Apparently American style 'physician assistants' (PAs) are to be introduced to the NHS. This is a rather worrying prospect. A two year course (following a previous degree) and apparently they are ready to do the job of a house officer, senior house officer, or even a registrar (there's a minimum of four years training, for graduate entry to medicine, before becoming a house officer, it makes you wonder why they bother if PAs are so much better) in the primary care and emergency medicine setting (at a rather more generous salary of £39,500 in 2003 compared to an F1 house officer on £21k in 2008*) diagnosing, prescribing, and ordering investigations (although prescriptions or X-rays are supposed to be countersigned by a doctor in the UK at the moment, the experience seems to be that discussion with the doctor are perfunctory at best, and there is likely to be pressure to follow the US model and allow them to prescribe).
Somehow we're supposed to be reassured that a pilot study using US trained PAs (with an average of 11 years experience* as PAs and allied health professionals) found that they worked well. Presumably a study of consultant vascular surgeons would be good evidence for allowing new house officers to carry out AAA repairs unsupervised.
This is absolutely crazy, you cannot create a new paramedical profession de novo and then roll it out across the NHS on the basis of a single study of a highly selected cohort with extensive previous experience. They should at least have evaluated newly qualified US PAs (who, unlike doctors, don't have a probationary year).
Paramedics, nurses, and other allied health professionals jump through a million hoops just to be allowed to do a few extra procedures that doctors can do from day 1. Now we're handing over direct clinical diagnosis and management (and de facto prescribing) to people with minimal knowledge, experience or training. Whatever you think about nurse practitioners, at least they develop their clinical skills in line with their extra responsibilities. The US PAs in this study were a lot closer in experience to UK nurse practitioners than to the newly trained UK PAs that could soon be fucking up our healthcare. Newly qualified junior doctors are scary enough, this is terrifying.
* Hopefully the pay differential is due to the US PAs being highly experienced since otherwise I can see junior doctors going on strike, at this pay rate you could get yourself two newly qualified doctors, or even a single specialist registrar (similar level of training to a GP, likely to have higher qualifications such as membership of the Royal College of Physicians) for this price! According to the Wolverhampton course you can "earn a starting salary of £22,500 - £32,000 at current levels" [my emphasis], brilliant, why go to medical school just to end up earning less and taking legal responsibility for someone else's mistakes, while being told that these people are working at a higher level of competence than you after half the training?