Doctors’ associations could face more training and tougher regulations as part of a review ordered by the Health Secretary today.
Wes Streeting has confirmed the role of the controversial doctors’ association (PA) and the anesthetists’ association (AA) will be scrutinized after concerns about patient safety.
The announcement comes amid uproar over its growing use in the NHS, with several high-profile cases of people dying after consultations given by PAs.
Professor Gillian Leng, president of the Royal Society of Medicine, will lead work on the role, how it affects safety and how it supports the wider healthcare team, including GPs.
Reporting in the spring, the findings will include recommendations on how the new role should be implemented in the future.
Mr Streeting said: ‘Many medical colleagues provide care and free up doctors to do things that only doctors can do.
‘But there are legitimate concerns about transparency for patients, scope of practice, and changing doctors.
“These concerns have been ignored for too long, leading to a toxic debate where doctors feel ignored and PAs feel demoralised.
‘This independent review, led by one of the UK’s most experienced health leaders, will establish the facts, iron out the issues, and ensure we get the right people, in the right places, doing the right things.’
Health Secretary Wes Streeting today confirmed the role of the controversial doctors’ association (PA) and anesthetists’ association (AA) will be scrutinized after concerns about patient safety.
Doctors’ associations could face more training and tougher regulations as part of a review ordered by the Health Secretary today (stock photo)
There has been recent uproar over the widespread use of PAs and AAs in the NHS, with several recent high-profile cases of deaths following consultations given by PAs (stock photo)
PAs have two years of post-graduate training and can examine, diagnose and treat patients under the supervision of a physician.
The NHS employs around 3,500 PAs and 180 AAs in England. But plans to increase these to 10,000 and 2,000 to help bridge the workforce gap have raised alarm among critics.
The Royal Colleges of Medicine wrote to Mr Streeting in September calling for a review of PAs and AAs amid ‘increasing concerns’ from doctors about the role.
Concerns about patient safety have ‘increased dramatically’ as the number of PAs and anesthetic associates (AAs) has increased, with increased scrutiny due to high-profile errors.
Last week, Roy Pollitt told how his wife died after the wrong drain was left in her stomach for 21 hours by a PA and accused the NHS of using ‘cheap labour’.
Susan Pollitt’s inquest concluded that her death at Royal Oldham Hospital in 2023 was caused by an ‘unnecessary medical procedure due to negligence’.
Meanwhile, Emily Chesterton, 30, died in 2022 of a pulmonary embolism after being misdiagnosed by a PA on two occasions when she visited a GP practice in north London.
He was under the impression that he saw the GP but the PA failed on both occasions to see the leg pain and breathlessness as a blood clot, which eventually traveled to the lungs.
The coroner later ruled that he ‘must be referred immediately to the hospital’s emergency unit’ where he will be treated for a pulmonary embolism and is expected to survive.
The NHS stipulates that 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, analyze test results and develop management plans.
Most associates work in GP surgeries, acute medicine and emergency medicine.
Health Secretary Wes Streeting and NHS chief Amanda Pritchard said they were aware there were clear and ongoing concerns about the use of PA and AA.
The association of doctors and the association of anesthetists are important members of NHS staff, Amanda Pritchard, chief executive of NHS England
Roy Pollitt didn’t know his wife, Susan, who was 77, was being treated by a fellow doctor, a relatively new role that required only two years of medical training and was originally designed to support doctors. Susan eventually died after being sent for an ‘unnecessary procedure’ by the PA
The Royal College of GPs previously published its own guidance which said that PAs should not see patients who have not been tested by a GP, and should only carry out work assigned by, and agreed with, their GP supervisor.
The review will examine ways to ensure patients know they are being reviewed by the association and why.
It will also seek evidence from patients, employers in the NHS, professional bodies and academia.
Prof Leng said: ‘To improve patient safety and strengthen the NHS workforce, it is vital 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 carry out this review, I hope to speak to many stakeholders and gather evidence from the UK and abroad so that we can reach a shared understanding of these roles and their place in the wider health team.’
Amanda Pritchard, chief executive of NHS England, said: “Associated doctors and anesthetists are important members of NHS staff – they come to work every day to care for patients and therefore should be treated the same as anyone else who comes to work in the NHS.
“While we have made it clear that they are not a replacement for doctors, there are clear and persistent concerns that we listen to carefully and take action to address – this independent review marks our commitment, together with the Government, to get this right.”
Emily Chesterton died in 2022 of a pulmonary embolism after being mistreated by a PA on two occasions when she visited her GP practice in north London.
The British Medical Association (BMA), which drew up its own guidelines while pushing for tougher regulation of the role, said it had become a ‘postcode lottery’ where patients did not know they were being treated by the right professional.
The union said PAs should not be responsible for the patient’s first assessment or diagnosis and be closely supervised when caring for someone who has already seen a doctor.
They should make it clear that they are not doctors or medical students and should not be put on the doctor’s rotas, which the union claims has been exacerbated by staff shortages.
BMA board chairman Prof Phil Banfield said: “This government has acknowledged the concerns of doctors and accepts there are safety issues with doctors’ association employees. Now the NHS must tell us how to keep patients safe while this review takes place.
‘You don’t fly the plane in the safety review, you are weak. So we need to know what immediate safety measures NHSE will put in place, how soon they will pause the PA expansion plan, and in the meantime if they will adopt the BMA’s own guidelines to start protecting patients now.
