Government orders review into role of physician associates, after fears over patient safety
The government has ordered a review of physician associates (PAs) and anaesthesia associates (AAs) in the NHS in England following a “toxic debate” and fears over patient safety.
The review, which will be published in spring 2025, will examine the tasks that PAs and AAs are allowed to undertake and look into measures to ensure patients know when they are being seen by a medical associate, rather than a doctor.
Announcing the review, Health Secretary Wes Streeting said there were “legitimate concerns over transparency for patients”.
Bereaved families who have campaigned for better regulation have welcomed the news, saying patients desperately need "clarity" and "renewed trust" in the NHS.
Emily Chesterton, 30, died from a pulmonary embolism in 2022 after she was misdiagnosed by a physician associate. She thought she had been seen by a GP.
Her parents are now taking legal action against the General Medical Council (GMC), accusing it of putting patients at risk by failing to distinguish properly between the role of doctors and medical associate professions.
Her mother Marion Chesterton told ITV News she "welcomes" this review.
“We desperately need clarity as to the exact role of a PA and renewed trust in our NHS," she said.
“There must be set limits as to what a PA can and cannot do, for all our sakes. There must be a definite description of the meaning of supervision.
“There must be no more Emilys. We miss her every minute of the day, our precious daughter had such a wonderful life ahead. This must not be allowed to happen to anyone else.”
The British Medical Association (BMA) has also joined legal action being brought against the medical regulator, as revealed exclusively by ITV News in October.
They are joining a legal case against the GMC alongside the campaign group Anaesthetists United. The BMA will financially support the case.
There are currently around 3,500 physician associates and anaesthesia associates working in the NHS in England, but the health service's Long Term Workforce Plan aims to increase that to 10,000 by 2037.
As regulations stand now, Physician Associates and Anaesthesia Associates 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 they cannot prescribe or order x-rays.
In recent years concerns have been raised following the deaths of people who were treated by PAs and mistakes were made.
In September the Academy of Medical Royal Colleges wrote to the health secretary and NHS England calling for a rapid review of PAs and AAs amid “mounting concern” from doctors.
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The academy called for an investigation into whether using medical associates was safe, cost-effective and efficient.
The government has now announced a review will take place, led by Professor Gillian Leng, who is president of the Royal Society of Medicine.
The review is due to report in the spring and will include recommendations on how the roles should work in the future, as part of the government’s 10-year plan for the NHS.
Streeting said many physician associates "are providing great care" and "freeing up doctors to do the things only doctors can do".
“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.
He added that the independent review would "establish the facts, take the heat out of the issue, and make sure that we get the right people, in the right place, doing the right thing".
The GMC will begin regulating PA and AAs from December.
In a statement it said: “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.”
"We have patient safety concerns raise with us by our members on almost a daily basis."
But the BMA is calling for immediate safety measures.
“You do not fly a plane under safety review, you ground it," the association's council chair Professor Phil Banfield said.
"So we need to know what immediate safety measures NHS England will put in place, how quickly they will pause their PA expansion plans, and in the meantime if they will adopt the BMA’s own guidelines to start protecting patients now.
“The NHS has failed to make the employment of associates safe for patients. By allowing a free-for-all on what PAs can and can’t do, hospitals have become a postcode lottery in which patients don’t know if they are being seen by a professional with the right skills.
“Only a clear, nationally agreed scope of practice, telling employers what PAs can and can’t do, will clear up this mess. This review must lead to one.”
But NHS England insists physician associates and anaesthesia associates are “important members of NHS staff”.
Amanda Pritchard, chief executive of NHS England, said: “They come to work every day to help care for patients and so they deserve to be treated with the same respect as anyone else coming to work in the NHS.
“While we have always been clear that they are not replacements for doctors, there are clear and ongoing concerns which we are listening to carefully and taking action to address – this independent review marks our pledge, together with the government, to getting this right.”
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