Undercover work at a GP surgery.

My once excellent GP's surgery is now not really fit for purpose. It's impossible to see a GP, being palmed off with nurse prescribers. My last appointment there (I've needed others, but not been able to get in) was with a NP.

I'm undergoing a surgery privately at some point, which I understand the NHS can't provide, because it's elective, but I did want to discuss it with my GP, to keep him up to date. But no chance.

SueDonim

I think it’s a post-graduate qualification so it’s not as if it’s 18yos doing it. I know someone who is qualifying about now and she has a first degree and a masters already in sciences.

www.birmingham.ac.uk/postgraduate/courses/taught/med/physician-associate.aspx#EntryRequirementsTab

Yes, it is, but a science degree doesn't qualify somebody to be a medic. Sorry, but I still can't think of one situation when I've seen a GP and anybody else could have done the same job.

I think it’s a post-graduate qualification so it’s not as if it’s 18yos doing it. I know someone who is qualifying about now and she has a first degree and a masters already in sciences.

www.birmingham.ac.uk/postgraduate/courses/taught/med/physician-associate.aspx#EntryRequirementsTab

www.bma.org.uk/media/2069/bma-principles-for-effective-working-doctors-and-maps-jan-2020.pdf

SueDonim

YEs, that’s wrong, to use them as a substitute. My dd is a doctor and she says so many people can be seen by PA’s and still be adequately treated. Though the hospital where she trained has pioneered PA training and usage so they’re probably at the cutting edge of the proper way to use their skills.

A PA can’t prescribe but they can ask a doctor to prescribe if eg they thought someone had a bacterial infection, and they can order tests etc. When I’ve seen one, it’s been obvious they are working hand-in-hand with a GP which doesn’t seem to be what’s happening at the practice in the Panorama programme.

I checked on the BMA site. PAs are currently not regulated, although the plan is that they will be by the end of 2022. I really find it shocking that it can be luck of the draw.

PAs can only prescribe if they have previously worked as healthcare practitioners and already have prescribing rights (I checked). It's not to do with the set up, but the individual's past training and qualifications.

But Nannarose your work was still protocolised (or should have been) in a way a GP's work isn't.

Sorry, another PS to growstuff:
I rather think that sometimes it depends on what personnel have what training. When I heard about PAs, I did wonder how they differed from Nurse Practitioners. My own impression (happy to be corrected) is that it is an idea imported from other countries. Some PAs started off as nurses, but I think some train as PAs right from the start because they don't want to do basic nursing.
Also wish we had an 'edit post' button as I've rather rambled!

PS: sadly, I also think that growstuff is right, but that is why we need to look at better ways of running our precious NHS

YEs, that’s wrong, to use them as a substitute. My dd is a doctor and she says so many people can be seen by PA’s and still be adequately treated. Though the hospital where she trained has pioneered PA training and usage so they’re probably at the cutting edge of the proper way to use their skills.

A PA can’t prescribe but they can ask a doctor to prescribe if eg they thought someone had a bacterial infection, and they can order tests etc. When I’ve seen one, it’s been obvious they are working hand-in-hand with a GP which doesn’t seem to be what’s happening at the practice in the Panorama programme.

I worked as a Nurse Practitioner (not in a GP surgery, but alongside) and my work was not routine. My speciality was children, and I took a much better history, taking time and understanding some of the complexities of life with children. I could observe for longer and notice things that doctors didn't have time for; I explained treatments, how best to administer, and took time to find out was was working well (or not, which can be important).
I was able to prescribe, and to have direct admission to the paediatric ward if I thought it necessary, and I would also advise on the best referral route.

I would perhaps describe PAs as more 'routine' work as they are used in GP surgeries. I do actually think that history taking and triaging is one of their most important uses.
Some PAs can prescribe, it depends on the set-up.
I am aware as I write this that I am basing this very much on my own experience, and maybe that is very different from the experience of some posters.
I suppose I wanted to make the point that we need medical teams, not just GPs to offer an efficient service, and poor practice doesn't help.

I guess this is the more efficient way of working the government wants, after Sajid David announced there is no new money for the NHS.

Meanwhile, private GP practices are popping up all over the place. When I've clicked to see who's working in them, I've recognised a number of names of GPs, who work (or have worked) in local practices. People aren't fobbed off with nurses or physician associates.

It seems quite simple. Make it incredibly difficult to see a GP, so people lose patience and pay to jump the queue. Genius!

Sadly our practice here has reduced hours after Covid. A friend took a sample in and she said there were no patients, no one on reception - she wandered through back offices until she found someone to hand it over to.
They have a new long long message when people ring up, explaining 6 or 7 ways why you will not be seeing a GP.

To be fair, after I resorted to sending an email to them, a GP did ring me up.

That's how it should be SueDonim - they should be additional to the number of GPs, but in the practice in the programme they were a substitute.

That practise sounds appalling but I hope not all PA’s are tainted by this article. I’ve seen a PA at our surgery and she has been excellent. To my knowledge she is an addition to the practice, not a replacement for a GP. Appointments with her are longer than the usual GP ones and you have time to explain all you need to, without feeling pressured to hurry up and get out.

Could you give an example Nannarose?

I'm afraid I'm struggling to think of one instance when I've been to a GP and haven't needed to speak to a GP or practice nurse. Practice nurses are excellent for routine procedures, but GP expertise is needed for complex problems. I can't think of anything which would be somewhere in-between (maybe it's just me), especially as Physician Associates can't prescribe.

I don't understand "they can take time to explain things better and in a way more suited to the individual they are dealing with". Are appointments with PAs longer? Why would they be able to talk to people in a more appropriate way?

What I find especially upsetting, is that using Physician Associates (along with others such as Nurse Practitioners and some other specialities) is a really good idea.
They don't just save expensive doctors' time - they can take time to explain things better and in a way more suited to the individual they are dealing with.
This story needed to come out because it is poor practice. But now, people are going to be distrustful, thinking they are 'fobbed off' when in fact, well managed, this can be an excellent service.

Our surgery is triageing patients via telephone and when |I recently rang as the pain was getting too much I was telephoned immediately by a GP who prescribed stronger and different approach to pain control and ordered an MRI which I'm having in a fortnight. under the old system I probably would have ha several visits to the GP before we got round to ordering an MRI. This all happened because when the receptionist took the call and started the triage I said the magic single word 'pain' as the reason for my request for an appointment.

Yes I imagine many practises are operating in a similar way. It's a far cry from the family doctors of our childhood.

Here's the list of their surgeries..
www.operosehealth.co.uk/our-services/primary-care.html

grannydarkhair I read the article too and took from it that many surgeries must be operating like this as the company is clearly huge.

I found it very disturbing. My surgery has gone the other way. Very difficult to access during covid, and limited availability of doctors, who work part time and distribute that time between four surgeries in the Practice. Also lack of administration staff; instead of buying into expensive online 'services' the money would be better spent on employing an extra receptionist and extending opening hours.

We are lucky with ours too. OH sent an engage consult message yesterday. His GP called him back in the afternoon and made a face to face appointment for today.

Thank goodness I am with a brilliant GP surgery. GPs ,nurses and receptionists are all brilliant. If it wasn't for them I wouldn't be having the correct treatment after years of not getting it where I used to live 100+ miles away. Hospital's up here are brilliant to. You are treated as a person and given time and attention. I am feeling healthier than I have for decades thanks to the better health care.