Basically we love our PAs we're making it clear you're going to take the responsibility for their mistakes.
'If they've suggested a prescription you have to duplicate work by making sure it is indicated, but at the same time we don't want our poor PAs to keep having to prove themselves so if they have a competence document saying they can take a clinical history and formulate a management plan then you better let them. (But again if they've fucked up it's your fault if you don't go back and check everything hehe) xx'
Blah blah blah blah š¶šµš¶
One team š„°š„°š„° ā¤ļøvalues
Blah blah blah blah ššš
IF YOU PRESCRIBE BASED ON THE PAāS RECORDING OF THE DRUG HISTORY AND THAT TRANSPIRES TO BE INCORRECT BECAUSE THEY CANāT DISTINGUISH BETWEEN METFORMIN AND METRONIDAZOLE THEN YOU GO TO JAIL š¤¬š®āāļø
Finally, to repeat, blah blah š¶š¶ one team š„°š„° ā¤ļøvalues
All the bullshit bingo
"Trust values"
"Clinicians" making sure boundaries blurredĀ
Lots of use of the word "scope" without any definitionĀ
"Governance framework"
Whilst being crystal clear doctors hold all the responsibilityĀ
Just so wrong. And not conducive to better quality patient care, which despite our moaning is what we really care aboutĀ
This feels like more weaponising of "be nice" to stop people pushing back on concerns about PAs.
All liability is heaped on the doctors to define scope and chose whether or not to trust PAs.
'Physician Associates (PAs) are an integral part of the multidisciplinary team'
*If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.*
What this lacks, like all thinks PA, is _clarity_ .
LNC needs to demand an SOP with examples. Clarify if re-clerking everyone is required, and if not then we need clear and concise cases where it is not. Same with prescribing and so on.
The BMA scope doc is clear on what they should and should not be doing. I double fucking dare them to produce something with that clarity.
They're basically saying they're ignoring BMA's document and using the "SoP to be determined locally by their own team" card which essentially means PAs can do whatever they want.
u/BMA-Officer-James can be this raised with their LNC?
Only way to get consultants to wake up is by making sure they are actually the only ones taking on responsibility for PAs.
No I donāt agree to take on your delegated task for the unregistered professional. Thanks.
Remember if shit goes down, they arenāt going to jump infront of a bullet for you
āEach team should agree shared levels of entrustment so that the PA does not have to prove their capability on numerous separate occasionsā
Like trainees who rotateā¦.particular cunt of a paragraph that one
> Finally, to repeat, Physician Associates are a valued part of our workforce and we do expect all colleagues to act within our trust values.
So good you had to say it twice. Tossers.
We acknowledge the BMA scope document but we are going to completely ignore it in favour of locally set scope because that suits us better.
Unacceptable. Doctors in this Trust, report every thing that is outside the BMA scope using the MAPs reporting portal here: https://bit.ly/MAPPortal
Follow the BMA guidance here: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/workforce/guidance-for-the-supervision-of-medical-associate-professions-maps
Itās your GMC licence on the line at the end of the day.
This shithole of a trust is abusing "local governance" to let PAs run rampant in many departments, it is a serious issue and the GMC will do fuck all to limit scope and the Royal College bureaucrats have caused huge damage to not only our profession but caused harm directly to patients.
*In the end the Party would announce that two and two made five, and you would have to believe it. It was inevitable that they should make that claim sooner or later: the logic of their position demanded it. Not merely the validity of experience, but the very existence of external reality was tacitly denied by their philosophy.*
From GMC : Weāre aware that issues related to the responsibility and accountability of doctors when supervising PAs and AAs have come to the fore in recent weeks. In part this is due to online discussions about a Medical Practitioners Tribunal determination from a case in 2017, which has been misrepresented as setting a precedent or policy position. One tribunal determination sets no legally binding precedent on future tribunals. The case involved significant concerns and allegations about the doctor over a period of time. The primary failure was the doctorās responsibility to urgently and personally review a patient upon admission because of how they presented, which he did not do. While the tribunal found that the doctor failed to adequately supervise a PAās review of that patient, other serious allegations were also found proven which were of an entirely separate nature.
>The trust maintains that PAs can record a current drug history as part of their clinical history in a structured format on Cerner.
