Amongst the many ways in which public services in the UK are being undermined is by deskilling them. I have already mentioned this in the context of HM Revenue & Customs this morning. The problem is at least as big, if not bigger, in medicine.
EveryDoctor, with whom I have done some podcasts, are highlighting this in the context of the plan to roll out many more physician associates in the NHS, about which there is a current consultation that is exceptionally difficult for anyone to answer. I know, because I tried.
The General Medical Council (GMC) is conducting a public consultation into the regulation of physician associates (PAs) and anaesthesia associates (AAs) in the NHS. As an organisation, EveryDoctor is enormously concerned about the systematic deskilling of the NHS workforce, and the impact of this on patients and staff. We have therefore been encouraging our network of NHS staff and patients to contribute to the consultation.
We have received feedback from many people who say the consultation is too complicated and difficult to fill in. We are deeply concerned about this; a public consultation must be accessible to all. We have summarised the general concerns from doctors in our network about the regulation of physician associates (PAs) and anaesthetic associates (AAs) in the NHS. We are now enabling everyone who shares our concerns to sign this letter. We will send this to the GMC. Please sign urgently - the public consultation closes on 20th May.
If you are worried about the degradation of service in the NHS, please consider signing their letter to the GMC. The link is here.
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This is a further step towards privatisation. Lack of front line skills – makes it easier to have the front line to act as a filter and requests for help/info/etc are then passed back to those nice people running (US) private health organisations.
I am reading “Vassal State” by Angus Hanton. It profiles the on-going take-over of the UK by US commercial interests. One of the more interesting (last remaining?) areas of commercial interest is health. The campaign by US health orgs is sustained and UK politicos have been groomed for decades by the US “health” industry. Accordingly Uk serfs’ expectations ref health have been lowered and in due course LINO (or perhaps the Tories) will pass what is left to US commercial interests.
This blog and the comments have provided extensive data on the funding/bribes? of UK politicos by those with a desire to move the UK to something akin to US private “health” (ill-health?). Most of this funding comes from cut-out men – used to conceal the real players. All legal, and the info is in plain sight but rarely discussed by the MSM (many of the journos have their own private health packages – why upset the apple cart?).
On a related note, US embassy staff rose from 700 in 2002 to 1000 in 2023 – almost certainly busy bunnies making sure the UK goes in the “right direction” with respect to health.
Mike
“This is a further step towards privatisation. Lack of front line skills – makes it easier to have the front line to act as a filter and requests for help/info/etc are then passed back to those nice people running (US) private health organisations. ”
While I agree in principle, there is a flaw in this suggestion. Healthcare needs properly trained health professionals. Currently in the UK private healthcare is mainly provided by NHS doctors working in their ‘spare time’. Junior doctors who are present in private hospitals are at the beginning of their training period, but receive no training during their career in private healthcare. It doesn’t matter whether the care is provided free at the point of delivery or paid for, if there are too few doctors there will be insufficient healthcare.
Is this, perhaps a further example of governmental hatred for experts?
there are much more useful models just across the Channel. We never see politicians going on ‘fact finding missions’ to them. Certainly not Tory ones.
Same with policing and prisons.
Thank you and well said, Mike.
I have not read yet, but hope to soon. I’m interested to read if these US investors are also mentioned with regard to Brexit.
One reason why the the MSM went easy on Brexiteers is that many of the stenographers and courtiers, especially at certain BBC flagship shows, have side hustles for such investors or hope to soon as legacy media perishes. This is also where and why stories about Putin, always personalised, organised Brexit are spouted.
I have never understood when progressives are asked difficult questions by these corporate stooges, they never hit back by quoting Mandy Rice Davies and explain why. Most of these hacks are ignorant. That’s why Richard is rarely on air. They don’t dare risk facing Richard.
One thing with regard to the creeping privatisation, I think the fig leaf of the NHS will be retained to avoid scrutiny of the corporate looting, but also to allow some hapless politician to face the music and perpetuate the myth that the public sector is no good at anything. The sham will also provide sinecures for leches bottes, aspiring politicians, retreads etc.
I will be in touch soon.
My daughter – a Health Visitor – commented a while back that, with HAs, there will be increasing use of decision algorithms (used in 111 and some surgeries) and these will be funded, written and designed to benefit HealthCo and Pharma.
Correct
The over view has to be that artificial internal markets created in monopoly services like the NHS prevent proper workforce planning and that fragmentation has consequentially damaged co-ordination and service delivery since 2010.
