By Professor John Robertson OBA

From BBC Health this morning:

Julia’s first four years as a physician associate [PA] was everything she hoped it would be. After working in the NHS for the best part of a decade in a non-patient facing role, she was delighted to be on the wards supporting doctors and the wider healthcare teams.

“I loved the contact I had with patients, assessing them and playing a part in their care. I felt supported and part of a team.”

That all changed about a year ago.

“Suddenly we came under attack. Doctors in the radiology department started refusing to talk to me about scans and others have been saying we don’t deserve to get paid what we do.

That last sentence suggests a real risk to patient care triggered by this scheme launched by the Conservative Government in 2015 as a quick, cheap fix for doctor shortages in NHS England.

According to the Herald, there were 143 PAs in Scotland in November 2023.

Per head, the above would equate to 1 430 in NHS England but, in effect, there around 4 000, approaching three times as many.

Only Aberdeen University in Scotland offers PA training.

Why does Scotland have so few PAs?

First, 10% of the population but 65% more doctors in training

From Undergraduate medicine degree admissions at Scottish universities: FOI release, published yesterday, we see 1 240 entrants to ‘Pre Clinical’ medicine for 2022-23, the latest HESA data available (245 from rUK).¹

From NHS England’s NHS England update on medical school training places, 28 February letter to Royal College of Physicians, published in February 2024:

We are currently ahead of plan on our initial milestone to increase medical training places from an intake of 7,500 in September 2023 to 8,200 places by September 2025, as set out on p129 of the LTWP. In September 2023, a total of 7,571 medical school places were funded for students, 71 higher than originally planned. Since then, the Government has confirmed funding for an extra 205 places in September 2024, an additional 350 places by September 2025, as well as up to 200 medical apprenticeship places. Therefore, the overall position for September 2025 is now expected to be up to 8,326 medical school places, which would be higher than the original LTWP planned trajectory.

So, self-satisfied, ‘ahead of plan’, NHS England had 7 500 medicine students enrolled in 2023, one year ahead of the Scottish figure of 1 240?

With only 10% of the population, per head, all things being equal, Scotland might have been expected to have 750 such students but had 1 240, 65% more!

Sources:

1. https://www.gov.scot/publications/foi-202400431082/
2. https://www.england.nhs.uk/long-read/nhs-england-update-on-medical-school-training-places-28-february-letter-to-royal-college-of-physicians/#:~:text=In%20September%202023%2C%20a%20total,to%20200%20medical%20apprenticeship%20places.

Second, better conditions:

Slightly? Only if you understand percentages of large populations about as well as 11 year-olds before you teach them and, remarkably, if you have not read your own results below.

From, I have to say, properly done research by the General Medical Council today, evidence of significantly better conditions for doctors in Scotland.

That 25% gap between the satisfied and dissatisfied in Scotland is massive because it’s 25% of more than 20 000 doctors (see below from the BMA) or around 5 000 doctors:

As of December 2023, there were 16,733 doctors working in secondary care in Scotland, which is equivalent to 15,001 full-time doctors and as of 2023, there were 4,474 general practitioners (GPs) in Scotland, excluding specialist trainees. 

Again note the statistically significant difference between the conditions of GPs in Scotland.

A major reason deriving from SNP Government performance over 17 years –

However, Scotland has more GPs per capita than the rest of the UK, with 76 GPs per 100,000 people compared to the UK average of 60.

Sources: https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk/workplace-report

https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-under-pressure-scotland#:~:text=The%20medical%20workforce%20in%20Scotland,%2Dtime%20doctors%20(FTE)