Hmmm.
This doubling down in its self raises its own suspicions. Itās oddly specific.
It reeks of a āworkaroundā or a āloopholeā
To me this sounds like āwriting up regular medsā which then enable someone the medicolegal nightmare of countersigning a non-prescriberās work at the click of a few buttons (+/- proper checking of said non-prescribers work, or perhaps it goes on āvibesā after a while?).
If thatās the case (Iād bet on it but I canāt because I have no money), thinking with a Swiss cheese hat on:
-They should probably explicitly BLOCK **ALL** areas of prescribing and imaging requesting from non-prescribers;
-This would almost certainly prevent things like the numerous PA prescribing/imaging requesting SUIs that have happened to date.
I don't think it's meaningless at all. I think this statement sends out very clear messages as to how the senior management at the trust perceive and value non doctors undertaking medical roles, but also sends out a very clear message who is medicolegally liable for any mistakes or errorsĀ
I think more than ever it dissuades Consultants taking on an extra burden of responsibility. The Trust has made its position clear that it is the Consultant responsible. It is difficult for the BMA legal services to support any Consultant who allows any PA to work beyond the scope set by the BMA.
Totally get it but they want docs to be beneath them and listen to what they need for their patients, doctors get scapegoated, thereās some cases they can manage yes sure, but they need their own repertoire of things they can prescribe, that give them accountability and not leaning on doctors shoulders
The issue of PAs being unsafe prescribers isn't solved by moving all the liability away from the supervising doctors, that just avoids us taking the flack but unsafe prescribing will still continue and without any safety net.
PAs should not prescribe full stop. They shouldn't be doing roles where they need to get a doctor to prescribe for them.
>PAs work under the supervision of consultants as part of the clinical team.
A common misconception on the subreddit is that PAs actually work under the supervision of an F1.
Under the supervision should also mean the consultants are fully liable. Consultants are however rarely always there, and de facto day to day decision making and supervision falls onto the resident doctors. I guess now, with the trust acknowledging this, all PAs should be asked to go to their supervisors for all their day to day needs!
Guess who takes the blame when a significant event occurs?
(not the consultant)
What is the point of a PA if a doctor needs to repeat every step of the PA's work to be medicolegally covered?
There is no point in a properly supervised and scoped PA. They're not worth the hassle, too expensive and not efficient.
This document is essentially saying "be nice, let them play doctor, do their prescriptions but the responsibility is on you". It's the only way to make PAs viable, let them play outside the BMA scope and shirk responsibility on to doctors.
Firstly, that's why PAs need to be able to prescribe independently and request ionising radiation.
Secondly, and until PAs can prescribe independently, nurses have asked doctors since the dawn of "can you prescribe X/Y/Z", due diligence is done, the patient gets their medication, and the world continues to rotate around its axis.
Thirdly, there is a thousand times more risk clinically supervising a dodgy locum doctor with minimal or no NHS experience than there is your average PA who are always NHS trained and have often been around for several years at least.
1) OK
2) nurses asking for paracetamol is a world of difference to PAs asking you to prescribe or request investigations for a patient they clerked. you clearly recognise this considering point 1
3) a "dodgy locum doctor" has their own license on the line. Personally, I think most trusts have reasonable mechanisms to deal with a locum that the department does not feel is safe or requires additional support/training
Well, if youāre constantly being asked to prescribe medications and request ionising radiation on a PAās behalf, I suppose itās an easy mistake to make.
Basically we love our PAs we're making it clear you're going to take the responsibility for their mistakes. 'If they've suggested a prescription you have to duplicate work by making sure it is indicated, but at the same time we don't want our poor PAs to keep having to prove themselves so if they have a competence document saying they can take a clinical history and formulate a management plan then you better let them. (But again if they've fucked up it's your fault if you don't go back and check everything hehe) xx'
Blah blah blah blah š¶šµš¶ One team š„°š„°š„° ā¤ļøvalues Blah blah blah blah ššš IF YOU PRESCRIBE BASED ON THE PAāS RECORDING OF THE DRUG HISTORY AND THAT TRANSPIRES TO BE INCORRECT BECAUSE THEY CANāT DISTINGUISH BETWEEN METFORMIN AND METRONIDAZOLE THEN YOU GO TO JAIL š¤¬š®āāļø Finally, to repeat, blah blah š¶š¶ one team š„°š„° ā¤ļøvalues
All the bullshit bingo "Trust values" "Clinicians" making sure boundaries blurredĀ Lots of use of the word "scope" without any definitionĀ "Governance framework" Whilst being crystal clear doctors hold all the responsibilityĀ Just so wrong. And not conducive to better quality patient care, which despite our moaning is what we really care aboutĀ
Spurted straight from a McKinsey analysts mouth
This feels like more weaponising of "be nice" to stop people pushing back on concerns about PAs. All liability is heaped on the doctors to define scope and chose whether or not to trust PAs.
