Story Highlight
- Physician associates assist doctors in various medical tasks across the UK.
- Some physician associates are considering leaving due to negative experiences.
- Independent report highlights confusion and safety concerns about physician associates.
- Calls for clearer identification and responsibilities for physician associates exist.
- Government review recommends changes to improve the roles of physician associates.
Full Story
Introduced in early 2003, physician associates (PAs) support doctors and GPs with various tasks, including taking medical histories, managing patients with chronic conditions, and administering vaccines, thereby allowing senior clinicians to focus on more complex responsibilities. However, concerns have emerged regarding the pressures faced by PAs, as highlighted by John, a PA in Wales who requested anonymity to escape harassment. He described receiving abusive comments, such as “killer” and “noctor,” which led him to abandon social media. John said he now regrets his decision to become a PA, noting that many others share his feelings, which is exacerbating staffing issues within the NHS.
Currently, around 5,000 PAs are employed in the UK. They undergo two years of postgraduate medical training, providing essential support across GP practices and emergency departments. Another PA, Rosie, working in a London GP practice, expressed her concerns about the job’s long-term security and the negativity surrounding the profession. She stated, “There’s so much uncertainty around the profession, the role, and all the negativity and the hostile environment. It’s just been a really unpleasant experience.”
Issues regarding PAs have gained attention following several high-profile incidents linked to fatal misdiagnoses. An independent review, known as the Leng review, identified confusion among patients regarding the role of PAs, alongside concerns about their ability to operate safely in different healthcare environments. Richard Marking, whose mother Pamela died after a misdiagnosis by a PA, noted the immense stress PAs experience in understaffed A&E wards, suggesting a lack of alternative care options during crises.
The case of Emily Chesterton, who died after a PA misdiagnosed her understanding of a calf sprain when it was actually a blood clot, has raised further alarms. Emily’s parents, Marion and Brendan, discovered their daughter had been seen by a PA merely five months after her death. They argued for better supervision of PAs and improved patient awareness to bolster trust and safety.
The Leng review has led to recommendations accepted by the UK and Welsh governments. These include a proposal to rename the role to “physician assistants” and to establish clear identification protocols for PAs, such as differing coloured scrubs and badges to distinguish them from other medical staff. Furthermore, the review suggests PAs should be integrated into a redesigned multidisciplinary team framework with defined roles and responsibilities. Professor Leng emphasised that a designated doctor should supervise each PA, and standards for training and credentialing should be developed.
The union representing PAs, UMAPs, cautioned that a strictly defined scope of practice could hinder PAs’ effectiveness. Stephen Nash, UMAPs’ leader, remarked on the disparity in responses to incidents involving doctors versus PAs, arguing, “In the last 3 years, the moment something happens, it’s all physician associates are bad.”
Dr Dan Jones from BMA Wales indicated that merely increasing staff numbers may not enhance safety, lamenting the reduction of medicine to simple tasks that sometimes push PAs beyond their competency. A Department of Health and Social Care representative affirmed the importance of PAs within the NHS and acknowledged the Leng review as a pivotal moment for improving collaboration among staff groups for the benefit of patient care. Meanwhile, a Welsh Government spokesperson reiterated the vital role PAs play in supporting doctors while clarifying that they are not replacements for them.
Source: read the original report.
What this means for your site
The challenges facing physician associates (PAs) in the NHS highlight critical areas for improvement in safety management and regulatory compliance. It is evident that stronger supervision and clarity in the responsibilities of PAs are necessary to enhance patient safety. Implementing more robust training standards and credentialing, as suggested by the Leng review, could mitigate risks associated with misdiagnoses. This aligns with the Health and Safety at Work etc. Act 1974, which mandates employers to ensure the health and safety of employees and patients alike.
To prevent incidents similar to those reported, healthcare organisations could adopt a structured onboarding process for PAs that includes mentorship from supervising doctors. Additionally, ensuring that PAs are easily identifiable within the healthcare setting, through distinctive uniforms or identification, could foster greater patient trust and improve communication. This aligns with the Management of Health and Safety at Work Regulations 1999, emphasizing the importance of risk assessments and training processes that prevent confusion and enhance safety outcomes.
