent
@DrLindaDykes
@fiercerabbit2
@jewett6a
@iDrSunny
The fact that there is nothing to stop an employer recruiting someone to work as a PA who hasn’t even passed the PA using taxpayer £ is just 🤯. There comes a point where it’s hard not to believe that the govt is complicit in this.
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@scarymonstertwo
I don’t work in healthcare at all and my point isn’t that ACPs don’t deserve their pay, but that if they are working in exactly the same roles as some junior Drs but earning significantly more that does appear to be a problem that needs addressing by increasing Dr pay.
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@medicalmodelbri
@JanetEastham
@carolvorders
@parthaskar
@Dr_Done_
@NHSEngland
@ExplosiveEnema2
So I could do a PA degree and potentially be applying to this after 2 years….
Meanwhile if I wanted to do medicine it would take an extra 2 years for grad medicine, plus 2 years FY1/2, plus a successful application to specialty training.
Make it make sense?
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@Sunraged
@JTibballs
@GMB
@susannareid100
@edballs
This is not true. PAs remain unregulated and have done since the role was created. This means patients have no comfort that misconduct will be investigated and sanctioned by a regulator.
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@John_for_hope
@vinniemcdermott
@DrNeenaJha
Not true, there are 1000s of drs out of training/ leaving the NHS due to bottlenecks.
Why do we need to reduce educational & training requirements and create an entirely new role (which still remains unregulated to this day) to widen access to medicine?
It makes no sense.
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@cjsnowdon
Speaking of money, do you think it’s economically efficient for the starting salary of a physician associate to be £11k higher than a doctor’s?
(Hint: it’s not)
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@DocShivSharma
Sorry… meaning that there could potentially have been no medical doctors on the examination panel?
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@StarbuckToby
@rhiannonlucyc
Jesus wept.
‘Natural birth’
‘Unnecessary surgical intervention’
Tell me you don’t understand maternity care without telling me you don’t understand maternity care.
You’re not an ally at all.
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@Xeon4f145d96s1
@rcpsych
Let me get this straight: the trust is letting go of a lesser paid JD to employ a lesser qualified but more expensive PA, courtesy of govt funding?
It’s honestly breathtaking.
The PA element of this is just the cherry on top of the cake to highlight the absurdity of it all.
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@DrEilidhMaria
If there are some people who now believe you can effectively step into the shoes of and do the same job as a surgeon without a medical degree or post grad training, but through some other training, they should admit that openly and be required to justify why.
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@Dr_Done_
This is completely nonsensical.
So if they make a mistake does that mean the patient can hold them to the same standard the registrar would have been held to?
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@goldstone_tony
@_VivekTrivedi
@RobLaurensonD4P
@Vish_Sharm
@trentconsultant
@DrPhilBanfield
@ERunswickBMA
@Doctors_Vote
@BMA_JuniorDocs
@NHSMillion
@10DowningStreet
This is unconscionable.
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@MohsenSubhani
@UKGastroDr
@DrAsifQasim
@SyedGerdezi
@BritSocGastro
Pressure from higher up I imagine.
Training PAs to replace Drs reduces Drs’ bargaining power. More easily controlled workforce, cheaper in the short term. A way to usher in private healthcare thru the backdoor as those with £ vote with their feet.
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@andycatherall1
@LeanneHPatrick
@Statsjamiefact
I don’t agree. I am a patient and I put my trust in Drs and indeed all HCPs to not expose me to unnecessary risk. Allowing capacity to expand at the expense of safety is just going to end in a whole raft of disastrous outcomes and negligence claims.
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@medicalmodelbri
A PA student posted this on their Instagram unredacted?
Unless done with explicit consent (would be v surprised) this is absolutely disgraceful and needs to be reported.
This makes me feel sick. If someone did this to me…well, good luck to them. Poor patient.
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@doctor_katie
@BMA_GP
This is unbelievable. At a time when it’s increasingly difficult to see a GP. This government has so much to answer for. What they’ve done to the NHS is beyond shameful.
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@Shamz_141
@Dr_Done_
How can this position be maintained once PAs are statutorily regulated by the same regulated? It’s completely indefensible. I don’t see any reason the GMC could sanction an F3 for doing this if they wouldn’t a PA.
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@andycatherall1
@LeanneHPatrick
@Statsjamiefact
I would also argue that allowing people who are under qualified to treat patients will expose them to further risk and likely harm, and will cost the NHS even more £ when things inevitably go wrong. It would be more cost effective to just retain and train the Drs we have.
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Coming from someone who will almost certainly only be treated by consultant doctors and privately.
I don’t believe you care one jot about patient safety, the NHS or even PAs.
Shame on you.
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@JanetEastham
@DrPhilBanfield
If this is true it needs to be reported and investigated by the police.
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@DrEilidhMaria
Is this actually already happening or planned to happen? Absolutely beyond belief.
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@ExplosiveEnema2
@Dr__Chloe
@19MW98
@DrHuw
Is this a lawful way to prescribe medication? Who has signed off on this as being so?
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@JoOgidi
@parthaskar
@DrEilidhMaria
@NHSEngland
I can see the nuance/distinction you’re trying to draw but I think the reality is that if the trust would have otherwise had to pay for a locum Dr to step in, you are effectively replacing them. If you are supplementary to the doctors, then you aren’t. Do you see the distinction?
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@medicalmodelbri
Where on earth is this from?