Of course it isĀ
Telling absolutely no mention of trainee doctors. The gaslighting by these brainwashed sellouts is appalling.
'Physician Associates (PAs) are an integral part of the multidisciplinary team' *If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.*
What MDT value do they add that isnāt there already you slug?
What this lacks, like all thinks PA, is _clarity_ . LNC needs to demand an SOP with examples. Clarify if re-clerking everyone is required, and if not then we need clear and concise cases where it is not. Same with prescribing and so on. The BMA scope doc is clear on what they should and should not be doing. I double fucking dare them to produce something with that clarity.
They're basically saying they're ignoring BMA's document and using the "SoP to be determined locally by their own team" card which essentially means PAs can do whatever they want. u/BMA-Officer-James can be this raised with their LNC?
I certainly will. Also might be a really bad time for an individual Trust to put its head above the parapet on this issue. Watch this space. āš¼
The hero we donāt deserve š«”
No chanceĀ
Only way to get consultants to wake up is by making sure they are actually the only ones taking on responsibility for PAs. No I donāt agree to take on your delegated task for the unregistered professional. Thanks. Remember if shit goes down, they arenāt going to jump infront of a bullet for you
Is this written by a doctor? If so they should hang their head in shame.
There is zero chance in that. They love the powerĀ
Are doctors a valued part of their workforce? Has any Trust in any part of the country made such a statement? Fuck'em all.
āEach team should agree shared levels of entrustment so that the PA does not have to prove their capability on numerous separate occasionsā Like trainees who rotateā¦.particular cunt of a paragraph that one
> Finally, to repeat, Physician Associates are a valued part of our workforce and we do expect all colleagues to act within our trust values. So good you had to say it twice. Tossers.
Chief medical officer knows which side his bread is buttered with Nhse. Likely up the career ladder. Will be on a massive pensionĀ
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Wishful thinking I am afraid. Do you really think this character who wrote this gives a shit what the colleges say?Ā
They lost me at the first sentence.
We acknowledge the BMA scope document but we are going to completely ignore it in favour of locally set scope because that suits us better. Unacceptable. Doctors in this Trust, report every thing that is outside the BMA scope using the MAPs reporting portal here: https://bit.ly/MAPPortal Follow the BMA guidance here: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/workforce/guidance-for-the-supervision-of-medical-associate-professions-maps Itās your GMC licence on the line at the end of the day.
Nothing is slowing down this gravy train for Trusts and back-stabbing GP partners
So nothing useful
Get in the fucking bin. Or the sea.
This shithole of a trust is abusing "local governance" to let PAs run rampant in many departments, it is a serious issue and the GMC will do fuck all to limit scope and the Royal College bureaucrats have caused huge damage to not only our profession but caused harm directly to patients.
It seems that every trust is releasing a statement like this..
This Nhse must have sent out an email
*In the end the Party would announce that two and two made five, and you would have to believe it. It was inevitable that they should make that claim sooner or later: the logic of their position demanded it. Not merely the validity of experience, but the very existence of external reality was tacitly denied by their philosophy.*
From GMC : Weāre aware that issues related to the responsibility and accountability of doctors when supervising PAs and AAs have come to the fore in recent weeks. In part this is due to online discussions about a Medical Practitioners Tribunal determination from a case in 2017, which has been misrepresented as setting a precedent or policy position. One tribunal determination sets no legally binding precedent on future tribunals. The case involved significant concerns and allegations about the doctor over a period of time. The primary failure was the doctorās responsibility to urgently and personally review a patient upon admission because of how they presented, which he did not do. While the tribunal found that the doctor failed to adequately supervise a PAās review of that patient, other serious allegations were also found proven which were of an entirely separate nature.
