Plans to extend physician associate roles rejected as 87% of doctors worry about patient safety

The government has announced that legislation to regulate PAs and AAs (Anaesthesia Associates) will be put forward on Wednesday

Doctors have overwhelmingly rejected plans to increase the use of Physician Associates (PAs) in the NHS after a survey shared exclusively with ITV News revealed that 87% believe they can sometimes be a risk to patients. 

The British Medical Association, who conducted the survey, claim it is by far the biggest response to the subject of unregulated PAs in the NHS, receiving nearly 19,000 responses from doctors - including GPs. 

It also found that 86% of doctors believe the public don’t understand the difference between PAs and doctors.

What is a Physician Associate?

Physician Associates are not doctors, but healthcare professionals who work under the supervision of a named senior doctor, such as a General Medical Council registered consultant or GP.

They work within a defined scope of practice. They can:

• Take medical histories from patients

• Carry out physical examinations

• See patients with undifferentiated diagnoses

• See patients with long-term chronic conditions

• Formulate differential diagnoses and management plans

• Perform diagnostic and therapeutic procedures

• Develop and deliver appropriate treatment and management plans

• Request and interpret diagnostic studies

• Provide health promotion and disease prevention advice for patients

The definition of a PA, according to the Department for Health and Social Care, is a “healthcare professional trained to the medical model.”

They have been working in the NHS since 2002 and cannot prescribe medication.

PAs work in acute medicine, GP practices and Emergency Medicine. They complete a three-year undergraduate biomedical sciences degree followed by a two-year post-graduate course in Physician Associate studies.

They are not regulated in the UK, and there is only a voluntary register to monitor them. 

'To lose a child and then learn that it was totally preventable, it is a scandal': Marion Chesterton said she would have asked for a second opinion had she known her daughter wasn't being treated by a doctor

In 2022, Emily Chesterton thought she’d seen a doctor when she presented to her GP surgery with leg pain and breathlessness. Emily was prescribed anti-anxiety medication.

Hours after her appointment, she was taken to hospital and died after suffering a pulmonary embolism. Six months later, her parents discovered she’d not seen a doctor, but a PA.

Her parents, Marion and Brendan Chesterton, are now campaigning for tighter controls on the use of PAs in the NHS.

"To lose a child and then to learn that it was totally preventable and needless… after you've brought your child up and done all you can do to look after them, well, it's a scandal, absolute scandal," Marion told ITV News.

"And the sooner everyone finds out about these physicians, associates the better people need to know what's happening.”

In Emily’s case, the physician associate suggested that Emily’s breathlessness was due to anxiety and long Covid and prescribed propanolol for anxiety.

Emily messaged her mum saying she’d seen a "doctor", but it appears that she was never told the person she was consulting for medical assistance was not a fully qualified GP.

The circumstances that led to Emily Chesterton’s death were investigated by a coroner. The conclusion of the coroner was: "Emily Chesterton died from a pulmonary embolism, a natural cause of death.

"She attended her general practitioner surgery on the mornings of October 31 and November 7 2022 with calf pain and shortness of breath, and was seen by the same physician associate on both occasions.

"She should have been immediately referred to a hospital emergency unit. If she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived."

Two weeks after conducting the serious incident review, the practice made a collective decision to terminate the contract of the particular PA and they no longer employ PAs.

This case raises serious questions about the wider use of them in the NHS.

As of June 2023, there were:

• 1508 Physician Associates working in NHS Hospital Trusts and other core organisations in England

• 1707 FTE PAs working in GP practices and primary care network

The government has announced that legislation to regulate PAs and AAs (Anaesthesia Associates) will be put forward on Wednesday, December 13, 2023. 

The General Medical Council, the doctor’s regulator, will set standards of practice, education and training for associate professionals by the end of 2024.

A press release from The Department for Health and Social Care said: "PAs (and AAs) will have the same levels of regulatory oversight and accountability as doctors and other regulated healthcare professionals.” 

Doctors have been calling for a different organisation to be used to regulate PAs and AAs. 

GP Helen Salisbury said: "The GMC was set up to make sure that patients knew when they went to see a doctor that was a proper doctor.

"And I think we're getting some very unhelpful blurring If physician associates end up on the same register with numbers that are indistinguishable from from doctors, actually it becomes really very difficult."

'The first worry has to be about patients and their safety', says GP Helen Salisbury and that PA's have a place in medicine 'if they are being supervised'

Health Secretary Victoria Atkins said: "Physician Associates and Anaesthesia Associates are already making a great contribution to the NHS, supporting doctors to provide faster high quality care for patients.

"This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety.

"This is part of our Long Term Workforce Plan to reform the NHS to ensure it has a workforce fit for the future."

ITV News have contacted DHSC for further comment.

Professor Philip Banfield, BMA chairman of council, said: “Doctors in the UK have been growing more and more worried about the consequences of the government’s plan to expand the number of PAs and AAs in England. Here, at last, are numbers that show the shocking scale of that concern.

“The creeping expansion of these roles and their central part in the government’s workforce plan for the NHS has been undertaken against the advice and warnings of an entire profession.

"To change the nature of medical care in this country without the consent of the medical profession is utter folly and will be revealed as such.

“There is still time for the government to reverse course and finally listen to the medical professionals who know what they are talking about. The BMA will continue to oppose this dangerous path every step of the way.”

The NHS Long Term Workforce Plan sets out plans to increase the PA workforce to 10,000 by 2036 and the AA workforce to 2,000. 

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