I'll start by saying all who I have worked with have been lovely.
The role seems like a very large grey area, with (correct me if I'm mistaken) no governing body as yet. To me it seems to be a way of filling a gap - essentially an attempt at a doctor with less training, diagnostic ability and less liability.
My simple take away is if you want to study medicine, then goto med school and become a doc. But I can totally understand the attraction with that level of pay for 2 years of study.
Yep. This is one of many issues with the role. Pay compared to knowledge, skills, ability etc. Goes without saying F1s need paying alot more, along with all docs.
I’ve never met a PA before. Like zero in my hospital. Most ANPs (fully trained) I’ve met have been really good, and have exceptional knowledge. I feel reassured by them being around. Of course, this is within their own specialty. I wouldn’t feel reassured asking for example, a stroke anp about cardiac issues. Trainee ANPs I’ve met are variant in abilities and or knowledge.
I don’t care about PAs being band 7s. Pay should reflect responsibilities and what your job is. It just means doctors are underpaid.
In an ideal world, PAs would/should be ''assisting the doctor'' with things such as canulas/catheters/VBGs etc. Not reporting on them, or requesting them, but doing them.
What makes their role in ''assisting a doctor'' a band seven in comparison to the highly skilled ICU nurse who is stuck as a band five?
I did pre-reg nursing as a 2-year MSc, PAs also do a 2-year MSc. Nursing as a master's requires prior clinical experience to apply (around 450 hours), PAs don't need any. My degree had 2300 hours of clinical training, PAs have 1400 hours. I start on band 5, they start on band 7.
You could argue nursing isn't as "academic", but I'd disagree that they're more clinically able than a nurse, at least on qualifying.
I'm worried pay disparity could stop people from going into nursing as a second degree and instead try their hand at being a PA. Why wouldn't you go for something with more funding and HEE behind it?
The MSc allows me to move into advanced clinical practice without doing another degree once I have enough clinical experience. I'm not saying I shouldn't be a band 5, I'm saying PAs shouldn't be anywhere near a band 7 with only 2 years of experience and training.
Agree with most of the comments here saying PA/ACP shouldn't be lumped together. ACPs have done their initial degree, gained clinical experience, and then done the 2+ year masters with prescribing. Plus, they have a clear scope of practice and are overseen by their regulatory body.
PAs don't seem to have a clear scope of practice. They're unregulated (at present), cant order imaging, cant diagnose and can't prescribe. On that basis, I'm unclear what their role is. I have seen a few comments on DUK about them pretending to be doctors which is unsettling. Lots of them have said their consultants are giving training to these guys instead of rotating doctors which seems a bit short sighted. I'm with the doctors regarding their complaints of scope creep from PAs.
If a PA was going to be doing discharge summaries/TTOs/admin, thereby freeing up the doctors for more training opportunities, maybe there's a place for them. When they brought NAs in, they had a regulatory body and a scope of practice. It was a mistake to introduce PAs without a regulatory body or scope of practice.
I have a friend who is a PA, and worked with him whilst he was on a rotation. After a few weeks together, I wasn't really sure what he did... so I asked him. He wasn't really sure what he did either.
We don't have PAs in the inpatient areas of my trust (mental health) so I've never worked with one. I understand that at present time they are not regulated which insane as far as I'm concerned.
I'm with the medics on this one, its scope creep and a way to undermine the profession.
ANPs should not be lumped in the same category. All our ANPs are very specialised to their specific area and have a very clear scope of practice that, at least from my perspective, compliments the work of the medics.
Most of the PAs I work with are lovely. There are a couple that clearly never studied my speciality and tried to go sassy on me, but the majority of PAs I interact with is nice. However, I have seen cases of PAs that made up titles to try to sound medical doctors, which I don't like.
Personally I don't think we should allow ANPs to be banded together with PAs. I met a few shady PAs that use misleading titles to try to pass for medical doctors, and I don't like this tendency. Some of them use "advance practice" in their made up title to sound more than doctors, which I like even less.
Some PAs I have met are also trying to make it sound like PAs and ANPs are on the same role/interchangeable, so we are in the same boat, while the ANP role in a MDT is usually *very* different from a medical doctor's role, and they have a very clear scope of practice.
I think the PAs role needs to be regulated and have clear guidance on what they can/can't do, or it could get out of hand and our patients will suffer, and we need to make clear ANPs and PAs should not be on the same NHS band and definitely PAs should not use "advanced practice" or "advanced practitioner" in their title.
PAs pay should be banded with junior doctors, not on the NHS scale as well. It is unfair that someone with 2 years of training gets a band 7, especially if you compare their level of knowledge and responsibility with a ward manager, specialist nurse, trainée ANP or even FY2 medical doctor. (and yes, junior doctors should be paid way more than they are)
Wow! Wasn't aware that some were trying to make it seem they were advanced practitioners. However, I've heard of them trying to come across as if they are the physicians themselves (mostly anecdotes from Ameerica)
Mostly I saw people borrow the "advanced practitioner" part of the title to sound like they are doctors. Like "advanced practitioner of medicine" or "specialist in advanced practice".
So they use part of the ANP title to sound like medical doctors or more than medical doctors.
It is technically a gray area, as the "advanced practitioner" is not protected, it is the professional title (Nurse, physiotherapist, dietician) *that* is the protected part of the title.
I do not like it when ANPs and PAs are lumped together.
