Physician associates face review over patient safety

Health Secretary to examine the way graduate medical workers are deployed amid backlash from doctors about risks

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Physician associates could be banned from diagnosing patients under a review of the role stemming from safety concerns.
The NHS has become engulfed in controversy over the responsibilities given to the graduate workers, who have two years’ training, but no medical degree.
Amid a growing backlash from doctors about risks to patients, Wes Streeting, the Health Secretary, is seeking to commission a review of the way such staff are deployed.
PAs are supposed to “support doctors in the diagnosis and management of patients” under supervision, with around 3,500 such workers – which some have dubbed “cut price medics” – employed by GP surgeries and hospitals.
Existing NHS plans aim to triple the number in coming years, with around 10,000 in post by 2037, along with 2,000 anaesthesia associates.
But in recent months there has been growing concern about the way PAs are being used, with fears that they are being given responsibilities which should only be done by a doctor.
The profession came under scrutiny following the death of Emily Chesterton, who suffered a pulmonary embolism in 2022 at the age of 30 after she was misdiagnosed by a PA on two occasions who she had believed was a GP.
Mr Streeting said earlier this week that he was “taking very seriously the concern that’s being expressed about physician associates, particularly in relation to doctor substitution”.
The Health Secretary is understood to be keen to announce a review of PAs, which will look at their roles, the safety of their practice and where they fit within medical teams.
It is expected to examine whether such workers should be allowed to diagnose patients, without them being seen by a doctor first. Senior health sources said it would also look at how closely PAs were being supervised.
Findings from the review, chaired by a senior doctor, would feed into a 10-year plan for the NHS which is due to be published early next year.
Professor Gillian Leng, president of the Royal Society of Medicine, is understood to have been asked to chair the review.
The intention is to carry out a wide-ranging examination of the issues – in particular safety risks – which is as robust as the Cass Review was in examining healthcare for transgender children.
The British Medical Association has said GP practices should stop hiring the associates at all, and phase out those who are already employed.
Meanwhile, the Royal College of GPs has said all patients should be assessed by a GP before being seen by a PA to reduce their risk of harm. Its guidelines drawn up last month say the workers should explain that they are not doctors when introducing themselves.
Last month the Academy of Medical Royal Colleges waded into the row by calling for a rapid independent review of the matter.
While Mr Streeting and NHS England are understood to be keen to proceed, the matter is understood to remain under consideration by Downing Street.
On Wednesday Mr Streeting said he was taking “very seriously” concerns about PAs being used as substitute doctors.
The Health Secretary said he wanted to look into the issues around the roles before a planned expansion in the number of medical associates.
Mr Streeting acknowledged there were concerns around the tasks PAs were doing and transparency, with patients not necessarily realising they were not being treated by a doctor.
The Health Secretary said: “I’m taking very seriously the concern that’s being expressed about physician associates, particularly in relation to doctor substitution, scope of practice and transparency for patients.
“I actually think physician associates have a role to play and I don’t want to throw the baby out with the bath water as we address those concerns, but I’m increasingly convinced there are legitimate concerns that we need to look into.
“We’ll have more to say on that shortly,” he said.
On Wednesday Mr Streeting told BBC Breakfast: “I am taking these concerns seriously and I’ve spent a lot of time listening to clinicians, listening to physician associates as well, by the way.”
Under the NHS long-term workforce plan the number of associates will expand from around 3,500 at present to 10,000 physician associates and 2,000 anaesthesia associates by 2036-37.
Mr Streeting said: “Before we put the foot down on the accelerator to expand the number of roles, I think we also firstly need to take stock on where we are, dive deeply into some of the challenges that are being put to us by the medical profession about the deployment of these roles because I need to assure myself, in order to assure the country, that we’ve got the right people in the right place doing the right thing.”
A man whose wife died after a drain was mistakenly left in her abdomen for 21 hours said his wife would have lived if the NHS “had not used cheap labour”.
Roy Pollitt did not know his 77-year-old wife Susan was being treated by a PA. Mrs Pollitt died in July 2023 at Royal Oldham Hospital, with a coroner concluding that the death was caused by an “unnecessary medical procedure contributed to by neglect”.
Following Mrs Pollitt’s inquest, Joanne Kearsley, coroner for North Manchester, issued a Prevention of Future Deaths notice owing to her concerns about PAs, highlighting the lack of a national framework covering their training, supervision and competency assessment.
In June, a survey of RCGP members found 81 per cent thought that using PAs in general practice could negatively affect patient safety.
First introduced in 2003, a PA’s role allows them to take medical histories, perform physical examinations, analyse test results and make diagnoses.
However, they are supposed to only work under supervision and are not allowed to prescribe drugs or refer patients for procedures.
From December, the workers will be regulated by the General Medical Council [GMC].
But this has met fierce opposition from medics, who say this will add to confusion and blurring of the distinction between PAs and doctors.
The GMC is facing a legal challenge over the matter of Anaesthetists United, a campaign group backed by the BMA and the parents of Miss Chesterton.
Plans for an expansion of physician associates in England were laid out in the NHS Long Term Workforce plan which was published by NHS England last year.
However, this is now under scrutiny and could be rewritten.
Mr Streeting has promised to divert billions of pounds into general practice, with a shift from hospital care to prevention.
The National Audit Office has pointed out that current long-term plans would mean the number of fully qualified GPs increases by 4 per cent by 2037, compared with a 49 per cent growth in hospital consultants.
A Department of Health and Social Care spokesman said: “We do not comment on leaks.”
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