Medical leaders back rise in physician associates

NHS has 3,286 PAs, who assist healthcare teams and are not authorised to prescribe or request scans. British Medical Association (BMA) is concerned about a new law allowing the General Medical Council to regulate PAs. The doctors’ union says it blurs the lines between doctors and PAs and could risk patient safety. Like PAs, AAs are healthcare professionals who work as part of a multidisciplinary team with supervision from a named senior doctor.

They often have a science undergraduate degree, but that is not a prerequisite. Emily Chesterton, from Salford, died aged 30 after a blood clot was missed in two appointments with a PA she believed was a GP. Emily had a blood clot in her left leg which led to her dying of a pulmonary embolism. She was breathless, light-headed and she had difficulty walking.

The PA did not examine Emily’s calves, and did not make it clear that she was not a doctor. Ben Peters, 25, went to the emergency department at Manchester Royal Infirmary with chest pain and shortness of breath. The 25-year-old was looked at by a PA, who ordered an ECG and all other appropriate tests. He was discharged with a panic attack and gastric inflammation diagnosis after a discussion between the PA and the duty consultant.

Ben’s father Steve found him dead the following morning in their home. The inquest found that Ben suffered from a very rare condition called an acute aortic dissection. The consultant did not see Ben in person. His family have now all been screened for the same condition from which he died.

Ben’s chest pains were put down as anxiety so he was sent home with tablets. Steve was found to have a faulty aortic valve and enlarged aorta, which resulted in surgery in 2023. NHS England said that as of 30 September 2023 there were 3,286 PAs in primary and secondary care in England and 76 AAs in secondary care. Adam Skeen started working as a PA in 2021 before going to medical school.

He is a BMA representative, but not speaking on behalf of them. He said his day-to-day tasks were difficult for the untrained eye to distinguish from that of the team of doctors with whom he worked. PAs’ basic training puts them in a good position to do rudimentary clinical examinations, which eases the load on wards. Prof David Strain, a consultant based in Exeter who chairs the BMA#38;s board of science, said that basic training is good for PAs.

Both houses of Parliament have approved the new law, meaning regulation can be made into law. PAs and AAs will go on the register of the GMC, which will oversee their work. The GMC says this will mean that it can set conditions for PA and AA course providers to meet. Currently there is a curriculum for them, but no overseeing regulator.

GMC and Royal College of Physicians (RCP) make it clear that there needs to be additional education, a defined scope of practice and guidance for PAs and AAs. Donya Mighty has been working as a PA since 2018, while studying to become a doctor herself. GMC wants to make it easier for patients to see their GP. The move is seen as a step in the right direction for the NHS.

The NHS says it wants to ensure patients get the best care possible. But critics say the move is a step too far and will harm patients. My advice to anyone is always ask who you are seeing. That is the biggest regret of my life.

I don’t know if I would have survived if I hadn’t done that. That was my biggest regret. I didn’t know who I was seeing at the time. I’m still not sure if I could have survived.

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