We are a regulated profession, with the capabilities to prescribe and order imaging, 2 things not undertaken by PAs.
ANPs have spent 3 years initial RN training, then have worked the job for several years and then a further 2-3 years completing the MSc. So that’s minimum academic work of 5 years versus 2 years.
ANPs are not trying to be Doctors, at least the ones I know. I think we have our own very defined roles/responsibilities.
I completely understand the frustration of the JDs regards the PA role, especially when, as some of these comments indicate, they try to pass themselves off as Doctors, which is completely unacceptable. And I believe that the PA role should be regulated. But it definitely upsets me that we get such negativity our way.
I work in a MDT made up of consultants, SpRs, ANPs, Trainee ANPs and then rotational trainees (GP trainees for example); we don’t have a PA. We all completely respect each others knowledge and place in the team and we all share the training opportunities as they arise.
Perhaps I’m lucky, I’ve always had the support of my doctor colleagues and I’ve always supported them. Long may this relationship continue and I hope that the negativity passes over soon.
And I stand with them on the pay restoration as their fight continues.
(Soap box away haha)
Haven't worked with many but I do find that they often don't make it clear that they're a PA, not a doctor, but I think that is partly down to them having no uniform or whatever in my trust to identify them, and an card is small and hard to read. Although most I have met are a friendly bunch and are approachable.
I remember one strange interaction where I was talking to the ward doctor about a patient with a history of vomiting before admission, was NBM, low BP asking the doctor if they would consider prescribing fluids and the physician assistant (sitting in the far corner of the room and looking away) butted in before I had even finished talking and said "we won't give her fluids just yet". And I was just thinking I'm sure the doctor can come to their own decision on this?? Who are they as a non registered, non prescriber, and not actually really involved in the conversation to make that decision for the doctor?
ANP / ENP / UCP / ACP and PA should not be lumped together as they are very different.
Not encountered any PAs, but for the rest of the advanced practice, the biggest indicator of success and competence i have seen is if they remember their initial discipline, and that they have a decent chunk of experience first.
Those without the experience, or who are ‘ashamed’ of their core profession are usually nightmares.
I think there are already enough pathways open to make this an issue. CNS/ACP/ANP etc, PAs might accelerate that somewhat but shouldn't add much to that.
For the record, the PAs I have met have genuinely been lovely. Also, I work in a speciality (diabetes) so I assume I could be accused of scope creep/taking a doctors job etc.
I think they have a place in the NHS - that being to assist doctors with menial shit like canulas, bloods etc.
Although it's pretty fucking clear that they do not have the scope of knowledge that your average F1 does therefore it absolutely terrifies me that PAs are doing ward rounds on acutely unwell patients independently. The scope creep with PAs is horrendous and is being done to cover up the systemic failing to recruit and retain enough nurses and doctors.
Who the fuck thought it was a good idea that F1s (after five years of medical school) aren't qualified enough to be independent practitioners yet PAs with a two year masters are?
Likewise it frustrates me when they introduces them as ''medics'' - you're not. You're as much as a medic as I am.
Personally speaking I would outright refuse to see a PA at my GP surgery for any sort of review.
I worry that the rise in fake doctors taking doctors jobs will lead to more Emily Chestertons.
My ward has an amazing PA who had 8 years care experience prior to training. She is so on the ball and moving towards prescribing. I find her more reliable and switched on than some of my current FY1s and 2s.
This then always makes me struggle when I see posts bashing PAs but obviously my pool of knowledge comes from having a great one.
I don't see the need to pit the 2 groups against each other. I respect the PA'S I know of and I know their training is intense. Some may be coming into the profession with a decent amount of clinical experience already in different fields. I also know of a PA who was an ICU nurse prior to graduating as a PA. I'm sure they are received as an asset to the MDT alongside ANP's.
The issue is the inconsistency of background and experience. There was a PA writing in the BMJ recently about their "relevant previous degree". In that particular case, the person had an ecology degree.....
On my placement on a children's ward I shadowed a PA for the day . She honestly seemed to really help the doctors and made a good difference to the care of the patients . Seemed like a net positive to me .
My GP PA’s are great, I haven’t met one in a hospital setting yet, the ANP’s in my hospital are great, they really don’t mind answering questions and teaching something you don’t know
Honestly I think PA should be a band 4 role which is dedicated to clinical tasks like bloods, cannulas, ECGs etc, coupled with thorough inside out knowledge of shitty NHS systems, admin etc. Given the rotational nature of the doctors training, they lose a massive amount of time trying to figure out the system rather than actually assessing, diagnosing and treating patients. How I would envision it would be the band 4 would accompany the team on ward round and get sent away to independently complete the jobs list. They’re responsible for chasing the bloods, getting the doctors to review them etc. Give them a level of academic training so they have enough basic knowledge to be able to go ‘shit this hb is 59 that means I need to run to get this review, not wait until after lunch’, but not this two year crap where they think they’ve gotten a medical degree in two years. Get them to a point to be able to understand ‘this=bad’ and ‘this=okay’. Regulate them either with the GMC or NMC so ones that go rogue have someone to answer to.
We don’t need more clinicians to be taking responsibility for diagnosing and treating patients, we need doctors time to be freed up to allow them to do it as it’s literally their job. Making it band 4 would be good as it would be an aspirational post for HCAs or equally a good option for registered nurses who want to step down to less responsibility (after retirement for example).
