The role of physician associates in the National Health Service (NHS) has come under intense scrutiny as Health Secretary Wes Streeting orders a comprehensive review amid growing concerns from the medical profession about patient safety. The review, to be led by healthcare expert Professor Gillian Leng, will examine the safety of physician associate roles, their scope of practice, and how patients should be informed about the differences between these professionals and fully qualified doctors.
Physician associates, also known as PAs, are healthcare professionals who work under the supervision of doctors. They undergo two years of medical training, significantly less than the extensive education required for doctors. Currently, around 3,500 PAs and 100 anaesthetic associates are employed in hospitals and GP surgeries across England. The NHS long-term workforce plan aims to triple this number to approximately 10,000 by 2037, raising concerns among medical professionals.
Concerns Over Patient Safety and Transparency
The deployment of physician associates has sparked a heated debate within the medical community. Many doctors have expressed fears that the limited medical knowledge of PAs could potentially lead to substandard patient care. There are also concerns about patients being confused about whether they have seen a doctor or a PA, as their titles and ability to diagnose illnesses can be misleading.
The tragic case of Emily Chesterton, a 30-year-old actor who died after a PA at a GP surgery misdiagnosed her calf pain as a strain rather than a blood clot, has highlighted the potential risks associated with PA care. This incident has further fueled calls for greater transparency and clearer distinctions between the roles and qualifications of doctors and PAs.
Medical Profession Demands Swift Action
The British Medical Association (BMA), the trade union representing doctors in the UK, has been at the forefront of raising concerns about the safety risks posed by physician associates. Professor Philip Banfield, leader of the BMA, welcomed the review but emphasized the need for immediate safety measures. He criticized the NHS for failing to ensure the safe employment of associates, resulting in a “postcode lottery” where patients are unsure if they are being seen by a professional with the appropriate skills.
You do not fly a plane under safety review; you ground it. So we need to know what immediate safety measures NHS England will now put in place [and] how quickly they will pause their PA expansion plans.
Professor Philip Banfield, Leader of the British Medical Association
Legal Action Against Regulators
The parents of Emily Chesterton have joined forces with the campaign group Anaesthetists United to take legal action against the General Medical Council (GMC), which regulates doctors and is set to start regulating physician associates from next month. They argue that the GMC has not adequately distinguished between doctors and PAs. Similarly, the BMA has initiated a separate lawsuit against the GMC for referring to doctors and PAs collectively as “medical professionals,” claiming that this blurs the lines between the two roles.
Balancing Workforce Needs and Patient Safety
Health Secretary Wes Streeting acknowledged that many physician associates provide valuable care and help alleviate the workload of doctors, enabling them to focus on tasks that only doctors can perform. However, he emphasized the importance of addressing the legitimate concerns surrounding transparency, scope of practice, and the potential substitution of doctors.
But there are legitimate concerns over transparency for patients, scope of practice and the substituting of doctors. These concerns have been ignored for too long, leading to a toxic debate where physicians feel ignored and PAs feel demoralised.
Wes Streeting, Health Secretary
Professor Gillian Leng, appointed to lead the review, stated her commitment to conducting a thorough examination of the roles played by physician and anaesthesia associates in the NHS. The review aims to promote patient safety and strengthen the NHS workforce.
The Way Forward
As the review gets underway, stakeholders across the healthcare sector are eager to see its findings and recommendations. Danny Mortimer, chief executive of NHS Employers, expressed hope that the review will provide NHS leaders and senior doctors with the guidance needed to address public concerns about the clinical work performed by physician and anaesthesia associates.
The outcome of the review will have significant implications for the future of physician associates in the NHS. It will need to strike a delicate balance between ensuring patient safety, maintaining public trust, and optimizing the NHS workforce to meet the growing demands on the healthcare system. As the debate continues, all eyes will be on Professor Leng and her team to provide clear and actionable recommendations that prioritize patient well-being while supporting the dedicated professionals who work tirelessly to deliver high-quality care.
