Government launches review of the role of physician associates in the NHS

The Government has launched a review of the role of physician associates (PAs) and those working in anaesthesia after concerns were raised about patient safety.

Professor Gillian Leng, president of the Royal Society of Medicine, will lead the work looking into how the roles affect safety and how they support wider health teams including GPs.

The review, which will report in the spring, will also publish recommendations on how new roles should work in the future.

The current plan is to expand 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).

It comes after the Academy of Medical Royal Colleges wrote to Health Secretary Wes Streeting in September calling for a review of PAs and AAs amid “mounting concern” from doctors.

The academy called on the Government and NHS England to look at whether associates are having a negative impact on patient safety, whether they really free up doctors’ time for other tasks and whether they improve the overall quality of care for patients.

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.

Last week, Roy Pollitt told the BBC how his wife died after a drain was mistakenly left in her abdomen for 21 hours by a PA, and accused the NHS of using “cheap labour”.

Susan Pollitt’s inquest concluded her death at Royal Oldham Hospital in 2023 was caused by an “unnecessary medical procedure contributed to by neglect”.

Emily Chesterton, 30, died in 2022 from a pulmonary embolism after being misdiagnosed by a PA on two occasions when she visited her GP practice 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.

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 would have survived.

According to the NHS, PAs work under the supervision of a doctor and can diagnose people, take medical histories, perform physical examinations, see patients with long-term conditions, analyse test results and develop management plans.

Mr 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.

“This independent review, led by one of the UK’s most experienced healthcare leaders, 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.”

The review will examine ways to ensure patients know they are being seen by an associate and why.

It will also seek evidence from patients, employers within the NHS, professional bodies and academics.

Prof Leng said: “To promote patient safety and strengthen the NHS workforce, it’s crucial that we have a comprehensive review of the role of PAs and AAs.

“This will cover recruitment and training, scope of practice, supervision and professional regulation.

“As I conduct this review, I am looking forward to speaking to a broad range of stakeholders and to gathering evidence from the UK and abroad so that we can reach a shared understanding of these roles and their place in wider healthcare teams.”

Dr Jeanette Dickson, chairwoman of the Academy of Medical Royal Colleges, said: “Professor Leng’s independent 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.

“We are grateful the Secretary of State has acted on the concerns outlined in our request in September, and royal colleges and their members look forward to engaging with this vital evidence-based review.”

Amanda Pritchard, chief executive of NHS England, said PAs and AAs are “important members of NHS staff” but “we have always been clear that they are not replacements for doctors”.

Dr Mumtaz Patel, acting president of the Royal College of Physicians, 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 said there was a need to protect patients now.

He added: “The NHS has 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.”