BMA backs family suing regulator over the role of physician associates in the NHS

ITV News has learnt that the family of a woman who died after being misdiagnosed by a physician associate has won the backing of the BMA in a legal fight for better regulation, as ITV News' Rebecca Barry reports

Words by Health Correspondent Rebecca Barry and Health and Science Producer Philip Sime

ITV News can exclusively reveal that the British Medical Association (BMA) is joining legal action being brought by a bereaved family against the medical regulator over the role of physician associates in the NHS.

The parents of 30-year-old Emily Chesterton, who died from a pulmonary embolism after she was misdiagnosed by a physician associate, accuse the General Medical Council (GMC) of putting patients at risk by failing to distinguish properly between the role of doctors and medical associates.

They are joining a legal case against the GMC alongside the campaign group Anaesthetists United.

The doctors' union, the BMA, will financially support the case.

Physician associates (PAs) and anaesthesia associates (AAs) should work under the supervision of doctors in hospitals and GP practices.

They must complete a three-year health, biomedical or science undergraduate degree, followed by two years of postgraduate medical training.

They can take medical histories and help to diagnose patients, but can’t prescribe or order x-rays.

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There are around 3,500 physician associates and anaesthesia associates working in the NHS in England.

The health service's Long Term Workforce Plan aims to increase that to 10,000 by 2037.

Ahead of this expansion, there are growing calls for the GMC to create a national scope of practice, which clearly sets out the tasks that PAs and AAs should and should not be allowed to undertake.

Emily Chesterton's parents, Marion and Brendan, spoke to ITV News as they joined the legal action.

"We're just trying our best for Emily," Marion Chesterton said.

"I just want to help other people and get something good out of this because she was such a beautiful person. She wouldn't want anyone to go through what we have been through. She has lost her life and she had such a wonderful life ahead of her," Marion said.

"We don't want other families to go through what we go through and we don't want other Emilys who are collateral damage for this push to put PAs and AAs into the NHS," Brendan Chesterton said.

BMA Council Chair, Professor Philip Banfield, says there is a "lack of limits" to what physician associates can and can't do.

"As a doctor, I have things that I can and can't do. My practice is regulated by the GMC," Professor Banfield said.

"What we're seeing is physician associates being placed in situations which are unsafe for them and unsafe for patients," he added.

Meanwhile, Dr Richard Marks, co-founder of Anaesthetists United said: "We think the public would be shocked that, not only are there no national rules saying what associates can and can't do, but they're not even planning on introducing any so we want to set that straight."

The GMC has an overarching duty to protect the public, says Dr Richard Marks

At the Royal Berkshire Hospital in Reading, they have 46 physician associates across 16 specialities.

Speaking to ITV News on a ward on Tuesday, Chief Medical Officer Dr Janet Lippett, said they are a valued and vital part of the team, and that they work under the supervision of qualified and experienced doctors.

Dr Lippett described the current debate around the use of physician associates as "toxic".

"These bright, young, enthusiastic individuals went to university to learn their trade, just as I did as a doctor," Dr Lippett said. "Properly supervised, properly nurtured, they really are a welcome addition to the team."

The GMC will start regulating physician associates from December this year.

Responses from the General Medical Council, the Department of Health and Social Care and NHS England

A spokesperson for the GMC told ITV News:

"We are very grateful to Mr and Mrs Chesterton for giving us the opportunity to meet with them and to listen to the important issues they raise, following the terribly sad and avoidable death of their daughter, Emily.

"Regulation is a vital step towards strengthening both patient safety and public trust in these professions. It will help provide assurance to patients, employers and colleagues that PAs and AAs have the right level of education and training, meet the standards that we expect of the professions we regulate and that they can be held to account if serious concerns are raised.

"Physician associates and anaesthesia associates are not doctors, cannot replace them, and should never be used to fill gaps in doctors’ rotas. When we begin regulating PAs and AAs later this year, we will expect them to be supervised by a doctor and to practise within their competence. In regulating PAs and AAs, we will be clear that people in these roles will have a responsibility to communicate who they are, and their role in the team.

"Employers also need to make sure there are appropriate governance structures in place, to make sure that PAs and AAs are working under supervision."

A spokesperson for the Department of Health and Social Care said: "This is a tragic case and our thoughts are with Emily Chesterton’s family and friends. "We are clear that physician associates should be supporting, not replacing, doctors and should receive the appropriate level of supervision by healthcare organisations.

"The NHS has issued clear guidance on the deployment of physician associates and anaesthesia associates in the NHS and we expect trusts to follow this."

An NHS England spokesperson said:

"The NHS has always been clear about the role medical associates play in supporting clinical teams to provide high quality care for patients – they are not replacements for doctors, but support teams with specific tasks they are trained to do, under supervision.

"We know that the confidence of the public and the medical community is absolutely essential as we develop an NHS workforce that is fit for the future, which is why the NHS has issued updated guidance on the appropriate deployment of these roles, and will continue to work together with government and medical and patient groups to provide clarity on these roles for patients and the public, ahead of the GMC regulation coming into effect at the end of the year."

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