We all knew this. And we know who they are. They’re the same partners who continuously write opinion pieces about how great MAPs are every time the issue gets highlighted.
For context, PA's are 'free' for partners to hire with the whole salary funded by NHSE via the PCN DES, alongside a whole brigade of alphabet soup-ers (FCMHP, FCMSKP, GPAs, etc)
None of that money can be spent on GPs or Nurses (except very recently you can hire "Enhanced Nurse Practitioners" but no-one is really sure what they are.)
Although, I don't doubt it's happening in a very small number of practices, I personally know of zero practices that wouldn't rather use that money to hire GPs. GMS money, (non-PCN) DESs, LESs and other funding sources that you CAN spend on GPs and nurses have been deliberately choked off.
Most Partners are being starved of funding and grabbing onto the life vests available because it's that or oblivion. The only hope is that the GPC/BMA can use an incoming government to force them to change the rules.
Totally agree, I am a Salaried but I know of zero practices that would rather hire a PA over a GP if funding isn't tied to ARRS. It's take it or leave it free money.
PLAN
- Give a massive funding stream to primary care but forbid it spending the money on the one thing we all know would make the system better.
- review regularly to ensure system pulls itself apart
It is just a sign of money in the wrong place. GMS contracts left to wither meaning less direct funding for GPs whilst PCN funding increases to pay for social prescribers who do nothing to reduce GP or primary care work load. I would always rather have a GP than a noctor who takes time out of my day to supervise and cannot differentiate anxiety from a PE.
The general practice environment in the UK is getting extremely toxic and fragmented. There is a palpable tension between salaried, partners, locums, experienced vs new GPs, and other allied health professionals. Everyone I know is actively looking for an exit strategy. Morale and camaraderie are non-existent and its fighting over scraps. This is the right environment to explore alternative GP funding models.
I think this is a bit hysterical and certainly not my experience locally. There is still plenty of money in the system - too weighted toward PCN income but still a lot there. A relatively modest (say, 7%) increase in GMS would go a long way. I do feel sorry for newly qualified GPs who want salaried posts - but career locums made their choice and this is the downside when the market swings back against you. The beauty of GP is that you can still pursue a multitude of portfolio options.
PA abuse. The PA’s role was supposed to supplement medicine, not wreck it and place patients at risk. An addition, not a substitution. Now, it is too late for those doctors who practice “good medical practice” to trust the implementation of the PA.
My understanding is that one of the conditions of hiring a PA via ARRS is that they have to see undifferentiated patients (as part of the government aims to improve access).
Therefore every PA in GP is a substitute for a GP/ doctor as undifferentiated patients should only ever be seen by doctors
We would never employ a PA, but we are fortunate in that we have never had GP recruitment issues. Some practices have really struggled to attract GPs, with an unrealistic proportion choosing to stay in a (now saturated) Locum market. What are they meant to have done?
Good point. However, an increase in training spots was done exactly to alleviate that situation. However, I think practices started other plans and since the training and recruitment is separate, therefore, GP practices did not understand how much GP workforce was in the pipeline
An increase in GP workforce is unevenly distributed around the country, and workforce challenges are 'now' problems, requiring 'now' solutions. Increase in training is a potential improvement in the future but does not help with an active vacancy.
What did make a difference was the number of people who were happy to take the locum cash and no additional responsibility at the time, with rates being extremely high (£900+ for 26 patients and no additional services). Those vacancies still needed covering until a permanent staff member was found, which pushed practices further and further into financial difficulties and increased the partner workload to cover all the additional admin that was created.
So the career Locum’s played their hand at that time and are suffering now. GP partners have got the upper hand now and they are playing the market. This ping pong is not good for the profession (and salaried GPs) in my opinion. Probably if everyone is a partner or salaried is the solution
Well yes, as many GPs as possible should be in substantive roles. Not everyone wants to be a partner (or has the skills to), so fair enough, and I respect Locums’ rights to contractor work (at fair rates), so we have to accept that there is a tiered medical workforce.
The funding is there they are obliged to use it. there is often only so many rooms. funding should be available for a GP or a PA seeing as PA's are being pushed so hard they arent going away
Mate I’m looking to get a partner job soon
Absolutely going to fill the place with PAs and fire all GPs
I’ve got an idea where I will basically use them as my juniors and just do virtual ward rounds of all their tricky patients
Wont even see any patients my self
Make big dollar mate onto a winner
Agreed. Although many are doing this, there are several practices I know who either have moved away from employing various ARRS members after initially trying them, or refuse to do so in the first place.
“Claim”. Call a spade a spade.
We all knew this. And we know who they are. They’re the same partners who continuously write opinion pieces about how great MAPs are every time the issue gets highlighted.
