FPM's anonymous blogger shares their secret diary with thoughts on the Physician Associate consultation and where that could leave PA's, their Practices and their Patients. 

The NHS Consultation Process

The suggestion of a consultation process put forward by Wes Streeting has met with much derision. Why? I do not know.

I do not buy into the idea that this is being done as Labour have no ideas how to solve the crisis, and that during all the years in opposition they should have had things ready to implement.

I actually applaud the move and hope as many people as possible put in their views, as it can help educate the ministers and civil service on what reality is like.

Like most things in politics, people will always find issues with any policy and there needs to be consensus to prioritise which important issues need tackling first.

It is going to take longer than the 10-year plan to put things right; it is a pity that we cannot have a cross-party support policy for the next 20 years, so that if a change of government happens it is not back to the drawing board for a new idea on fixing the NHS.

So, as we face the Labour Budget this week, it will be interesting to see how the NHS will fare. The signs are good that increased funding is to be found, subject to changes in working practices.

There must be some changes in the working of the NHS, and I know we are all trying to protect ourselves. We may need to adapt to change, and should not criticise before we hear the facts. Can we honestly believe that we can just carry on as before because it suits us?  We are now being asked to be part of the question as to what we want off the NHS over the 10 years, so let’s not waste this chance of dialogue.

Physician Associates (PA’s)

The ongoing issues over the role of the PA and the BMA, GMC and RCGP stance rumbles on.  I think we need to look at the issue through several aspects:

(1)    From The PA's Perspective

The PA has a clear, definitive role within primary care to take some of the minor/routine issues away from clinicians.

When employing a PA, both sides must be comfortable with the role and the supervision needed to make the best use of the skills they were taught.

Following several high-profile issues, this role has been deemed by the BMA to not be working and should be phased out. Where that leaves the PA, and practices that have already employed them, no one really knows.

Sadly, mistakes happen with all types off clinicians and incidents may arise that could not have been predicted - so should we withdraw those clinicians as well? It makes no sense.

The new guidelines issued makes the viability of employing a PA (with basically everything being reviewed by someone else) an expensive resource not viable.

PA’s themselves feel let down and hung out to dry, and many are facing redundancies from a job they had trained for, and a job that will more than more than likely not now exist.

The point should be made that the role was never meant to be a replacement for a GP, but a part of the treating process; undoubtedly some surgeries have cut down on GP’s, but that is not really acceptable.

(2)    From a Practice Perspective

Those practices that have employed a PA have more than likely invested time and money into them, and have worked to train and support them, and manage the roll-out of them.

In most cases I am sure that they were monitored and supervised and that the guidelines followed.

From this perspective, and what they were being paid, it was of great benefit having a good PA in place. So, what happens now? It looks as though practices will need to look at making them redundant, or offering them another role within the practice.

These PA’s were highly paid and converting them into Health Care workers or admin staff will necessitate a large drop in salary.

Sadly, with what is being asked of surgeries to do with their PA - to virtually be with them the whole time - it is financially unviable.

Making someone redundant is never a pleasant thing to do but it is particularly sad when it is under these circumstances.

(3)    From the Patient’s Perspective

Patients are now very reluctant to see a PA following the very negative press. However, before the issue was blown up to where we are today, there was little resistance, providing it was clear the appointment was with a PA and that the right patients were being booked in to them. We had a lot of positive feedback with ours.

Where do we go from here?

It looks to me as though there is no way forward for this role. Sadly the current PA’s are going to be left without work, and I understand the upset by them for being thrown under the bus as a result of various incidents.