The grieving parents of a young actress who died after being misdiagnosed by a doctor’s associate are joining an unprecedented legal action by senior doctors against the General Medical Council.
They say they feel “duped” by the regulator’s chief executive who they say has broken his promise to ensure tragedies like this do not happen again.
Marion and Brendan Chesterton’s beloved daughter Emily, 30, died in 2022 from a blood clot in her lung which was incorrectly diagnosed as anxiety and a sprain by a physician associate (PA) – a healthcare worker with just two years’ training. Amid growing national concerns about the use of “cut-price doctors” to cover staff shortages, the couple met General Medical Council chief Charlie Massey in July. He assured them there would be “no more Emilys” when the body begins regulating PAs in December, The Mail on Sunday can reveal.
Emily Chesterton died in 2022 from a blood clot in her lung that a medical associate misdiagnosed as anxiety and a sprain.
The Chestertons left the meeting “reassured” that limits would be placed on what personal assistants could and could not do.
They believed the GMC would ensure that PAs were properly supervised by qualified doctors (rather than working with little or no supervision, as has too often happened) and required it to be made clear to patients that they were not doctors.
These points, and particularly the last one, were crucial in Emily’s case: she was not told she was seeing a physician’s assistant; otherwise, says her mother Marion, the family would have sought a doctor’s opinion and they believe she would not have died.
But they now feel “let down” by the General Medical Council after it emerged in legal documents that the regulator has no plans to limit the scope of PAs or anaesthetist associates, saying it has “no power” to do so.
The documents, seen by this newspaper, emerged as part of a judicial review launched by campaign group Anaesthetists United.
They also suggest the regulator will not require associates to describe their “skills and experience” to patients, nor will it define how they should be supervised.
The revelations have prompted the Chestertons – and other grieving families whose loved ones have been the victims of mistakes by medical assistants – to join Anaesthetists United in legal action. Their aim is to force the council to clearly define the boundaries of medical assistants’ roles to prevent them from performing medical tasks. The NHS plans to recruit 10,000 doctors and anaesthetists’ assistants – abbreviated as AAs – by 2038 to ease pressure on the service.
But over the past year, The Mail on Sunday has uncovered repeated incidents where PAs have gone beyond their intended role – carrying out basic tasks such as filling in forms and carrying out basic health checks to free up doctors’ time.
We have uncovered evidence of PAs diagnosing patients, performing operations, prescribing medications and covering doctors’ shifts.
As part of our campaign to stop medical assistants, we have also reported a number of deaths and even a baby who was left disabled due to errors by medical assistants.
Doctors are also concerned. On Friday, the Royal College of Family Physicians voted overwhelmingly to ban medical assistants from working in GP surgeries.
Speaking to the Minister of State, Ms Chesterton, a retired language teacher, said: ‘During our meeting, Mr Massey agreed with more or less everything I said we wanted to achieve and that patient safety should be paramount.
‘In the end, he looked at me and said, ‘I promise you there will be no more Emilys. ‘ We left feeling very confident that the kind of regulation we wanted would be implemented.
‘I even sent her a photo of Emily afterwards, asking her to keep it in mind when she was planning what the regulation would look like. It was one of her with Paul McCartney, taken at her 2017 graduation from the Liverpool Institute of Performing Arts. She was beaming and we were so proud of her.
‘But now, having seen from the legal letters that proper regulation is not going to be achieved, I wonder if they were appeasing us a little, or if they were misleading us a little.
“We are taking part in the legal action to prevent other families going through the same hell. The General Medical Council must live up to its responsibilities. We need absolute clarity on what PAs and ancillary assistants can and cannot do.” In a letter sent by the General Medical Council to lawyers representing Anaesthetists United in August, the regulator insists that the Government is not requiring it to limit the tasks of PAs, but only to set “standards” for their training and skills. It says the Department of Health could have ordered the regulator to impose such limits, “however it chose not to do so”.
Emily beams in a photo with Paul McCartney, taken at her 2017 graduation from the Liverpool Institute of Performing Arts.