The failure of the Lansley reforms, so bad that even the Tories dropped them, symbolise this divisive approach.
It is utterly unbelievable that the very first English NHS workforce plan is dated 2023… Market failure or what ?
There is nothing wrong in having an associate level, at whatever point below consultants, but surely that workload has traditionally been delivered by registrars, but more often senior or junior house doctors.
If that model has been broken it is down to government failure.
The blame needs to be attributed to the responsible politicians – Cameron and Osborne will do.
That the Tories have deliberately undermined both nurses and medics over the years, and especially since Covid, was inevitably going to increase pressures.
The reason it is being pushed now is to gap fill, to try to cover the shortfall in medical training and available expertise, and cover for the lack of recruitment into med schools a decade ago (another Gideon austerity fail).
My GP told me recently that the numbers of junior doctors in consultants’ teams had been reduced, and this was one of the reasons why these new quasi-professionals with reduced training and experience are being recruited, and why cutting waiting lists is taking longer than it ought.
(We are incredibly lucky we have a local GP service that does actively engage us patients in discussions on the NHS).
Any genuine attempt to improve the sustainability of NHS workforces from 2025 onwards, (whether by some belated workforce planning or at a strategic political level) , needs an urgent review of how medical training of both doctors and nurses progresses.
This really does need some realism as to how improved pay and better conditions (and staff support) can improve retention, which is dire.
A career path that allows proper progression from associates to fully qualified medics is also an essential provision.
I have previously commented that improving secondary science education is essential in improving the number of trainee medics. As most will be female, then future maternity and child care also needs better planning, and provision specifically for those undertaking 12hr NHS shifts.
Join the dots please.
The elasticity problem remains. There is a 6-8 yr time lag needed to be filled to ensure that there are enough NHS staff with the right level of qualifications to deliver services now, and associates need to be properly regulated from within the profession, with proper oversight by doctors and not politicians who, let’s face it, know SFA.
Whether Wes has the nous to make this a priority, instead of the ersatz option of more outsourcing and contracting out, remains to be seen.
I am on antibiotics and heavy painkillers today, prescribed yeseterday as I have an otitis externa – which are pretty painful.
I got an appointment with the GP in 2 hours yesterday
I saw someone without a name badge on. There was no name on the door. I asked who they were. I was told they were an ‘advanced practitioner’. I asked what that meant. It turned out she was a paramedic. Now, I have ant all against paramedics – I have been immensely grateful for what they can do in my time. Bit she clearly had little idea about treating me. The risk in my case was sepsis. I took my wife (MRCP, MRCGP) who fed her all the clues that I needed antibiotics to manage that risk. She did not notice them. She did not take my temperature, blood pressure or take a full history. And, based on my experience of this condition, I had to ask for pain control as I always need it. She eventually gave me what I know from experience I needed, but she was not an advanced practitioner. I am sure she would have been great ambulance crew, but I am not sure she was in her comfort zone in surgery. And that is the problem with the current model of the NHS. It’s not fair to staff or patients.
Don’t worry, I’m sure that Wes Streeting will change all this when he’s running the Department of Health. I mean, it’s not as if he has any reason to bung public money towards the private sector, is it?
Can you, please, clarify whether the planned roll-out of many more physician associates applies only to NHS England or also to NHS Scotland.
I think it is also a Scottish phenomenon, but in a more controlled fashion
Further to the question regarding Associates (PAs) NHS Scotland, I’ve had a bit of a search but can’t find any reliable up-to-date information.
According to an article in The Herald last November, as of June 2023 there were roughly 1.8 PAs for every 100 doctors across NHS England and in November there were 143 PAs in Scotland with a total medical and dental workforce of over 15,000. At the time the Scottish Health Secretary was “supportive of a gradual increase in PAs”.
In common with many other people in Scotland, I find the careless use of the phrase “the NHS” irritating. There isn’t just one monolithic organisation.
NHS Scotland is quite separate from NHS England and is differently organised – e.g. no NHS Trusts and a lot less privatisation.
Thanks
tony
“There is nothing wrong in having an associate level, at whatever point below consultants, but surely that workload has traditionally been delivered by registrars, but more often senior or junior house doctors.”
There have always been trained doctors in hospitals who are not consultants. They were called Medical Assistants in the 80’s, then Associate Specialists. The work done by registrars and house officers provides a service but is also an integral part f their training. They are all doctors. If non-doctors start doing the work, what is going to happen to the training schemes? Let alone professional standards.