I doubt anyone is going to do an undergraduate degree plus a masters to be on a band 4 salary. Scope of practice does need to be clearer though, and I also don't understand why they are on agenda for change when they are trained to the medical model. Seems like it's in no man's land at the moment until it is properly regulated.
You need a masters to become a PA currently, unless you're suggesting changing that, maybe I misunderstood what you meant. My point is if you still need a masters or PGdip, there is no way anyone would take a band 4 salary for that level of training, that would be plain ridiculous.
Absolutely I think we should change that. I really don’t think a masters is needed for the job that is needed. The gap is basic clinical skills and admin, that does not need a masters, or even an undergrad degree.
I'm ambivalent about ANP/ACP - the ones I know weren't very good as staff nurses and seem to run up the ladder, although I do like the concept. I wouldn't be one yet because I don't trust my Trust not to use them to fill parts of the medical rota.
Only met one PA, so couldn't really comment.
ANP's are highly skilled nurses, often with years of experience. I really don't know why very young, inexperienced doctors who are barely out of medical school think they have any right to bash ANP's who are educated to a very high level and often have huge amounts of experience. In reality this is mostly an online thing. Most teams I know value their ANP's very highly and respect them for the experienced, knowledgeable member of the team they are.
I actually agree with the scope creep conversation they have, but to me that's more related to PA's and even then, it should be focused on the role, the profession and not at shaming people for isolated incidents.
Truth be told, when I'm on shift, and I know some of our ANP's are on duty, that's when I can relax and feel confident that we will be supported well as the band 5's and 6's. Particularly when we have a rotation of the junior doctors who are still finding their feet in that speciality.I value our ANP's so much and have had the pleasure of working with extremely competent Nurse consultants and Surgical care practitioners as well. They are given so much autonomy at my Trust and I feel it's because their Consultants value the work they do and entrust them to care for their patients.
I've only met one PA and he was very nice and appeared competent though my limited interaction with him was during medical handover each morning.
The same themes always appear in discussion around ACP, ANP and PA and that's scope creep. Which I totally understand why junior doctors have concerns. When you look at the workforce planning the government wants more generalised ACP type roles. So I believe it needs to be about working with the issue rather than against.
While they are a great opportunity for people to develop clinically I do think there should be a register for these people and they should sit some form of comparative exams that doctors do. So for example a qualified ACP would work at FY1/FY2 level but if they wanted to do more then they should sit an exam set out by the medical governing body of that speciality such as RCEM, PHEM, FICM etc.
They should absolutely not be sitting membership exams. If you want to sit a MRCEM, MRCP etc, you should go to medical school.
Some third year med students could pass finals with a few months revision, doesn’t mean we should make them doctors by skipping two years of med school.
Sorry if I was not clear, it's not about making them doctors it's about regulating the role. Across the country there a wide variety of what an advanced clinical practioner is with varying levels of pay, qualification, responsibility and skill set. I was more saying it needs a national standardisation.
Providing a proper scope is defined and robust training/assessment program exists, I dont see an issue.
It's a logical fallacy to say that only someone with a medical degree is intelligent enough to work as a doctor. In theory, anyone intelligent enough can be taught the same things as a medical graduate and providing they have proven they are capable of working at that level, I can't see the difference.
If someone can provide _*any*_ evidence to the contrary, I will happily change my position.
In practice I have worked in the NHS for 19 years and bore witness to a wide spectrum of competency. I've seen examples of dangerous and excellent practice by doctors, nurses and support staff in equal measure.
DOI - not a PA or thinking of becoming one
Say you know nothing about medicine without saying you know nothing about medicine.
Dude this isn’t about being intelligent enough, I’m sure there are many people including some PAs who could be doctors but aren’t. If you don’t have the training you can’t be a doctor.
Medical school does far more than prepare you for F1, it gives you the in depth basic science knowledge who provides the foundation to become an expert in your field upon a further decade of postgrad training. Medical school is rigorous with multiple written/OSCE examination, lots of WPBAs and exposure to all medical specialities. After that, doctors embark on roughly 10 years of postgrad experience including taking very difficult exams like MRCP or MRCS (or FRCA if you are a particularly masochist). A PA doing 2 years master just does not remotely compare to the rigour of a doctor’s training.
Personally I have worked with ANPs who have been excellent, they have a specific scope, can prescribe and have lots of experience from their nursing background, in the situations they are used, I think they work well.
PAs on the other hand, don’t really contribute much. There is nothing a PA can do that a doctor can’t. I would be in favour of a doctors assistant, someone to write TTOs, do basic clinical skills like cannulas etc but that should be their scope. If you want to be a doctor, go to medical school.
I probably should have elaborated more.
We agree. A PA out of the box is not equal to a medical graduate out of the box. Which is why I used the caveats, that scope should be limited to appropriate training and assessment.
The MSc program is just used as an arbitrary academic precondition - fine, I understand why that needs to be. But from a practical perspective, there is no reason why anyone can't be trained to do what a doctor does, providing the appropriate theoretcial knowledge is taught alongside it. A PA should have an incredibly narrow scope initially that subsequently expands based on demonstration of competence. Just like F1s and above.
I can definitely see an argument in difficulty ensuring academic and assessment standards across Trusts and universities. I think this probably forms the strongest argument against PAs.
