Government launches probe into ‘cut-price’ medics: Heath Secretary Wes Streeting says doctor associates may face extra coaching and harder guidelines

Physician associates could face more training and tougher regulation as part of a review ordered by the Health Secretary today.

Wes Streeting confirmed the roles of controversial physician associates (PAs) and anaesthesia associates (AAs) will be scrutinised following concerns over patient safety.

The announcement comes amid unrest over their growing use within the NHS, with several recent high-profile cases of people dying after consultations given by PAs.

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

Reporting in the spring, the findings will include recommendations on how new roles should work in the future.

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.’

PAs have two years’ post-graduate training and can examine, diagnose and treat patients under the supervision of doctors.

The NHS employs around 3,500 PAs and 180 AAs in England. But plans to increase this to 10,000 and 2,000 respectively to help plug workforce gaps have caused alarm among critics.

The Academy of Medical Royal Colleges wrote to Mr Streeting in September calling for a review of PAs and AAs amid ‘mounting concern’ from doctors about the roles.

Worries over patient safety have ‘dramatically increased’ as numbers of PAs and anaesthesia associates (AA) have risen, with increased scrutiny due to high profile mistakes.

Last week, Roy Pollitt told 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 had been caused by an ‘unnecessary medical procedure contributed to by neglect’.

Meanwhile, 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.

The NHS stipulates PAs must work under the supervision of a doctor but are allowed to make diagnoses, take medical histories, perform physical examinations, see patients with long-term conditions, analyse test results and develop management plans.

Most associates work in GP surgeries, acute medicine and emergency medicine.

The Royal College of GPs previously 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.

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

Amanda Pritchard, chief executive of NHS England, said: ‘Physician associates and anaesthesia associates are important members of NHS staff – they come to work every day to help care for patients and so they deserve to be treated with the same respect as anyone else coming to work in the NHS.

‘While we have always been clear that they are not replacements for doctors, there are clear and ongoing concerns which we are listening to carefully and taking action to address – this independent review marks our pledge, together with the Government, to getting this right.’

The British Medical Association (BMA), which drew up its own guidelines while pushing for tougher regulation over the role, said it had become a ‘post code lottery’ where patients do not know if they are being treated by the right professionals.

The union has argued PAs should never be responsible for the first assessment or diagnosis of a patient and be closely supervised when tending to those already seen a doctor.

They should make it clear they are not doctors or medical students and should not be put on doctors’ rotas, which the union claim is increasingly happening due to staff shortages.

BMA council chair Prof Phil Banfield said: ‘This Government has acknowledged the concerns of doctors and accepted there is a safety issue with the employment of physician associates. Now the NHS must tell us how they are going to keep patients safe while this review is carried out.

‘You do not fly a plane under safety review, you ground it. So we need to know what immediate safety measures NHSE will put in place, how quickly they will pause their PA expansion plans, and in the meantime if they will adopt the BMA’s own guidelines to start protecting patients now.’