BMA Releases New Statement on Prescribing & PAs, AAs, SCPs (30 Oct 2023)
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- Опубликовано: 1 ноя 2023
- New BMA statement here: www.bma.org.uk/news-and-opini...
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Don’t mind the quality at all! Professional lighting is great but what matters most is what you’ve got to say. Thanks for spotlighting this update, it’s encouraging to see as a medical student that guidance for postgraduate doctors is being developed to navigate the situation.
Video wasn't low quality at all - would definitely appreciate more like this if it means you're able to keep up with the situation better with everything that's going on!
Thank you for highlighting this important issue. It's great that you're keeping up with and reporting on these issues.
Hi Dr Ollie, I'm aware the number of neurosurgery st1 posts has been shrunk recently to stop post CCT holders not getting a substantive consultant post, is this because there is little demand for neurosurgeons, or is it that the government is being stingy and not paying for the amount of care needed?
Probably a combination of both I suspect, depends on perspective. Neurosurgery is a very expensive service to provide, and is limited to a handful of centres. Demand is also much higher for certain types of problem (e.g. spine) than others (say tumours). There's very large demand but not anywhere near enough the training throughput for them.
@@OllieBurtonMedThank you doctor, does this mean there will be lots of trust grade roles, meaning CESR becomes common, even for UK graduates?
It seems like a pointless role to go into then if this is the general stance on them. Their scope may as well be fetching patient notes for doctors and scribing for them. I guess this all could have been avoided if the role wasn't developed and all of that money had gone into improving access to medicine itself
This is the BMA's stance. The issue at present with the role is that nobody has formally defined what the role is supposed to be, which is why there's such variation. My position remains that scope of practice needs locking down fairly firmly in a more restricted state now, such that exploration can be done for expanding the role later, with proper safety and validation research behind it. At the moment it's just a complete free for all where the clinical risk is absorbed by the senior doctor.
update: Regarding PA use in GP clinics, NHSE still won't define scope of practice for PAs and have instead laid the responsibility onto supervising GPs to make a decision on PA capability on an individual basis. This removes the risk of NHSE bearing responsibility for potential harm enacted from PA overstepping and delays the formal classification of PA scope of practice, which will undoubtedly undermine the position when set and affect the RCPs intention to ramp up enrolment.
Thanks for your insight, interesting and helpful as always, Ollie!
As a PA student, I hadnt actually thought of the impact the role can have on the exposure that Jr Doctors can get on different procudures. As you rightfully pointed out, while we might be able to help on cutting down waiting list times, it also means that autonomous practitioners, by nature, will then end up getting less exposure and therefore become deskilled as a result.
In light of this, do you feel like a conversion programme for PAs to become doctors will eventually exist? Also, does the same problem exist in america? If not, how did they avoid this issue?
Great questions!
Thanks for the understanding. It is a poorly appreciated problem that exists antithesis to the NHS's relentless focus on short term planning.
I actually hope such a bridge programme is developed and would very happily support such a thing.
Same issue does exist in America but for perhaps different reasons. PAs exist in America to be extensions of a particular doctor or surgeon, because then that doctor can bill for their time further - or rather that is where the motivation for having them chiefly seems to come from.
There isn't necessarily an analogue in the UK, and this is one of the issues. Nobody has formally defined what exact problem PAs are meant to solve, other than 'see more patients' - and this is a problem for PAs and everyone else. We really need to see a formal scope of practice to understand this better.
@@OllieBurtonMedto be honest the poor nhs planning is why the ambulance service has almost no one left because of a lack of planning over the past couple of decades. We are basically screwed these days because of a lack of training and mandatory retirement there are almost none of us left these days. We have already seen the short term planning screw-ups and create clear pathways for progression and scopes of practice for these guys.
@@OllieBurtonMed I feel very much the same. Especially when we think about the amount of PAs being trained right now (I think theres supposed to be a couple thousand in a few years time, but dont remember the source of that stat!), that is a potential pool of new doctors we could pull very quickly with a conversion programme.
