Hospitals are breaching NHS rules by allowing staff with just two years’ training to treat pregnant women and stroke victims instead of doctors, The Mail on Sunday can reveal.
In a move described as a “huge potential threat to patient safety”, several NHS hospitals are routinely using physician associates (PAs) to cover doctors’ shifts.
A personal assistant is an NHS worker without a medical qualification who is only meant to assist doctors and nurses. They are not qualified to diagnose patients, prescribe medication or order scans and must be supervised by a doctor.
But an investigation by this newspaper has uncovered dozens of cases in which hospitals have used medical assistants to cover the shortage of doctors in departments such as gynaecology and emergency services.
This goes against NHS guidelines.
In 2022, Emily Chesterton, 30, died after a personal assistant failed to detect a blood clot. A personal assistant saw the actress twice and told her she had anxiety and long COVID.
In one of the most worrying cases, GPs have stood in for doctors on the stroke ward at Blackpool’s Victoria Hospital on 14 occasions since the start of the year. According to a Freedom of Information request, the hospital has also allowed GPs to cover doctors’ shifts in A&E.
The same stroke ward was embroiled in scandal last year when a nurse and a junior colleague were convicted of illegally sedating patients.
A murder investigation is also underway after a patient bled to death on the ward from internal injuries after being assaulted by an unknown member of staff. Six years on, police have been unable to identify the suspect.
There is no suggestion that any of these crimes were committed by medical assistants or occurred during shifts where these non-physicians were present.
In response to our findings, the family of a woman who died due to errors made by a personal assistant at a GP surgery have urged the NHS to stop using underqualified doctors to make up for a shortage of doctors.
In 2022, Emily Chesterton, 30, died after a personal assistant failed to detect a blood clot. A personal assistant saw the actress twice and told her she had anxiety and long Covid.
Her parents claim that at no point during the appointment was Emily informed that the person she was seeing was not a GP. A coroner concluded that Emily should have been referred immediately to a hospital emergency unit.
The north London GP where she was treated has since decided to stop employing medical assistants.
“It’s terrifying to think that there are people being treated in hospital by people who think they are doctors but are actually just GPs,” said Emily’s mother, Marion Chesterton, 65, a retired teacher from Salford.
“We lost our daughter as a result of the mistakes of a physician’s assistant who was not qualified to diagnose her. The fact that hospitals continue to allow physician assistants to work this way shows that lessons have not been learned.”
Emily’s parents say that at no point during the appointment did Emily realize that the person seeing her was not a family doctor.
Emily pictured with her mother Marion and sister Jasmine, left.
The NHS plans to recruit around 10,000 PAs by 2038 to ease the pressure of a doctor shortage.
Last night, NHS England criticised the trusts named in our investigation. “There should never be circumstances where GPs replace doctors,” a spokesperson said. “We are following this up with all the trusts involved. The NHS has always been clear that GPs are not a substitute for doctors.”
Doctors’ union the British Medical Association (BMA) has urged new Health Secretary Wes Streeting to take action. “These reports confirm that medical assistants have been used instead of doctors on medical shifts in healthcare centres across the country,” said BMA Council Chair Professor Phil Banfield.
“This practice represents a huge potential threat to patient safety and is a cause for national alarm. Physician assistants do not have the rigorous medical training or qualifications necessary to assume the responsibility of a physician in patient care, in these facilities or anywhere else.”
She added: “While PAs can play a useful role in supporting the wider medical team, NHS England itself has repeatedly communicated to hospital trusts that PAs should not be used as replacements for doctors on any shift. It is inexcusable for these trusts to use PAs in this way.
“Following no action by the previous Government, it is essential that the new Secretary of Health steps in and stops this practice immediately.”
Protesters gather outside Parliament to protest against the transfer of responsibilities to associate doctors who have limited medical training and are not doctors.
Protesters argue that using junior doctors instead of doctors could endanger patients and lead to loss of life.
The Mail on Sunday was the first to raise the alarm about medical assistants last year and has been running a campaign to rein in medical assistants. We believe there should be strict limitations on the tasks that medical assistants can and cannot undertake.
Amid growing concerns, NHS England issued new guidance in March stating that “PAs should not be used as replacements for doctors on a rota”.
But last month we revealed that Royal Berkshire Hospital had used personal assistants to cover doctors’ shifts in emergency rooms more than 70 times over the past six months, including 21 times since March.
On several occasions, the hospital also asked medical assistants in training (who had not yet completed their two years of training) to replace doctors.
Following these revelations, we sent Freedom of Information requests to all hospital trusts in the country, asking them to disclose every time they had used personal assistants to cover doctors’ shifts since December 2023.
More than 100 NHS trusts responded. The vast majority did not use personal assistants in this way, and several provided strong responses distancing themselves from the practice.
Maidstone and Tunbridge Wells NHS Trust said it would “not ask a PA to fill vacant posts on any medical rota”.
Mid Cheshire Hospitals NHS Foundation Trust said it does not use PAs to fill gaps left by doctors on shifts as they “cannot prescribe or order X-rays”.
However, not all trusts shared this attitude. Between December 2023 and May 2024, Northampton General Hospital NHS Trust asked PAs to cover doctors’ shifts 25 times, usually in its emergency department. The trust, which employs eight PAs, admitted they were given the shifts because “there were no doctors available to cover”.
London North West University Healthcare NHS Trust said its 37 PAs had replaced doctors 76 times over the same time period, but did not give details of which wards these shifts occurred on.
Barts Health NHS Trust in east London has included GP assistants in its junior doctor rota in A&E 20 times over the past six months. Four of these cases occurred after the NHS ordered trusts to end the practice. A spokesperson said: “GP assistants play an important role in caring for patients in our hospitals, and we employ 16 in addition to our 2,500-strong medical workforce.
‘Their clearly defined duties are consistent with their training, experience and qualifications and they always work under the supervision of senior physicians.’
Shrewsbury and Telford Hospital NHS Trust said it had approached the PAs “to fill a gap in the number of doctors on the rota” and “cover some aspects of the on-call team rather than leave a gap”.
The trust, which said leaving a vacancy unfilled would “negatively impact on patient care”, said it would take too long “to establish the number of shifts covered by associate doctors”.
And Rotherham NHS Foundation Trust listed five occasions where doctors’ shifts were covered by GPs, all on its gynaecology ward.
A spokesperson said: “Physical assistants perform a range of tasks within their scope of practice, always ensuring the safety of patients. All care involving medical assistants is supervised by qualified gynaecologists to maintain the highest standards of medical care.”
Dr Helen Fernandes, president of the Doctors’ Association, which represents NHS doctors, said: “PAs should not replace doctors in any area.”
A Department of Health and Social Care spokesman said: ‘Medical associates have an important role to play but they should always work with doctors, not replace them.
‘As we fix the NHS, we will end the workforce crisis and deliver the NHS’s long-term plan, so that patients are always cared for by the right, qualified healthcare professional.’
All hospitals mentioned were contacted for comment.
The NHS has a shortage of almost 9,000 doctors, according to the British Medical Association.