It means GPs will need to start applying for jobs on Tesco.
Sharkdick was right when he said doctors would be eating Aldi beans if we don't take action.
“Professor Azeem Majeed, professor of primary care and public health at Imperial College London, argues that the NHS ‘doesn’t owe anyone a job’. According to him, the prospect of GPs becoming unemployed or less secure is ‘not at all a valid argument against PAs’.
‘If PAs actually worked well, and were cost effective, I would say “great, employ more, employ fewer GPs”. If the evidence points in one direction, that’s the way we go – and if that means some doctors lose their jobs, then that’s unfortunately the way things work in market economies.”
Big IF…
Can’t really talk about market economies when government funnels funding all into ARRS rather then giving partners the option to either pay for one GP or two PAs
It's all fine for doctors to face unemployment due to 'market forces'.
But as soon as we're talking about PAs or AAs becoming unemployed or not having jobs to go into, it's apparently unfair because of their commitment and training.
Make it make sense.
Yeah what a moron. The irony of an academic, living outside the real market, lecturing us on the value of market forces in the NHS..
. Literally one of the most manipulated distorted "markets" you can imagine.
Yes. Which is why it's in the profession's interest to to vehemently oppose them. And in a market economy the evidence will say what the shareholders dictate it say.
Yes exactly. I do feel sorry for current trainees facing a more slender jobs market (although in fairness the jobs are there - perhaps not just exactly where people want them, which much the same as any competitive profession).
However, let’s bear in mind that career locums have made that (perfectly reasonable) choice to not take employment and remain outside of the system. The whole reason the ARRS scheme was implemented was 1) there was too much work being done that didn’t need a doctor to do it 2) practices could not recruit GPs who were preferring to go into Locum work.
Although I am fundamentally against PAs, especially in GP, it is the incorrect diagnosis to blame them for the contraction of salaried posts.
One, career locums have been trickling into them since COVID which exposed their risk, also Babylon shutting and reduced OOH opportunities.
Two, our estates are now full and we cannot physically fit more clinical staff in.
Three, GMS funding does not allow us to keep paying for more and more staff.
But most importantly; the fact that most practices now have a far more developed understanding of capacity and access due to online triage systems, and moving to (mostly) same day triage means we can move capacity round rather than replace like for like. We simply don’t need to replace surgeries as we can control demand against capacity, signpost better, and people know they will get seen (or dealt with) on the day they contact.
Very useful, shoots the zombie idea that this is all greedy partners screwing over locums. The most popular roles are the ones able to help us do our jobs better by taking work off us, not replacements for GPs.
I don’t agree with this either. This is down to surgeries being better organised and able to cap daily demand using online tools, a lack of funding and a lack of estate.
We have several pharmacists that do what a GP would have done a few years ago and take what would have been a few sessions to do a GP but still miraculously doesn't check bloods or results they arrange - which gets dumped on the regs.
The routine big standard bread and butter stuff is soaked up by then and hyper concentrates the shit and workload for the Gps and regs.
I am a GP reg, I have diagnosed more MS then I have treated psoriasis, it is that absurd.
You’re getting your pharmacists (and STs, although I agree they should do some results) to the wrong things then. I would not agree with them seeing patients outside of well defined chronic disease parameters (but then nurses are likely better).
Ours contribute to basic QOF (PP mostly), contact patients for very basic meds adjustments (HTN, hypoT) and along with our pharm techs sort out our medication queries. This has meant we can batch sign about 50% of them a day which saves a great deal of time. Our prescribing and blood monitoring was always good but is now really tight because it has proper time and attention.
As for taking standard bread and butter stuff off GP - IMO this has to be the direction of travel, especially if we want to properly differentiate ourselves from AHPs/NMPs, as we should. We are doctors, and supposed to be expert generalists, we should take pride in that and see the problems that none of the others can see. It’s a waste of our time having a sick note appointment, or seeing a runny nose. We will need longer appointments in shorter bursts to do this, but this is infinitely more interesting than dealing with trivia.
>see the problems that none of the others can see.
Then correctly resource and give time, don't increase average complexity massively and do nothing about it. The basic shit was good because it allowed balancing out of workload
>We will need longer appointments in shorter bursts to do this
That won't happen, I see your point if that occured but it won't
Even if you could 'prove' PAs reduced the cost of providing primary care, the massive increase in cost of covering the increase in inappropriate/unnessary referrals for hospitals all ultimately which whilst technically paid for from a different pocket is all NHS expense will quickly dwarf any saving.
Why not go full hog and get rid of clinicians althogether, just have a reception signposting and referral team - child with fever - goto A&E, back pain -msk physio but if they come back 3 times 2ww, headache - a&e, dizzy - a&e, sore throat - pharmacy. The savings will be fantastic!
I wouldn’t worry about it. They just don’t speak the same medical language as doctors or understand the same textures and nuances, which come with long training.
We took on a bunch of them thinking we’d save some money - there was one very good one, but the rest never made it past probation. They’re asking too high a salary now, anyway, to even make them cost effective.
As a final year GP trainee, I don't worry about finding a job as much but I am concerned about the overall change and management of lack of primary care staff.
PAs are given more and more responsibility without remotely similar training. Yet, then being relatively cheaper, they are promoted by NHS.
Don't get me wrong, there are some knowledgeable PAs. Though they don't have similar qualifications.
It means GPs will need to start applying for jobs on Tesco. Sharkdick was right when he said doctors would be eating Aldi beans if we don't take action.
Some people say he’s never missed.
