Tuesday, 20 February 2007

PAs:good value or expensive waste?

Have a peek at these questions that may have been sent to the Department of Health. It was in response to some replies that they supplied on the topic of 'Physicians Assistants'.

Given that we will have a surplus of several thousand unemployed highly skilled and highly trained junior doctors come this August (thanks to the shambolic work force planning of this administration) Is it really sensible to be training thousands more physicians assistants and nurse practitioners? Each doctor has cost several hundred thousand pounds to train; so just from an economic tax paying perspective it seems like lunacy to waste their talents in this way. Add to this that there is no evidence that these non-doctoring grades are more cost-effective! It is not as simple as just cost-effectiveness either. There are numerous ways in which modifying the health system by introducing new non-doctoring grades is expensive.

Just think: these new professionals must be regulated (not cheap), existing healthcare structures need to be modified to accommodate these new professionals (more reorganisation-not cheap), their performance must be monitored rigorously as they are an unknown entity(not cheap), what of the effects on the long term sustainability of the service and training? and how will the consultants of tomorrow be trained? (this has not been adequately considered, the same is true for the privatisation of the NHS and the impact this will have on medical training and the sustainability of the service). It seems that the DOH has no evidence at all to prove what it is doing will improve the service provided or save money. If anything it will waste a lot of money in the ways mentioned and have a potentially disastrous impact on the sustainability of the NHS.

I wonder where that CFISSA money went? There was certainly far too much money missing for it to be explained by Tony's mortgages alone. Anyway the DOH has been sent some further questions:

"Dear DOH,
I am writing again in reply the response I received as regards physicians assistants.
I am not keen and do not have time to shadow a physician's assistant unfortunately. It would not have any affect either my requests or line of argument.
I have a further few questions under FOI act:
"The Department of Health documents on New Ways of Working are written in collaboration with the NHS, and tested with key stakeholders (Royal Colleges, regulatory bodies and soon). The information is easily accessible on the Department of Health website (http://www.dh.gov.uk/) and is open to public scrutiny."
1. I am aware of this information but my question was "Are the DOH publications peer reviewed or subjected to the same level of scientific rigour as a proper medical journal? ". Thus I assume the answer is no, unless you respond otherwise.
Quoting again from your answer "Experience has shown that the continuity of the role within the medical team does free up time for the more skilled and experienced staff to concentrate on more complex patient care requirements. "
2. Specifically what evidence do you have that time is freed up? And is there any other evidence other than this 1 study of PAs working in cardiology.
3. ' http://www.hsmc.bham.ac.uk/publications/pdf-reports/Physician%20Assistant%20final%20report.pdf ' I am not convinced by this rather long winded piece of writing. It has not published in a journal and has not been peer-reviewed. Do you not have any evidence other than this? and by evidence I mean something that has been published in a reputable peer-reviewed journal.
4. "Employers will have the opportunity to, and the choice in, defining the skill mix they require to meet patient needs. If, as you suggest, PAs and Nurse Practitioners are more expensive, this would be something that the employer would consider during their decision-making process." I think this statement reveals a slight problem. Tax payers money goes towards training all these professionals (PAs, NPs, doctors, nurses). How can it be sensible to train too many, thus creating a surplus of unemployed skilled staff? This is surely a waste of tax payers cash and an inefficient way of providing a service. Can you convince me otherwise?
5. http://www.aagbi.org/pressoffice/statements/anaethesia_practitionersfeb06.htm It seems that not all the medical bodies are in agreement with the RCS and RCP. I wonder if you have any evidence that the RCGP, RCP or RCS consulted their members adequately about the introduction of physicians assistants? (as if it is merely the senior members making these decisions the consultation process would not seem adequate)
6. Has the medical profession in general been consulted in the introduction of Physicians Assistants? ( via the BMA or otherwise)
7. Will doctors be able to apply for the Physicians assistant posts? (surely they are adequately trained) and if not, why not?
8. Who will regulate the Physicians Assistants? ("Local clinical governance arrangements and national regulatory requirements take account of the practice of healthcare practitioners." I do not think this statement is sufficient.)
9. It seems all reform in the NHS today. I wonder if you have any evidence that nurse practitioners or physicians assistants are more cost effective that doctors? (as surely what is the point in changing the system if they are the same cost- the measures to put changes in place will make the overall process more expensive)
10. Given that there are over 30,000 junior doctors applying for under 10,00 run through training posts, has the Department of Health estimated how much money has been wasted training these doctors?
11. Will these unemployed junior doctors be able to apply for nurse practitioner posts as well? (surely they are adequately trained for these jobs) and if not, why not?
12. "The Department would refute the suggestion that the product from these PA programmes will not be trained sufficiently. However, as with all new education programmes, they will be subject to internal and external review, and amendments to the programmes will be considered to ensure that practitioners are fit for practice and purpose. " What is the DOH planning to monitor the performance of these Physicians Assistants? I assume there will be some concrete clinical measures in place?
13. "The information is easily accessible on the Department of Health website (http://www.dh.gov.uk/) and is open to public scrutiny." How is the information open to public scrutiny other than by being accessible via the website? Why not introduce some kind of on lone voting process whereby members of the public can agree or disagree with policies?
14. On another topic. What evidence does the DOH have that the medical profession and public were consulted adequately on the roles of nurse practitioner and surgical nurse practitioner?
I am very grateful for the excellent responses I have had so far to my questions,
yours, "

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