It is so concerning that anyone would think it is safe or in the best interests of patients to step into the shoes of a GP and act as a doctor in all but name despite having not done a medical degree or post grad GP training.
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@RoshanaMN
@RCPhysicians
I don’t want to sound like a conspiracy theorist, but surely something deeper is going on here or it doesn’t make any sense. Maybe they cannot afford (literally) to not proceed as planned.
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@Statsjamiefact
@LeanneHPatrick
I’m also a patient, not anon, and it definitely works both ways as I have now experienced personally. These are difficult and uncomfortable topics. I don’t agree with individuals being personally attacked but the institutions/ the system need to be held to account.
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@LeanneHPatrick
Leanne, I have to say I disagree. At the very least I am concerned about the disparity in pay between junior doctors and PAs/AAs and the implications of this given potential differences in demographics of these two groups.
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@quackophage
@RCObsGyn
In what context is a physician associate comparable to an ST1/2? Is there no need for medical degrees or postgraduate specialty training anymore? Who is writing / signing off on this stuff and why? I just don’t understand. Can anyone explain this?
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@james_bedford
@bjemec
@ExplosiveEnema2
@DrSarahClarke
This sounds v challenging.
I don’t understand why you cannot have more Drs but the trust can afford a (likely more expensive) PA? Do you know why? It doesn’t make any sense to me.
Hypothetically speaking, if you could use that £ for more Drs instead, would you?
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“Either all staff in general practice seeing undifferentiated patients adhere to the set standards of medical school, vocational training, traineeship, and exams or none of us do. Holding doctors to a different set of standards is illogical.”
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@TomKat56184663
@RCPhysicians
@rcgp
These are the contributors.
It’s utterly mind-boggling. I still can’t believe it’s a genuine document.
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@EileenBurns13
Is there any other unregulated role in the nhs that is allowed to work in the way PAs appear to be, for example in GP surgeries? Looking at this from the outside and as a patient, it is extremely concerning.
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I’m reluctant to say this would never happen in law, but I can’t see it because the entire industry is very tightly regulated (as in the actual law firms themselves and everyone working for them is regulated) and there is just no incentive for this to happen.
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@GorillaGardner
Seems a bit unnecessary to personally insult me from an anon account for asking questions/raising issues in good faith. Why not just engage with the content of the tweets if you disagree with them.
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@DrAsifQasim
@TrinCollCam
Trinity are allowing their med students to be supervised by PAs at GP and hospital placements? If this is true and I have no reason to assume otherwise… wow 🤯
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@LukeAmos__
It’s so plain as day at this point what the true intention of the govt is. None of this is by accident it’s by design to create a 2 tier healthcare system.
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@medicalmodelbri
@NHSEngland
@rcpsych
@mencap_charity
What gap are they filling that couldn’t be filled more efficiently by more actual medical doctors in the form of psych trainees?
Make it make sense.
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@LeanneHPatrick
@GaryNosam
@Advclin
@cannula_service
The thing is we are already at the point. The real consequences are already happening, take it from me as a patient. Drs’ pay is so far from the private rate that there’s not even a comparison. The only option is to restore Drs pay, or in the long run we’ll all pay even more.
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@Xeon4f145d96s1
@JanetEastham
What on earth? Surely not. This is horrifying.
And there is still no regulator who can investigate and sanction misconduct 🤯
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@DrPastry
@SecretPhysician
@john_brittenden
@DrEilidhMaria
Of course, but why are they going along with it. I accept it may be v difficult to resist if the govt is hell-bent on this direction of travel but it’s hard to understand the lack of push back.
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@IncogAssociate
@Xeon4f145d96s1
@RCPhysicians
@FPARCP
@gmcuk
That seems to suggest that the only things a doctor can do that a PA can’t is prescribe and request ionising radiation?
Is there any other difference to your mind?
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@Gastrografin2
@michael_mul1
This person supposedly qualified as a PA 2 years ago and they are openly equating their standards with that of a qualified GP?
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@EMTDocAndie
So we currently a situation where two people could be working in exactly the same role in the NHS, with their training and role regulated by completely different regulators with no formal standardisation, and being paid completely differently. If so that is very troubling…
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@doctor_dru_
Because of doctors’ perceived power/status in society people seem to have a hard time believing that they could be treated so poorly by their employer. Unfortunately no one is immune from this, especially if their employer is a v large public body like the NHS.
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@GorillaGardner
You may not realise but legal issues like this are extremely complex. Many £m of pounds are spent litigating employment issues against the govt/public bodies & large corps every yr.
As I said, even if it is technically lawful, it doesn’t make it fair or right.
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@glambystefania
@timricketts_
@lifeoftazza
I don’t work in healthcare but are you suggesting that upon graduating PAs are as qualified in the field of medicine as a doctor who has completed a degree in medicine?
FYI many doctors also have prior degrees in science…
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@Xeon4f145d96s1
@OcoRory
@ollieburtonmed
@timricketts_
@ExplosiveEnema
Yep. I honestly don’t think many people have fully comprehended the full scale what is going on with junior doctors in the NHS at the moment. Probably because it’s all so absurd it’s hard to actually believe.
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@cannula_service
@ExplosiveEnema2
@Dr__Chloe
@19MW98
@DrHuw
How can you safely delegate this level of responsibility/decision making re the prescription of anaesthesia drugs to someone who doesn’t have their own prescribing rights and is not even statutorily regulated?
This is in effect giving prescribing rights by the back door.
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