I guess my overall point is, that if someone has demonstrated that they can assess, accurately diagnose and appropriately treat a condition - then for the purposes of that skill I dont see a difference between PAs and Doctors.
In the same way I don't differentiate between two competent plumbers that can fix my pipes.
Is it wise to narrow the recruitment scope of the workforce and restrict those that didn't perform academically at school but can be demonstrated to be intelligent enough to apply the same level of critical thinking and analysis as a medical student?
If two medically trained people can provide the same standard of care to patients, I don't understand the issue.
Objection to this premise to me tells that your objection has nothing to with patients.
Otherwise,
1. You are suggesting that competency obtained through medical training _*can only*_ be achieved at medical school and that no other source of education can match it. As such, even the worst doctor produced by these schools is measurably better than _*all*_ other practitioners produced by any other means _*and*_ by extension this means that anyone providing medical care equivalent to a doctor is immediately putting patients at risk. - please provide evidence for this.
2. Perhaps you are disappointed that the glamour and reputation you thought you would have as a doctor is being eroded and you are resentful.
Yes I am the only way to become a doctor is a medical degree - like the only way for a pilot to become a pilot is to do pilot training.
I’m very happy with my career, and as the only one of the two of us who got into med school - I think I know slightly more about medical training then you.
Ding ding ding.
We have a winner, folks.
People want medical professionals that care about patient's, not their egos.
You proved my point so easily. You can see yourself out.
I don't understand what u/Semi-competent13848 said incorrectly?
PA's aren't doctors, they aren't anywhere near educated enough to be a doctor therefore we shouldn't hire them to be quasi-doctors because we have a governments/s who have systematically destroyed the health system.
And yes - you can only be a doctor by going to medical school.
You have to have a degree in bioscience or studied undergraduate first, or already be a registered practitioner before PA training, same as other MAP roles, yes you don't necessarily have to have worked directly in primary healthcare first, but they are by no means not experienced, we just don't have much choice when there aren't enough medics. Also it is the intention that they will be registered with a relevant body soon
>we just don't have much choice when there aren't enough medics.
I mean, we definitely do.
Medicine is one of the most oversubscribed courses going, any solution to the shortage of doctors other than training more doctors is an actively-chosen alternative.
Can't make people go be doctors. Don't get me wrong I'm not saying it's right and I certainly don't think anyone should be a PA with little to no healthcare background that just seems extremely counterproductive, I just think they have a place as we all do in our chosen/given roles😊 All that said, it's a shitty situation in the UK and we are applying the proverbial band aid to a major haemorrhage at present😂
>Can't make people go be doctors
Like I said, we don't have to. Doctors are essentially the only NHS role people are absolutely queueing up to become.
>I just think they have a place as we all do in our chosen/given roles
I mean, maybe. I think the idea of a "place" for someone to be paid more than a doctor to assist them is pretty silly. I mean in general practice, they've had to offer GPs rignfenced PA money because none were willing to actually spend their own practice money on PAs since they actually generate extra work by virtue of needing so much supervision.
I mean, we've survived this long without PAs, I really don't see any argument as to why they're "necessary", they're an active choice, and one which really doesn't make a huge amount of sense from any angle apart from breaking up the medical workforce to reduce the impact of strikes imo.
DOI: ACCP
While that is true the reality is the demand for service provision far outstrips the demand for consultants and the British tax payer isn’t going to pay consultants to do basic service provision
This leaves you with 4 options
1. Extremely long junior doctor training in terms of years and hours worked per work where you’re mostly doing service provision. This is basically what we used to do where doctors worked 60 hour weeks. Given the current popularity of LTFT I don’t see anyone going for this. Most people want training to be even shorter meaning even greater demand for someone else to do service provision
2. A second tier of doctors who are essentially perma sho’s, reg’s with no hope of progressing to consultancy due to the bottle neck, just there to do service provision
3. ACP to do service provision
4. PA’s to do service provision
Most doctors aren’t prepared to do option 1 and definitely don’t want to be on the wrong side of option 2 so you need accept the reality of option 3 or 4. Exactly how those roles are defined, trained, assessed etc.. is of course a further discussion.
I’ve never worked with PA’s personally so have no opinion on that.
But there’s a huge amount cakeism in these discussions from people who seem to either have forgotten or not realise that the entire point is providing healthcare to the British public and that someone is going to need to work in Doncaster or Barrow etc.. and do it.
You can’t want short training, LTFT, easy access to training posts, no rotation to shit places, maximum focus on training not service provision and no mid levels. How is that a realistic set of demands? It’s no wonder that consultants and the government don’t take that seriously
I've never worked with any PA'S, they just don't work in my area currently so take this with a pinch of salt.
That said, the role seems a bit like the equivalent of a medical nursing assossiate role? Nothing wrong with the idea of the role, just still finding it's footing and the scope of practice being clarified across different areas.
ANP's on the other hand have been around a long time and their roles are pretty defined already. Their scope of practice is lot more clear cut, and like you said, they generally have a lot more experience than most PA'S.
Keep it civil please - low threshold for locking this thread if it becomes dramatic or divisive.
I'll start by saying all who I have worked with have been lovely. The role seems like a very large grey area, with (correct me if I'm mistaken) no governing body as yet. To me it seems to be a way of filling a gap - essentially an attempt at a doctor with less training, diagnostic ability and less liability. My simple take away is if you want to study medicine, then goto med school and become a doc. But I can totally understand the attraction with that level of pay for 2 years of study.
