September 21st, 2016
An American in Yorkshire: Initial Impressions of the NHS
Faster than you can say “cheers,” summer is turning into fall, and I find myself having passed the 2-month mark as a physician assistant working for the National Health Service (NHS) in Yorkshire, England, as part of the National Physician Associate Expansion Program (NPAEP). There have been learning experiences, celebrations, crossed wires, and countless cups of tea as I continue to learn more about the NHS and the role for PAs here in the U.K. Today, I’d like to share a couple of misconceptions I had about the NHS prior to making the journey to jolly old England.
Since the U.K. has nationalized healthcare, I had envisioned months-long waiting lists for appointments and surgeries, particularly to see a specialist. While I cannot speak for other areas in medicine, in gynecologic oncology this has not at all been the case. The reason why, I believe, has a lot to do with the target-date-based pathway system the NHS uses, which prioritizes patients with a diagnosis of a gynecologic malignancy. With a cancer diagnosis, a window is assigned in which the patient must be seen by the appropriate specialist and receive definitive treatment (31 and 62 days, respectively). Additionally, there are special “fast-track” clinics that I work in that exclusively deal with patients presenting with symptoms suspicious of a gynecologic cancer, and these patients must be seen within 2 weeks. I think you would be hard-pressed to consistently meet that mark when referring to a specialist in the U.S. Additionally, there are sanctions if not enough patients are seen and treated within the specified windows. So understandably, there is a focus to get these patients seen as soon as possible. And in working terms, it means that patients are seen by the diagnostic gynecology team (which includes yours truly) and, if needed, the gynecologic oncology team (which as it happens, also includes me) pretty impressively quickly.
Another misconception I had about working in the NHS is that doctors and patients would be resistant to the idea of physician assistants. This again has not at all been my experience. Doctors in the NHS seem very interested in my role, training, and the type of work I’m able to perform. As in the U.S., the NHS is experiencing a shortage of healthcare providers. My experience is that most doctors are very open to midlevel providers and other solutions that would help meet some of that patient demand. Furthermore, since every hospital in the U.K. trains physicians (as opposed to solely academic centers doing the training, like in the U.S.), these physicians-in-training make up a large part of the care providers in the NHS. I believe that as a result of this, doctors, staff, and patients especially all seem quite comfortable with the idea of team-based healthcare. Coming from the U.S., I was accustomed to explaining my role as a physician assistant to new patients and envisioned I would be having these discussions a lot more in the U.K. But what I’ve found is that patients are so used to seeing a physician-in-training or advanced nurse specialist when they have an appointment with an attending physician, that when Megan the PA walks in instead, it seems not to faze them in the least. (This does not extend to my accent, which is often a topic of conversation, and patients seem to enjoy betting their significant other over whether I’m American or Canadian.) Overall, patients seem happy to be seen and provided good care, regardless of my specific role (or accent for that matter).
These are just a couple of the comparisons between the American and British healthcare systems that I’ve been attempting to mentally catalogue during these past months. This experience continues to be eye-opening, exciting, and at times a bit daunting. I look forward to exploring and dissecting more of these similarities and differences in the near future. Until then, if you have any questions about the workings of the NHS or physician associates in the U.K., please post them below and I will try to address them in a future post.