If you think about it, the extra training needed (while would be a lot and timely), I'm guessing wouldnt be as much as a typical post grad med setup? Therefore, I'd imagine that you could feasibly have PAs still practising at least in a semi part time capacity as they convert? Especially if it was an apprenticeship type deal. Though, as you've bought up before, there's a tonne of critique to be bought at the apprenticeship model's door.
That being said, the only way I can see the apprenticeship model actually working is if it is deployed for PAs. I could imagine how that might end up being feasible. Though I barely know anything about med ed! I'm just an ex medical school applicant, who's hopeful and curious about trying again in the future.
Something needs to be done, I just despair at the current situation and I'm scared for the health service.
I think another two years of programme is probably what would be needed, because then at least it would be equivalent to GEM, remembering that 'time served' is actually important in terms of the number of registered hours of placement across the specialties. Med school in the UK isn't purely competency based, it's also time based, which is why hours tracking, checking that people are on placement etc is done. I'm not sure how the idea of working while doing this shortened pathway would work, as well as the idea that you'd need people to also do the Foundation programme and get thrown around the country semi-randomly once they qualify. Lots of challenges to overcome.
@@OllieBurtonMed I disagree Ollie, I think a conversion should definately be 3 years minimum. 2 years would not produce the quality doctors we need and wouldnt be enough to be anywhere close to GEM equivalent. And then they should start fy1, no skipping traditional milestones
This article didn’t specifically mention nurse specialists but I wonder if it similarly applies to them. At my hospital diabetic specialist nurses work under a consultant but always ask f1s to prescribe the insulin that they recommend from their assessment. Our palliative and pain specialist nurses are prescribers and so do it themselves but I am asked daily to alter and write prescriptions for insulin and when I ask why are they recommending that dose they often get huffy. I’m only asking cos it’s my name on the prescription and so I need to know the indication 🤷🏻♀️
It absolutely 100% does apply in that scenario, although the difference is that the diabetic nurse isn't a dependent practitioner of a particular consultant, Therefore there isn't a named consultant that you would be forwarding the request to. But yes you're right your name is on the prescription and they have a duty to explain their advice to you. Insulin dosing kills people when it's done wrongly and particular care needs to be taken.
Are f3's and SAS doctors now considered to still be in foundation training?
No. Foundation training is done once you've completed F1 and F2. You'd be considered outside formal training (or 'not in a training programme') but this is actually very normal. There are far more doctors outside training than in training.
I am hoping to become an associate ambulance practitioner eventually also known as an aap eventually
Good luck!
@@sabrinamurrayUnfortunately not an option for neurosurgery! ST1 and ST2 are the only points where you can enter formal training. If you get beyond those, the only option is to work as a trust grade or SAS doctor towards CESR, an equivalent of CCT. Sadly can't hop in and out of training.
@@OllieBurtonMedI thought you could apply for ST4,
You can work the other way. I know some specialities can though. The pathways for scopes of practice is not clear enough yet for the new guys and new guidelines. They need proper scopes like the ambulance service have had for technicians and paramedics for decades. We need to develop higher skills and clear pathways for progression with these new professionals. We also need clear scopes of practice for them. The ambulance service has regional scopes of practice so what people can do in different regions is based on local requirements. However these guys need clear scopes of practice and paths for progression.
@@OllieBurtonMed good luck with it. Hope you get on well if you train out I could quite see you working as SAS doctor and eventually becoming a consultant at Newcastle.
@@OllieBurtonMedI actually quite enjoy our debates on clinical ethics to be honest. Geeky medics is great training for emergency medical technicians in emergency paramedicence. Good luck
Sir how much do you earn as a doctor now in UK? Plz reply. Thanks a lot.
As of right now I get paid £17.77 per hour in a central London subspecialist centre.
@OllieBurtonMed London has a higher salaries though because the include outer London weighting allowances these days now