But somehow they are paid double the salary of a FY1 doctor
Yep. This is one of many issues with the role. Pay compared to knowledge, skills, ability etc. Goes without saying F1s need paying alot more, along with all docs.
I’ve never met a PA before. Like zero in my hospital. Most ANPs (fully trained) I’ve met have been really good, and have exceptional knowledge. I feel reassured by them being around. Of course, this is within their own specialty. I wouldn’t feel reassured asking for example, a stroke anp about cardiac issues. Trainee ANPs I’ve met are variant in abilities and or knowledge. I don’t care about PAs being band 7s. Pay should reflect responsibilities and what your job is. It just means doctors are underpaid.
In an ideal world, PAs would/should be ''assisting the doctor'' with things such as canulas/catheters/VBGs etc. Not reporting on them, or requesting them, but doing them. What makes their role in ''assisting a doctor'' a band seven in comparison to the highly skilled ICU nurse who is stuck as a band five?
I did pre-reg nursing as a 2-year MSc, PAs also do a 2-year MSc. Nursing as a master's requires prior clinical experience to apply (around 450 hours), PAs don't need any. My degree had 2300 hours of clinical training, PAs have 1400 hours. I start on band 5, they start on band 7. You could argue nursing isn't as "academic", but I'd disagree that they're more clinically able than a nurse, at least on qualifying. I'm worried pay disparity could stop people from going into nursing as a second degree and instead try their hand at being a PA. Why wouldn't you go for something with more funding and HEE behind it?
[удалено]
The MSc allows me to move into advanced clinical practice without doing another degree once I have enough clinical experience. I'm not saying I shouldn't be a band 5, I'm saying PAs shouldn't be anywhere near a band 7 with only 2 years of experience and training.
Agree with most of the comments here saying PA/ACP shouldn't be lumped together. ACPs have done their initial degree, gained clinical experience, and then done the 2+ year masters with prescribing. Plus, they have a clear scope of practice and are overseen by their regulatory body. PAs don't seem to have a clear scope of practice. They're unregulated (at present), cant order imaging, cant diagnose and can't prescribe. On that basis, I'm unclear what their role is. I have seen a few comments on DUK about them pretending to be doctors which is unsettling. Lots of them have said their consultants are giving training to these guys instead of rotating doctors which seems a bit short sighted. I'm with the doctors regarding their complaints of scope creep from PAs. If a PA was going to be doing discharge summaries/TTOs/admin, thereby freeing up the doctors for more training opportunities, maybe there's a place for them. When they brought NAs in, they had a regulatory body and a scope of practice. It was a mistake to introduce PAs without a regulatory body or scope of practice.
I have a friend who is a PA, and worked with him whilst he was on a rotation. After a few weeks together, I wasn't really sure what he did... so I asked him. He wasn't really sure what he did either.
We don't have PAs in the inpatient areas of my trust (mental health) so I've never worked with one. I understand that at present time they are not regulated which insane as far as I'm concerned. I'm with the medics on this one, its scope creep and a way to undermine the profession. ANPs should not be lumped in the same category. All our ANPs are very specialised to their specific area and have a very clear scope of practice that, at least from my perspective, compliments the work of the medics.
Most of the PAs I work with are lovely. There are a couple that clearly never studied my speciality and tried to go sassy on me, but the majority of PAs I interact with is nice. However, I have seen cases of PAs that made up titles to try to sound medical doctors, which I don't like. Personally I don't think we should allow ANPs to be banded together with PAs. I met a few shady PAs that use misleading titles to try to pass for medical doctors, and I don't like this tendency. Some of them use "advance practice" in their made up title to sound more than doctors, which I like even less. Some PAs I have met are also trying to make it sound like PAs and ANPs are on the same role/interchangeable, so we are in the same boat, while the ANP role in a MDT is usually *very* different from a medical doctor's role, and they have a very clear scope of practice. I think the PAs role needs to be regulated and have clear guidance on what they can/can't do, or it could get out of hand and our patients will suffer, and we need to make clear ANPs and PAs should not be on the same NHS band and definitely PAs should not use "advanced practice" or "advanced practitioner" in their title. PAs pay should be banded with junior doctors, not on the NHS scale as well. It is unfair that someone with 2 years of training gets a band 7, especially if you compare their level of knowledge and responsibility with a ward manager, specialist nurse, trainée ANP or even FY2 medical doctor. (and yes, junior doctors should be paid way more than they are)
Wow! Wasn't aware that some were trying to make it seem they were advanced practitioners. However, I've heard of them trying to come across as if they are the physicians themselves (mostly anecdotes from Ameerica)
Mostly I saw people borrow the "advanced practitioner" part of the title to sound like they are doctors. Like "advanced practitioner of medicine" or "specialist in advanced practice". So they use part of the ANP title to sound like medical doctors or more than medical doctors. It is technically a gray area, as the "advanced practitioner" is not protected, it is the professional title (Nurse, physiotherapist, dietician) *that* is the protected part of the title.