Furthermore, while the General Medical Council website says that medical assistants should have “some degree of supervision”, this would have to be determined by employers – i.e. hospital trusts or GP practices. The letter also says that there is “no requirement” for assistants to “inform patients of their experience or qualifications before treating them”, although the regulator has insisted to the Ministry of Health that they would still be required to introduce themselves to patients and explain their role.
Chesterton said the tone of the letter “is completely different to that of your meeting with Massey. It is very arrogant and again delegates responsibility. Families who have lost loved ones do not care about the distinction between standards or boundaries, we just want to know that regulation will be robust.” The letter adds that the Royal Colleges of Medicine would be the “appropriate bodies” to provide guidance on their scope of practice.
However, the Royal Colleges do not have regulatory powers, and the General Medical Council has not said whether it will enforce any guidelines they produce.
Solicitor John Halford of Bindmans, representing Anaesthetists United, said: “The Royal Colleges’ guidelines have no force. Without clear boundaries from the General Medical Council, junior medical assistants and physician assistants can do what they think they are capable of doing or what their trust tells them to do.”
“There are no boundaries. It’s the kind of Wild West we have at the moment and what led to Emily Chesterton’s death. It’s regulatory evasion.” The evidence suggests that existing Royal College of Anaesthetists guidelines on the use of AA (an updated draft of which is due to be published soon) are already being ignored by hospitals and are open to interpretation.
Documents recovered by Anaesthetists United under Freedom of Information laws reveal “really quite shocking” policies at the local level, according to Mr Halford.
The results show that aides are allowed to sedate patients, including children, without direct supervision by a doctor. In some cases, supervising doctors do not have to be in the same room or the same hospital building, but should be able to arrive within a few minutes. Others say doctors should only be able to communicate by phone.
In some cases, AAs are allowed to decide which medications to give to patients.
In a recent study of patients who suffered cardiac arrest during surgery, 47 percent died when an attending anesthesiologist was administering their anesthesia, a percentage that dropped to 30 percent if the anesthesiologist was not.
As for the scope of PAs, the Royal College of Physicians has not given any guidance on this. It is embroiled in another controversy, accused of “deliberately misleading Parliament” by suggesting in a government consultation that its members were in favour of the General Medical Council regulating PAs. Indeed, many oppose its oversight of PAs as it further blurs the lines between PAs and doctors.
The doctors wrote an open letter to the British Medical Journal (BMJ) last week condemning the RCP leaders.
Other Freedom of Information Act documents reveal the Department of Health paid the General Medical Council £8.1m over three years to draw up the regulatory package, with a further £2.2m payment expected to be needed this year.
Dr David Nicholl, a neurologist from Birmingham and one of the signatories of the letter to the BMJ, said it indicated the regulator was “acting as an arm of government rather than putting patient safety first”.
Another case included in the legal action is that of Susan Pollitt, who died last year after an unnecessary medical procedure performed by a personal assistant.
Emily graduated in 2017. Nationwide, concerns are growing about the use of “cheap doctors” to fill staff shortages.
Emily, front right, as a child, with her mother Marion, father Brendan and sister Jasmine.
Susan, 77, was admitted to Greater Manchester’s Royal Oldham Hospital after falling and breaking her arm in July 2023. She died from a bacterial infection caused by the procedure.
Coroner Joanne Kearsley said there was “no proper procedure” in place to ensure healthcare assistants were able to carry out such operations at the Northern Care Alliance, which runs the hospital. She took the unusual step of writing to the General Medical Council and the current Health Secretary, Wes Streeting, warning of the risk of further deaths unless steps were taken to better regulate healthcare assistants.
A General Medical Council spokesman said: “We have been consistent in saying that we expect GPs and medical assistants to always work under some degree of supervision and to perform within their competence. They will have a responsibility to communicate clearly who they are and what their role is in the team.
‘To register with us, PAs and AAs will also need to demonstrate that they have the knowledge, skills and experience to treat patients safely and that there are no outstanding concerns about their fitness to practise.
‘Including PAs and AAs in regulation will help reassure patients, colleagues and employers that they are safe to practise and can be held accountable if serious concerns arise.’
- Anaesthetists United need to raise £200,000 by the end of the month to fund their lawsuit against the General Medical Council. Donate here: crowdjustice.com/case/stop-misleading-patients
