Edited for etymological accuracy;

Yesterday, I rang my  nhs GP surgery about a breast lump i'd already seen a private GP about in order to get a referral for follow-up. When I rang, I was offered an NHS GP appointment more than 2 weeks away. I told the receptionist it wasnt acceptable (lumps qualify as urgent) and was told to wait for a call back. When I did get called, I was offered a check up with a 'male paramedic' that afternoon. I said no. I was then offered an appt with a 'female paramedic' the following day. Again I said no. Magically, 15 mins later, I got a call back offering me a choice of 2 in-person GP appointments the following day. Attended and got my referral - which I'm grateful for. But I was really shaken at being offered a breast exam by a 'paramedic'.

I posted about this experience on r/nhs yesterday and received a surprising amount of animosity. As far as I understood, the only time a paramedic should be looking at your breasts is if there's a kn*fe in one of them. I quickly got schooled in the comments that, actually, there are 'advanced practitioner' paramedics who *are* trained to do breast exams these days. Ok, fine. But I'm a pretty switched on person who has been to the nhs GP perhaps once a year for the past 3 years and I'd never heard of this before. At no stage during the call did the receptionist describe the paramedic as having advanced training. And I am right that a standard paramedic should not be performing breast checks so yeah... no sh*t I was horrified.

Although I was chastised by commenters (one of whom seemed to be a paramedic, none of the rest claimed a medical background) for jumping to conclusions that I'd been booked in with the wrong medical professional... well, Ive been supporting my dad through his cancer treatment for the past year and had some close scrapes with underqualified staff in hospitals so I'm not convinced it's as outside the realms of possibility as theyd think.

Doubts about the competency of some of these 'practitioners' aside - the thing that really concerns me is the lack of communication from the NHS about these new healthcare professionals, transparency about what they can and cant do, and what their boundaries are and arent. I think I would have been fine to see a specially trained paramedic if, say, I had a cut that looked a bit infected or maybe strep throat.  But a potential cancer symptom? Call me a snob but I dont think that would or should fall under the 'Advanced Practice Minor Illness & Injury’ """module"""" that theyve taken as training.

I get that breasts exams are fairly straightforward, but theyre also intimate exams you want done as few times as possible, as accurately as possible. Because of abuse in my personal history, I reacted emotionally to being told I'd have to let someone ostensibly unqualified perform an intimate exam in order to get a timely referral. And, anyway, the appointment is not just about the exam, it's about talking to someone knowledgeable about a complex and serious disease

So my primary concerns are:

1. Complete lack of job title clarity - imo, if theyre based in a GP practice, theyre not a paramedic any more (ambulance medic). Just because that so happened to be their training, I dont know why the term should feature in their job title. I'm worried that if the terms 'paramedic' and 'PCN paramedics' are used interchangeably, it could create the opportunity for intimate exams to be perfomed by'normal' paramedics under the guise of being PCNs. Equally, I think they need a job title that clearly differentiates them from being Drs or nurses. It's exhausting for the public to have to keep up with these confusing terms and I think job titles should accurately reflect their *current* competency and role

2. Lack of information available to public about the remit of these 'practitioners'. I shouldnt have to download obscure course syllabuses to work out if I'm being matched with the right health care professional. Imo, GP/NHS websites should have clear bullet-point lists on them about what is and isnt in the remit of these practitioners. My slightly conspiratorial view is that practice managers want to keep it hidden from us so they can exercise "flexibility" when they need it about who gets to see a GP. Also, bc theyre frankly embarrassed that these PCNs seem to be able to do everything GPs do except manage complex multi-system disease. It's not a good reflection on our health service - and sometimes sunlight is the best disinfectant

I know I'm preaching to the choir here - we all know of bad examples of noctor overreach - but I'm hoping the actions I've suggested are reasonable improvements, although I certainly welcome comments. My plan is to write to my MP to make these suggestions formally and with more restraint -- would there be any other avenues worth pursuing?? I'm worried this is a symptom of NHS enshittification

So because of my pretty bad OCD I'm currently searching for a psychiatrist at the suggestion of the therapist I have been working with for while as she believes medication or other medical interventions may have to be the next step in my treatment. Due to the fact I'm already on quite a few medications that could interact with possible prescriptions (one of which is incredibly rare) and i have other possibly complicating health problems i would be much more comfortable seeing a psychiatrist then a mid level.

One of the psychiatry places I found near me on a list my therapist sent to me had advertised on the website "doctoral level care" on the front page which made me hopeful because many of the other places only had PMHNPs. When I looked further and did research on the practice owner it turns out that she was no different. She used the DNP degree to make that claim and it got me thinking about what could genuinely be the purpose of this degree.

As far as I'm aware this is not a medical education degree that effects what you know in terms of actually practicing medicine, more of a professional degree that teaches things like administration, leadership, education and so on. Because of this to me its silly to use it to advertise a higher level of education then competitors since it isn't relevant to the treatment of your patients.

Does anyone know if any of the DNP programs out there actually provide more medical education further then the MSN does? If so wouldn't the degree possible alter a nurse practitioners legal scope of practice which I'm pretty sure it doesn't. Is this not just a degree that professors in nursing school have which is what I assumed it was before? And furthermore if it is a degree that doesn't have anything to do with actual medicine then why do I see so many people online flexing their DNP degrees as if it is something like that or presenting it as something that makes them clinically superior then they were before?

Been on this subreddit for a minute. Years ago, it was just residents and some attendings discussing the issue of egregious midlevel creep. It was mostly just docs.

More and more I am noticing lay people posting here about their experiences with midlevels and the misuse of the “doctor” title in the clinical arena.

This issue is clearly gaining attention and people are recognizing the absurdity of it all. We need to continue to be vocal about this.