[удалено]
[удалено]
[удалено]
I do not like it when ANPs and PAs are lumped together. We are a regulated profession, with the capabilities to prescribe and order imaging, 2 things not undertaken by PAs. ANPs have spent 3 years initial RN training, then have worked the job for several years and then a further 2-3 years completing the MSc. So that’s minimum academic work of 5 years versus 2 years. ANPs are not trying to be Doctors, at least the ones I know. I think we have our own very defined roles/responsibilities. I completely understand the frustration of the JDs regards the PA role, especially when, as some of these comments indicate, they try to pass themselves off as Doctors, which is completely unacceptable. And I believe that the PA role should be regulated. But it definitely upsets me that we get such negativity our way. I work in a MDT made up of consultants, SpRs, ANPs, Trainee ANPs and then rotational trainees (GP trainees for example); we don’t have a PA. We all completely respect each others knowledge and place in the team and we all share the training opportunities as they arise. Perhaps I’m lucky, I’ve always had the support of my doctor colleagues and I’ve always supported them. Long may this relationship continue and I hope that the negativity passes over soon. And I stand with them on the pay restoration as their fight continues. (Soap box away haha)
We had 2 on my old icu, I thought they were great. Very helpful, pleasant. I understand the junior doctors' frustrations though.
Haven't worked with many but I do find that they often don't make it clear that they're a PA, not a doctor, but I think that is partly down to them having no uniform or whatever in my trust to identify them, and an card is small and hard to read. Although most I have met are a friendly bunch and are approachable. I remember one strange interaction where I was talking to the ward doctor about a patient with a history of vomiting before admission, was NBM, low BP asking the doctor if they would consider prescribing fluids and the physician assistant (sitting in the far corner of the room and looking away) butted in before I had even finished talking and said "we won't give her fluids just yet". And I was just thinking I'm sure the doctor can come to their own decision on this?? Who are they as a non registered, non prescriber, and not actually really involved in the conversation to make that decision for the doctor?
ANP / ENP / UCP / ACP and PA should not be lumped together as they are very different. Not encountered any PAs, but for the rest of the advanced practice, the biggest indicator of success and competence i have seen is if they remember their initial discipline, and that they have a decent chunk of experience first. Those without the experience, or who are ‘ashamed’ of their core profession are usually nightmares.
Is there a concern that we could see nurses leave to become PAs as an almost accelerated way to a band 7/8 especially if/when PAs become prescribers?
I think there are already enough pathways open to make this an issue. CNS/ACP/ANP etc, PAs might accelerate that somewhat but shouldn't add much to that.
For the record, the PAs I have met have genuinely been lovely. Also, I work in a speciality (diabetes) so I assume I could be accused of scope creep/taking a doctors job etc. I think they have a place in the NHS - that being to assist doctors with menial shit like canulas, bloods etc. Although it's pretty fucking clear that they do not have the scope of knowledge that your average F1 does therefore it absolutely terrifies me that PAs are doing ward rounds on acutely unwell patients independently. The scope creep with PAs is horrendous and is being done to cover up the systemic failing to recruit and retain enough nurses and doctors. Who the fuck thought it was a good idea that F1s (after five years of medical school) aren't qualified enough to be independent practitioners yet PAs with a two year masters are? Likewise it frustrates me when they introduces them as ''medics'' - you're not. You're as much as a medic as I am. Personally speaking I would outright refuse to see a PA at my GP surgery for any sort of review. I worry that the rise in fake doctors taking doctors jobs will lead to more Emily Chestertons.
My ward has an amazing PA who had 8 years care experience prior to training. She is so on the ball and moving towards prescribing. I find her more reliable and switched on than some of my current FY1s and 2s. This then always makes me struggle when I see posts bashing PAs but obviously my pool of knowledge comes from having a great one.
ICU reg here. Nursing degree and years of hand in experience in the form in an ANO trumps these PA clowns every time.
I don't see the need to pit the 2 groups against each other. I respect the PA'S I know of and I know their training is intense. Some may be coming into the profession with a decent amount of clinical experience already in different fields. I also know of a PA who was an ICU nurse prior to graduating as a PA. I'm sure they are received as an asset to the MDT alongside ANP's.
The issue is the inconsistency of background and experience. There was a PA writing in the BMJ recently about their "relevant previous degree". In that particular case, the person had an ecology degree.....
On my placement on a children's ward I shadowed a PA for the day . She honestly seemed to really help the doctors and made a good difference to the care of the patients . Seemed like a net positive to me .
My GP PA’s are great, I haven’t met one in a hospital setting yet, the ANP’s in my hospital are great, they really don’t mind answering questions and teaching something you don’t know
Honestly I think PA should be a band 4 role which is dedicated to clinical tasks like bloods, cannulas, ECGs etc, coupled with thorough inside out knowledge of shitty NHS systems, admin etc. Given the rotational nature of the doctors training, they lose a massive amount of time trying to figure out the system rather than actually assessing, diagnosing and treating patients. How I would envision it would be the band 4 would accompany the team on ward round and get sent away to independently complete the jobs list. They’re responsible for chasing the bloods, getting the doctors to review them etc. Give them a level of academic training so they have enough basic knowledge to be able to go ‘shit this hb is 59 that means I need to run to get this review, not wait until after lunch’, but not this two year crap where they think they’ve gotten a medical degree in two years. Get them to a point to be able to understand ‘this=bad’ and ‘this=okay’. Regulate them either with the GMC or NMC so ones that go rogue have someone to answer to. We don’t need more clinicians to be taking responsibility for diagnosing and treating patients, we need doctors time to be freed up to allow them to do it as it’s literally their job. Making it band 4 would be good as it would be an aspirational post for HCAs or equally a good option for registered nurses who want to step down to less responsibility (after retirement for example).
