The government has launched a review of the role of physician associates (PAs) and those working in anaesthesia following concerns raised by a number of groups about patient safety.
Professor Gillian Leng, president of the Royal Society of Medicine, will lead the probe into how the roles impact patients and support wider health teams including GPs.
Recommendations are expected to be published by the spring on how new roles should work in the future.
The Academy of Medical Royal Colleges wrote to Health Secretary Wes Streeting in September calling for a review of associate roles amid “mounting concern” from doctors.
Plan to Triple Number of PAs
The current plan, backed by both the previous Conservative government and Labour in its election manifesto, is to almost triple the number of PAs in England from 3,500 to 10,000 by 2036-37, and to take on 2,000 more anaesthesia associates (AAs).The Royal College of GPs has issued its own guidance saying PAs must not see patients who have not been triaged by a GP, and should only undertake work delegated to them by, and agreed with, their GP supervisor.
PAs are graduates who have had two years of postgraduate training but do not have a medical degree.
They have hit the headlines in recent years after the deaths of people who were treated by associates but did not know it, and where mistakes were made.
Emily Chesterton, 30, died in 2022 from a pulmonary embolism after being misdiagnosed by a PA on two occasions when she visited her GP surgery in north London.
She had been under the impression that she was seeing a GP but the PA failed on both occasions to spot her leg pain and breathlessness was a blood clot, which ultimately travelled to her lungs and proved fatal.
A coroner later ruled she “should have been immediately referred to a hospital emergency unit” where she would likely have been treated for pulmonary embolism and could have survived.
‘Legitimate Concerns’
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 review “will 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.”
Amanda Pritchard, chief executive of NHS England, said that PAs and AAs are “important members of NHS staff” but “we have always been clear that they are not replacements for doctors.”
Dr. Jeanette Dickson, chairwoman of the Academy of Medical Royal Colleges, said that the review “offers a chance to chart a way forwards, ensuring these roles support the delivery of safe patient care and enable training opportunities for resident doctors, as envisioned.”
Dr. Mumtaz Patel, acting president of the Royal College of Physicians, also welcomed the review, adding: “‘We have been calling for a limit to the pace and scale of rollout of the PA role and a review of how the PA role works since March 2024, when our fellows voted overwhelmingly in favour of a slowdown in the expansion of the PA role.
“Patient safety is our absolute priority. Many of our members have significant concerns about the safe deployment of PAs which is why we’ve called on system leaders to lead work to develop a national scope of practice, with input from royal colleges and specialist societies.”
British Medical Council chairman, Professor Phil Banfield, accused the NHS of having “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.”