You know whatās useless? Both PAs and your stupid statement. Both can F off
>The trust maintains that PAs can record a current drug history as part of their clinical history in a structured format on Cerner. Hmmm. This doubling down in its self raises its own suspicions. Itās oddly specific. It reeks of a āworkaroundā or a āloopholeā To me this sounds like āwriting up regular medsā which then enable someone the medicolegal nightmare of countersigning a non-prescriberās work at the click of a few buttons (+/- proper checking of said non-prescribers work, or perhaps it goes on āvibesā after a while?). If thatās the case (Iād bet on it but I canāt because I have no money), thinking with a Swiss cheese hat on: -They should probably explicitly BLOCK **ALL** areas of prescribing and imaging requesting from non-prescribers; -This would almost certainly prevent things like the numerous PA prescribing/imaging requesting SUIs that have happened to date.
Yada yada yada one team yada yada yada MDT yada yada be kind yada yada dependant independent generalist specialists that are your responsibility.
Meaningless statement
I don't think it's meaningless at all. I think this statement sends out very clear messages as to how the senior management at the trust perceive and value non doctors undertaking medical roles, but also sends out a very clear message who is medicolegally liable for any mistakes or errorsĀ
I think more than ever it dissuades Consultants taking on an extra burden of responsibility. The Trust has made its position clear that it is the Consultant responsible. It is difficult for the BMA legal services to support any Consultant who allows any PA to work beyond the scope set by the BMA.
Cons will be bullied by management to do this sadlyĀ
is this some German joke Iām not understanding?
Why not just give the PAS prescribing rights. Why do docs have to listen to them?
Because they'll kill people.
Totally get it but they want docs to be beneath them and listen to what they need for their patients, doctors get scapegoated, thereās some cases they can manage yes sure, but they need their own repertoire of things they can prescribe, that give them accountability and not leaning on doctors shoulders
The issue of PAs being unsafe prescribers isn't solved by moving all the liability away from the supervising doctors, that just avoids us taking the flack but unsafe prescribing will still continue and without any safety net. PAs should not prescribe full stop. They shouldn't be doing roles where they need to get a doctor to prescribe for them.
Totally agree totally!
>PAs work under the supervision of consultants as part of the clinical team. A common misconception on the subreddit is that PAs actually work under the supervision of an F1.
Under the supervision should also mean the consultants are fully liable. Consultants are however rarely always there, and de facto day to day decision making and supervision falls onto the resident doctors. I guess now, with the trust acknowledging this, all PAs should be asked to go to their supervisors for all their day to day needs!
Guess who takes the blame when a significant event occurs? (not the consultant) What is the point of a PA if a doctor needs to repeat every step of the PA's work to be medicolegally covered?
There is no point in a properly supervised and scoped PA. They're not worth the hassle, too expensive and not efficient. This document is essentially saying "be nice, let them play doctor, do their prescriptions but the responsibility is on you". It's the only way to make PAs viable, let them play outside the BMA scope and shirk responsibility on to doctors.
Firstly, that's why PAs need to be able to prescribe independently and request ionising radiation. Secondly, and until PAs can prescribe independently, nurses have asked doctors since the dawn of "can you prescribe X/Y/Z", due diligence is done, the patient gets their medication, and the world continues to rotate around its axis. Thirdly, there is a thousand times more risk clinically supervising a dodgy locum doctor with minimal or no NHS experience than there is your average PA who are always NHS trained and have often been around for several years at least.
1) OK 2) nurses asking for paracetamol is a world of difference to PAs asking you to prescribe or request investigations for a patient they clerked. you clearly recognise this considering point 1 3) a "dodgy locum doctor" has their own license on the line. Personally, I think most trusts have reasonable mechanisms to deal with a locum that the department does not feel is safe or requires additional support/training
Well, if youāre constantly being asked to prescribe medications and request ionising radiation on a PAās behalf, I suppose itās an easy mistake to make.
Yet itās juniors who who do the prescriptions, request scans and the supervising consultant is taking the piss