Associate doctors could face more training and stricter regulation as part of a review ordered today by the Health Secretary.
Wes Streeting confirmed that the roles of controversial medical associates (PA) and anesthesia associates (AA) will be examined due to concerns about patient safety.
The announcement comes amid unrest over its growing use within the NHS, with several recent high-profile cases of people dying following consultations provided by personal assistants.
Professor Gillian Leng, President of the Royal Society of Medicine, will lead the work looking at the roles, how they affect safety and how they support wider healthcare teams, including GPs.
The findings, which will be reported in the spring, will include recommendations for how the new roles should work in the future.
Streeting said: “Many physician associates provide excellent care and free up physicians to do things that only physicians can do.”
‘But there are legitimate concerns about transparency for patients, scope of practice and physician replacement.
‘These concerns have been ignored for too long, leading to a toxic debate in which doctors feel ignored and PAs feel demoralised.
“This independent review, led by one of the UK’s most experienced health leaders, will establish the facts, alleviate the issue and ensure we have the right people, in the right place, doing the right thing.”
Health Secretary Wes Streeting today confirmed that the roles of controversial physician associates (PA) and anesthesia associates (AA) will be examined due to concerns about patient safety.
Associate doctors could face more training and stricter regulation as part of a review ordered today by the Ministry of Health
There has recently been unrest over the increasing use of PAs and AAs within the NHS, with several recent high-profile cases of people dying following consultations provided by PAs.
PAs have two years of post-graduate training and can examine, diagnose and treat patients under the supervision of physicians.
The NHS employs around 3,500 PAs and 180 AAs in England. But plans to increase this figure to 10,000 and 2,000 respectively to help close workforce gaps have caused alarm among critics.
The Academy of Royal Colleges of Medicine wrote to Mr Streeting in September calling for a review of PAs and AAs amid “growing concern” from doctors about their roles.
Concerns about patient safety have “increased dramatically” as the number of PAs and anesthesia associates (AAs) has increased, with increased scrutiny due to high-profile errors.
Last week, Roy Pollitt told how his wife died after a personal assistant mistakenly left a drain in her abdomen for 21 hours and accused the NHS of using “cheap labour”.
Susan Pollitt’s inquest concluded that his death at Royal Oldham Hospital in 2023 had been caused by an “unnecessary medical procedure contributed to by negligence”.
Meanwhile, Emily Chesterton, 30, died in 2022 from a pulmonary embolism after being misdiagnosed by a personal assistant on two occasions when she visited her GP in north London.
He was under the impression he was seeing a GP, but on both occasions the PA missed the pain in his leg and the difficulty breathing as a blood clot, which eventually traveled to his lungs.
A coroner later ruled that they “should have been immediately referred to a hospital emergency unit,” where they likely would have been treated for pulmonary embolism and survived.
The NHS stipulates that PAs must work under the supervision of a doctor, but are allowed to make diagnoses, take medical histories, carry out physical examinations, care for patients with chronic illnesses, analyze test results and develop management plans.
Most associates work in GP surgeries, acute medicine and emergency medicine.
Health Secretary Wes Streeting and NHS chief Amanda Pritchard have stated that they are aware that there are clear and ongoing concerns around the use of AP and AA.
Physician associates and anesthesia associates are important members of NHS staff, Amanda Pritchard, chief executive of NHS England.
Roy Pollitt was unaware that his 77-year-old wife, Susan, was being treated by a physician associate, a relatively new role requiring only two years of medical training and originally designed to support doctors. Susan eventually passed away after the PA sent her for an ‘unnecessary procedure’.
Emily Chesterton died in 2022 from a pulmonary embolism after being misdiagnosed by a personal assistant on two occasions when she visited her GP in north London.
The Royal College of GPs previously issued its own guidance saying that PAs should not see patients who have not been assessed by a GP and should only carry out work that has been delegated to them by and agreed with their GP.
The review will examine ways to ensure patients know they are being cared for by a partner and why.
It will also seek evidence from patients, NHS employers, professional and academic bodies.
Professor Leng said: ‘To promote patient safety and strengthen the NHS workforce, it is crucial that we undertake a comprehensive review of the role of PAs and AAs.
‘This will cover recruitment and training, scope of practice, supervision and professional regulation.
“As I carry out this review, I hope to speak to a wide range of stakeholders and gather evidence from the UK and abroad so that we can reach a shared understanding of these roles and their place in wider healthcare teams.”
Amanda Pritchard, chief executive of NHS England, said: “Physician associates and anesthetists are important members of NHS staff – they come to work every day to help care for patients and therefore deserve to be treated with care. the same respect as anyone else who comes.” to work in the NHS.
“While we have always been clear that they do not replace doctors, there are clear and ongoing concerns which we are listening carefully to and taking action to address – this independent review marks our commitment, alongside the Government, to getting this right.” ‘
The British Medical Association (BMA), which drew up its own guidelines while pushing for stricter regulation of the feature, said it had become a “postcode lottery” with patients not knowing if they are being treated by the appropriate professionals.
The union has argued that personal assistants should never be responsible for the first evaluation or diagnosis of a patient and be closely supervised when caring for those who have already been seen by a doctor.
They should make it clear that they are not doctors or medical students and should not be included in doctors’ shifts, something the union says is increasingly happening due to staffing shortages.
BMA council chair Professor Phil Banfield said: “This Government has recognized doctors’ concerns and accepted that there is a safety issue with the employment of associate doctors. Now the NHS must tell us how it will keep patients safe while this review is carried out.
‘You don’t fly a plane under safety review, you leave it on the ground. We therefore need to know what immediate safety measures NHSE will put in place, how quickly they will pause their PA expansion plans and, in the meantime, whether they will adopt the BMA’s own guidelines to start protecting patients now.