The same has happened in schools. Teachers have had teaching assistants in the classroom for a long time. Now they are running classes alone as they are cheaper than teachers. And, of course, trained to do a different job.
And the police service. Police Community Support Officers are not police officers. They do not have the same training, they do not carry warrant cards, but they are cheaper.
Much to agree with
One of my key concerns is of the apparent failure of workforce planning to deal with the issues of creating an overlapping hierarchy of trained medical assistants, who are not qualifed doctors, or even properly integrated. Sorry if that was not clear.
Absolutely, the training role of the consultant for junior doctors must not be weakened by adding in some overlapping professionals who also need supervision.
A complicating factor here is the current shortfall in medically qualifed staff, given the progressive reduction of the number of junior doctors on consultant teams. I know of general surgery teams in Glasgow that have been weakened by the loss of 3+ juinor doctors. That then interferes with career progression to consulant status.
In Greater Glasgow, a couple of years ago, 75% of adverts for medically qualified staff had not a single applicant on the first trawl.
Incidentally, as a qualifed and experienced teacher, my daily rate for supply would be 3-4x that of a non teaching assistant, who may well not be a graduate, or even have any education qualification or formal training. I don’t know the current English set up, but I don’t think that would be legal in Scotland. At least some of the new medfical assistants will be trained.. though you are right to be very suspicious.
Of course, the unstated aim of all this political interference is to dilute levels of professionalism, and undermine professions such as teachers and doctors, and obviously the police too.
Never mind the quality, feel the width is no way to run high quality health, education or police services. We are all neo-serfs now.
There are 6,000 unemployed GPs in the UK right now
Richard,
Then why is British mainstream media constantly going on and on about a GP and doctors in general shortage?
Inquiring minds want to know!
If there are 6000 locum GPs in England unemployed or underemployed then that is down to underfunding by government, as much as it is poor workforce planning with English internal markets
I was happy to sign this. You only have to spend a little time looking around to see the negative impacts of the increasing use of PAs and their equivalents in Surgery and Anaesthetic provision. There all ready instances of them running clinics and carrying out surgery unsupervised. Junior doctors can not get onto training schemes due to resource diversion to PA training. We have estimated 6000 GPs out of work because funding is geared towards employing PAs. That’s before we start on the already happening instances of misdiagnosis and risk to patients. Class legal action springs to mind.
We have PAs paid more than junior doctors. Junior doctors still waiting to find out where their next job placement is even though it is due to start soon. Regulation needs to improve. The doctors organisations are already raising
more concerns but the GMC remains deaf to these. It is an import from america. It is a waste of resources as doctors have to re-examine patients after they are seen by PAs or place themselves at professional risk if anything happens to the patient.
There is a good article in West Country Voices on the subject: https://westcountryvoices.co.uk/the-doctor-wont-see-you-now/
I saw one of the new PAs in February as my pain levels had increased significantly. He poked and prodded me about and declared that my hip was wearing out and gave me a few sheets of exercises, most of which I can’t do because of painful knees and direct pressure on my damaged spine. I think this came direct from the internet. He did not seem interested in hearing any “yes, but” talk.
This week I saw another MSK person at the surgery. He said, as I thought, that there is nothing wrong with my hips, except a bit of bursitis which only causes discomfort if I lie directly on it. He listened to my full history and has referred me for some bespoke physiotherapy to further strengthen my muscles to support the back, which is the problem. He also fully explained what I should do if I lose function of bowels or bladder, ie when it becomes a medical emergency.
This has delayed recovery and caused me significant distress, as the only way I can alleviate the pain from my lower back is to sit and cuddle my foot. I would not be able to do this if my hip was on the way out. I get some very weird looks in coffee shops when I do this, but needs must.
In addition to the new physiotherapy, I have been doing aquafit 4 times a week, which is marvelous; the pain goes completely in the water. Unfortunately, one local swimming pool with facilities for quite severely disabled people has just lost it’s funding and all other pools within striking distance have been inundated with new people, making it very difficult to book for aquafit and car parking a big issue. Those people, for whom there is no longer a pool that meets their requirements, have been left high and dry. Not only will they have no means of exercising safely, but they will miss out on the social aspect. They sit at home, probably gaining weight, at increased risk of developing a thrombosis and experiencing more isolation.
Such is the lot of the sick and disabled. With an ever-increasing older population and people waiting longer and becoming more disabled before they get their surgery, pool based physiotherapy is needed more than ever before.
Thank you for sharing this.
Good luck with getting the help you need.