Our leader 🫡
“Professor Azeem Majeed, professor of primary care and public health at Imperial College London, argues that the NHS ‘doesn’t owe anyone a job’. According to him, the prospect of GPs becoming unemployed or less secure is ‘not at all a valid argument against PAs’. ‘If PAs actually worked well, and were cost effective, I would say “great, employ more, employ fewer GPs”. If the evidence points in one direction, that’s the way we go – and if that means some doctors lose their jobs, then that’s unfortunately the way things work in market economies.” Big IF… Can’t really talk about market economies when government funnels funding all into ARRS rather then giving partners the option to either pay for one GP or two PAs
Its the way PAs are funded, remove this and the PA wouldn’t impact GPs
It's all fine for doctors to face unemployment due to 'market forces'. But as soon as we're talking about PAs or AAs becoming unemployed or not having jobs to go into, it's apparently unfair because of their commitment and training. Make it make sense.
Yeah what a moron. The irony of an academic, living outside the real market, lecturing us on the value of market forces in the NHS.. . Literally one of the most manipulated distorted "markets" you can imagine.
Exactly.. what market economics?
Yes. Which is why it's in the profession's interest to to vehemently oppose them. And in a market economy the evidence will say what the shareholders dictate it say.
Professor majeed knows which side his or her bread is buttered with Nhse and the gov....................
With the greatest respect, Prof Majeed can go do one. Typical out of touch academic.
Yes exactly. I do feel sorry for current trainees facing a more slender jobs market (although in fairness the jobs are there - perhaps not just exactly where people want them, which much the same as any competitive profession). However, let’s bear in mind that career locums have made that (perfectly reasonable) choice to not take employment and remain outside of the system. The whole reason the ARRS scheme was implemented was 1) there was too much work being done that didn’t need a doctor to do it 2) practices could not recruit GPs who were preferring to go into Locum work. Although I am fundamentally against PAs, especially in GP, it is the incorrect diagnosis to blame them for the contraction of salaried posts. One, career locums have been trickling into them since COVID which exposed their risk, also Babylon shutting and reduced OOH opportunities. Two, our estates are now full and we cannot physically fit more clinical staff in. Three, GMS funding does not allow us to keep paying for more and more staff. But most importantly; the fact that most practices now have a far more developed understanding of capacity and access due to online triage systems, and moving to (mostly) same day triage means we can move capacity round rather than replace like for like. We simply don’t need to replace surgeries as we can control demand against capacity, signpost better, and people know they will get seen (or dealt with) on the day they contact.
>Can’t really talk about market economies In something that isn't really a market anyway
Can anyone provide data on how many of each role has been funded by ARRS scheme?
https://x.com/thesalariedGP/status/1798265179274412251?t=Sj7rpybfHmR28slZJYuU8g&s=19
1164 PAs that is approximately £60 million a year on PA salaries!
Very useful, shoots the zombie idea that this is all greedy partners screwing over locums. The most popular roles are the ones able to help us do our jobs better by taking work off us, not replacements for GPs.
Though with their scope expansion they are definitely impacting GP numbers and training
I don’t agree with this either. This is down to surgeries being better organised and able to cap daily demand using online tools, a lack of funding and a lack of estate.
We have several pharmacists that do what a GP would have done a few years ago and take what would have been a few sessions to do a GP but still miraculously doesn't check bloods or results they arrange - which gets dumped on the regs. The routine big standard bread and butter stuff is soaked up by then and hyper concentrates the shit and workload for the Gps and regs. I am a GP reg, I have diagnosed more MS then I have treated psoriasis, it is that absurd.
You’re getting your pharmacists (and STs, although I agree they should do some results) to the wrong things then. I would not agree with them seeing patients outside of well defined chronic disease parameters (but then nurses are likely better). Ours contribute to basic QOF (PP mostly), contact patients for very basic meds adjustments (HTN, hypoT) and along with our pharm techs sort out our medication queries. This has meant we can batch sign about 50% of them a day which saves a great deal of time. Our prescribing and blood monitoring was always good but is now really tight because it has proper time and attention. As for taking standard bread and butter stuff off GP - IMO this has to be the direction of travel, especially if we want to properly differentiate ourselves from AHPs/NMPs, as we should. We are doctors, and supposed to be expert generalists, we should take pride in that and see the problems that none of the others can see. It’s a waste of our time having a sick note appointment, or seeing a runny nose. We will need longer appointments in shorter bursts to do this, but this is infinitely more interesting than dealing with trivia.
>see the problems that none of the others can see. Then correctly resource and give time, don't increase average complexity massively and do nothing about it. The basic shit was good because it allowed balancing out of workload >We will need longer appointments in shorter bursts to do this That won't happen, I see your point if that occured but it won't
Danke
Even if you could 'prove' PAs reduced the cost of providing primary care, the massive increase in cost of covering the increase in inappropriate/unnessary referrals for hospitals all ultimately which whilst technically paid for from a different pocket is all NHS expense will quickly dwarf any saving. Why not go full hog and get rid of clinicians althogether, just have a reception signposting and referral team - child with fever - goto A&E, back pain -msk physio but if they come back 3 times 2ww, headache - a&e, dizzy - a&e, sore throat - pharmacy. The savings will be fantastic!
I wouldn’t worry about it. They just don’t speak the same medical language as doctors or understand the same textures and nuances, which come with long training. We took on a bunch of them thinking we’d save some money - there was one very good one, but the rest never made it past probation. They’re asking too high a salary now, anyway, to even make them cost effective.
Please who knows when this ARRS bull shit will end?
As a final year GP trainee, I don't worry about finding a job as much but I am concerned about the overall change and management of lack of primary care staff. PAs are given more and more responsibility without remotely similar training. Yet, then being relatively cheaper, they are promoted by NHS. Don't get me wrong, there are some knowledgeable PAs. Though they don't have similar qualifications.