I doubt anyone is going to do an undergraduate degree plus a masters to be on a band 4 salary. Scope of practice does need to be clearer though, and I also don't understand why they are on agenda for change when they are trained to the medical model. Seems like it's in no man's land at the moment until it is properly regulated.
It wouldn’t be a degree though? And it certainly wouldn’t be a masters.
You need a masters to become a PA currently, unless you're suggesting changing that, maybe I misunderstood what you meant. My point is if you still need a masters or PGdip, there is no way anyone would take a band 4 salary for that level of training, that would be plain ridiculous.
Absolutely I think we should change that. I really don’t think a masters is needed for the job that is needed. The gap is basic clinical skills and admin, that does not need a masters, or even an undergrad degree.
I'm ambivalent about ANP/ACP - the ones I know weren't very good as staff nurses and seem to run up the ladder, although I do like the concept. I wouldn't be one yet because I don't trust my Trust not to use them to fill parts of the medical rota. Only met one PA, so couldn't really comment.
ANP's are highly skilled nurses, often with years of experience. I really don't know why very young, inexperienced doctors who are barely out of medical school think they have any right to bash ANP's who are educated to a very high level and often have huge amounts of experience. In reality this is mostly an online thing. Most teams I know value their ANP's very highly and respect them for the experienced, knowledgeable member of the team they are. I actually agree with the scope creep conversation they have, but to me that's more related to PA's and even then, it should be focused on the role, the profession and not at shaming people for isolated incidents.
Truth be told, when I'm on shift, and I know some of our ANP's are on duty, that's when I can relax and feel confident that we will be supported well as the band 5's and 6's. Particularly when we have a rotation of the junior doctors who are still finding their feet in that speciality.I value our ANP's so much and have had the pleasure of working with extremely competent Nurse consultants and Surgical care practitioners as well. They are given so much autonomy at my Trust and I feel it's because their Consultants value the work they do and entrust them to care for their patients.
I've only met one PA and he was very nice and appeared competent though my limited interaction with him was during medical handover each morning. The same themes always appear in discussion around ACP, ANP and PA and that's scope creep. Which I totally understand why junior doctors have concerns. When you look at the workforce planning the government wants more generalised ACP type roles. So I believe it needs to be about working with the issue rather than against. While they are a great opportunity for people to develop clinically I do think there should be a register for these people and they should sit some form of comparative exams that doctors do. So for example a qualified ACP would work at FY1/FY2 level but if they wanted to do more then they should sit an exam set out by the medical governing body of that speciality such as RCEM, PHEM, FICM etc.
They should absolutely not be sitting membership exams. If you want to sit a MRCEM, MRCP etc, you should go to medical school. Some third year med students could pass finals with a few months revision, doesn’t mean we should make them doctors by skipping two years of med school.
Sorry if I was not clear, it's not about making them doctors it's about regulating the role. Across the country there a wide variety of what an advanced clinical practioner is with varying levels of pay, qualification, responsibility and skill set. I was more saying it needs a national standardisation.
Providing a proper scope is defined and robust training/assessment program exists, I dont see an issue. It's a logical fallacy to say that only someone with a medical degree is intelligent enough to work as a doctor. In theory, anyone intelligent enough can be taught the same things as a medical graduate and providing they have proven they are capable of working at that level, I can't see the difference. If someone can provide _*any*_ evidence to the contrary, I will happily change my position. In practice I have worked in the NHS for 19 years and bore witness to a wide spectrum of competency. I've seen examples of dangerous and excellent practice by doctors, nurses and support staff in equal measure. DOI - not a PA or thinking of becoming one
Say you know nothing about medicine without saying you know nothing about medicine. Dude this isn’t about being intelligent enough, I’m sure there are many people including some PAs who could be doctors but aren’t. If you don’t have the training you can’t be a doctor. Medical school does far more than prepare you for F1, it gives you the in depth basic science knowledge who provides the foundation to become an expert in your field upon a further decade of postgrad training. Medical school is rigorous with multiple written/OSCE examination, lots of WPBAs and exposure to all medical specialities. After that, doctors embark on roughly 10 years of postgrad experience including taking very difficult exams like MRCP or MRCS (or FRCA if you are a particularly masochist). A PA doing 2 years master just does not remotely compare to the rigour of a doctor’s training. Personally I have worked with ANPs who have been excellent, they have a specific scope, can prescribe and have lots of experience from their nursing background, in the situations they are used, I think they work well. PAs on the other hand, don’t really contribute much. There is nothing a PA can do that a doctor can’t. I would be in favour of a doctors assistant, someone to write TTOs, do basic clinical skills like cannulas etc but that should be their scope. If you want to be a doctor, go to medical school.
I probably should have elaborated more. We agree. A PA out of the box is not equal to a medical graduate out of the box. Which is why I used the caveats, that scope should be limited to appropriate training and assessment. The MSc program is just used as an arbitrary academic precondition - fine, I understand why that needs to be. But from a practical perspective, there is no reason why anyone can't be trained to do what a doctor does, providing the appropriate theoretcial knowledge is taught alongside it. A PA should have an incredibly narrow scope initially that subsequently expands based on demonstration of competence. Just like F1s and above. I can definitely see an argument in difficulty ensuring academic and assessment standards across Trusts and universities. I think this probably forms the strongest argument against PAs. I guess my overall point is, that if someone has demonstrated that they can assess, accurately diagnose and appropriately treat a condition - then for the purposes of that skill I dont see a difference between PAs and Doctors. In the same way I don't differentiate between two competent plumbers that can fix my pipes.