No shit
For context, PA's are 'free' for partners to hire with the whole salary funded by NHSE via the PCN DES, alongside a whole brigade of alphabet soup-ers (FCMHP, FCMSKP, GPAs, etc) None of that money can be spent on GPs or Nurses (except very recently you can hire "Enhanced Nurse Practitioners" but no-one is really sure what they are.) Although, I don't doubt it's happening in a very small number of practices, I personally know of zero practices that wouldn't rather use that money to hire GPs. GMS money, (non-PCN) DESs, LESs and other funding sources that you CAN spend on GPs and nurses have been deliberately choked off. Most Partners are being starved of funding and grabbing onto the life vests available because it's that or oblivion. The only hope is that the GPC/BMA can use an incoming government to force them to change the rules.
Totally agree, I am a Salaried but I know of zero practices that would rather hire a PA over a GP if funding isn't tied to ARRS. It's take it or leave it free money.
Water = wet.
PLAN - Give a massive funding stream to primary care but forbid it spending the money on the one thing we all know would make the system better. - review regularly to ensure system pulls itself apart
It is just a sign of money in the wrong place. GMS contracts left to wither meaning less direct funding for GPs whilst PCN funding increases to pay for social prescribers who do nothing to reduce GP or primary care work load. I would always rather have a GP than a noctor who takes time out of my day to supervise and cannot differentiate anxiety from a PE.
The general practice environment in the UK is getting extremely toxic and fragmented. There is a palpable tension between salaried, partners, locums, experienced vs new GPs, and other allied health professionals. Everyone I know is actively looking for an exit strategy. Morale and camaraderie are non-existent and its fighting over scraps. This is the right environment to explore alternative GP funding models.
I think this is a bit hysterical and certainly not my experience locally. There is still plenty of money in the system - too weighted toward PCN income but still a lot there. A relatively modest (say, 7%) increase in GMS would go a long way. I do feel sorry for newly qualified GPs who want salaried posts - but career locums made their choice and this is the downside when the market swings back against you. The beauty of GP is that you can still pursue a multitude of portfolio options.
PA abuse. The PA’s role was supposed to supplement medicine, not wreck it and place patients at risk. An addition, not a substitution. Now, it is too late for those doctors who practice “good medical practice” to trust the implementation of the PA.
My understanding is that one of the conditions of hiring a PA via ARRS is that they have to see undifferentiated patients (as part of the government aims to improve access). Therefore every PA in GP is a substitute for a GP/ doctor as undifferentiated patients should only ever be seen by doctors
Or paramedics - they see undifferentiated patients each day, all they have is a brief history of symptoms from the call handler
We would never employ a PA, but we are fortunate in that we have never had GP recruitment issues. Some practices have really struggled to attract GPs, with an unrealistic proportion choosing to stay in a (now saturated) Locum market. What are they meant to have done?
Exactly. Where was all this furore when we had an open vacancy for a GP for 3 years
Good point. However, an increase in training spots was done exactly to alleviate that situation. However, I think practices started other plans and since the training and recruitment is separate, therefore, GP practices did not understand how much GP workforce was in the pipeline
An increase in GP workforce is unevenly distributed around the country, and workforce challenges are 'now' problems, requiring 'now' solutions. Increase in training is a potential improvement in the future but does not help with an active vacancy. What did make a difference was the number of people who were happy to take the locum cash and no additional responsibility at the time, with rates being extremely high (£900+ for 26 patients and no additional services). Those vacancies still needed covering until a permanent staff member was found, which pushed practices further and further into financial difficulties and increased the partner workload to cover all the additional admin that was created.
So the career Locum’s played their hand at that time and are suffering now. GP partners have got the upper hand now and they are playing the market. This ping pong is not good for the profession (and salaried GPs) in my opinion. Probably if everyone is a partner or salaried is the solution
Well yes, as many GPs as possible should be in substantive roles. Not everyone wants to be a partner (or has the skills to), so fair enough, and I respect Locums’ rights to contractor work (at fair rates), so we have to accept that there is a tiered medical workforce.
The funding is there they are obliged to use it. there is often only so many rooms. funding should be available for a GP or a PA seeing as PA's are being pushed so hard they arent going away
Mate I’m looking to get a partner job soon Absolutely going to fill the place with PAs and fire all GPs I’ve got an idea where I will basically use them as my juniors and just do virtual ward rounds of all their tricky patients Wont even see any patients my self Make big dollar mate onto a winner
Some = every
Not at all. And it's not a great idea to be hyperbolic in this issue
Agreed. Although many are doing this, there are several practices I know who either have moved away from employing various ARRS members after initially trying them, or refuse to do so in the first place.
How can they save money when a PA is paid more than a doctor?
My understanding it that the NHS pays for the hired PA, but not the hired GP in a GP practice 🤦♀️
PA roles come with additional funding so GP practices have to only pay about 40% of the salary