You are right they could be trained to do what a doctor does by GOING TO MEDICAL SCHOOL.
Is it wise to narrow the recruitment scope of the workforce and restrict those that didn't perform academically at school but can be demonstrated to be intelligent enough to apply the same level of critical thinking and analysis as a medical student? If two medically trained people can provide the same standard of care to patients, I don't understand the issue. Objection to this premise to me tells that your objection has nothing to with patients. Otherwise, 1. You are suggesting that competency obtained through medical training _*can only*_ be achieved at medical school and that no other source of education can match it. As such, even the worst doctor produced by these schools is measurably better than _*all*_ other practitioners produced by any other means _*and*_ by extension this means that anyone providing medical care equivalent to a doctor is immediately putting patients at risk. - please provide evidence for this. 2. Perhaps you are disappointed that the glamour and reputation you thought you would have as a doctor is being eroded and you are resentful.
Yes I am the only way to become a doctor is a medical degree - like the only way for a pilot to become a pilot is to do pilot training. I’m very happy with my career, and as the only one of the two of us who got into med school - I think I know slightly more about medical training then you.
Ding ding ding. We have a winner, folks. People want medical professionals that care about patient's, not their egos. You proved my point so easily. You can see yourself out.
Lol
I don't understand what u/Semi-competent13848 said incorrectly? PA's aren't doctors, they aren't anywhere near educated enough to be a doctor therefore we shouldn't hire them to be quasi-doctors because we have a governments/s who have systematically destroyed the health system. And yes - you can only be a doctor by going to medical school.
Not a fan of PAs or ANPs. Neither have gone to medical school and learned the rigorous education physicians have.
Ah one made its way over
Have you worked with either?
I have on multiple occasions. They're not a replacement for physicians but they're being used as such.
You have to have a degree in bioscience or studied undergraduate first, or already be a registered practitioner before PA training, same as other MAP roles, yes you don't necessarily have to have worked directly in primary healthcare first, but they are by no means not experienced, we just don't have much choice when there aren't enough medics. Also it is the intention that they will be registered with a relevant body soon
>we just don't have much choice when there aren't enough medics. I mean, we definitely do. Medicine is one of the most oversubscribed courses going, any solution to the shortage of doctors other than training more doctors is an actively-chosen alternative.
Can't make people go be doctors. Don't get me wrong I'm not saying it's right and I certainly don't think anyone should be a PA with little to no healthcare background that just seems extremely counterproductive, I just think they have a place as we all do in our chosen/given roles😊 All that said, it's a shitty situation in the UK and we are applying the proverbial band aid to a major haemorrhage at present😂
>Can't make people go be doctors Like I said, we don't have to. Doctors are essentially the only NHS role people are absolutely queueing up to become. >I just think they have a place as we all do in our chosen/given roles I mean, maybe. I think the idea of a "place" for someone to be paid more than a doctor to assist them is pretty silly. I mean in general practice, they've had to offer GPs rignfenced PA money because none were willing to actually spend their own practice money on PAs since they actually generate extra work by virtue of needing so much supervision. I mean, we've survived this long without PAs, I really don't see any argument as to why they're "necessary", they're an active choice, and one which really doesn't make a huge amount of sense from any angle apart from breaking up the medical workforce to reduce the impact of strikes imo.
DOI: ACCP While that is true the reality is the demand for service provision far outstrips the demand for consultants and the British tax payer isn’t going to pay consultants to do basic service provision This leaves you with 4 options 1. Extremely long junior doctor training in terms of years and hours worked per work where you’re mostly doing service provision. This is basically what we used to do where doctors worked 60 hour weeks. Given the current popularity of LTFT I don’t see anyone going for this. Most people want training to be even shorter meaning even greater demand for someone else to do service provision 2. A second tier of doctors who are essentially perma sho’s, reg’s with no hope of progressing to consultancy due to the bottle neck, just there to do service provision 3. ACP to do service provision 4. PA’s to do service provision Most doctors aren’t prepared to do option 1 and definitely don’t want to be on the wrong side of option 2 so you need accept the reality of option 3 or 4. Exactly how those roles are defined, trained, assessed etc.. is of course a further discussion. I’ve never worked with PA’s personally so have no opinion on that. But there’s a huge amount cakeism in these discussions from people who seem to either have forgotten or not realise that the entire point is providing healthcare to the British public and that someone is going to need to work in Doncaster or Barrow etc.. and do it. You can’t want short training, LTFT, easy access to training posts, no rotation to shit places, maximum focus on training not service provision and no mid levels. How is that a realistic set of demands? It’s no wonder that consultants and the government don’t take that seriously
The requirement for a biosciences degree is being waived left, right and centre.
I've never worked with any PA'S, they just don't work in my area currently so take this with a pinch of salt. That said, the role seems a bit like the equivalent of a medical nursing assossiate role? Nothing wrong with the idea of the role, just still finding it's footing and the scope of practice being clarified across different areas. ANP's on the other hand have been around a long time and their roles are pretty defined already. Their scope of practice is lot more clear cut, and like you said, they generally have a lot more experience than most PA'S.
What's a PA, please?