Doctors should stop diagnosing patients, senior medics say
Staff such as doctors should be banned from diagnosing patients, leading medics say, following the death of a woman whose fatal blood clot was missed twice.
The British Medical Association (BMA) has published guidance setting out what it believes is the level of responsibility that people in medical associate professions (MAPs), such as physician associates (PAs) and anesthesia associates (AAs), should have.
The union said they hoped the document would improve patient safety.”
MAPs were introduced to NHS workers in the early 2000s to improve access to care for patients, but have faced increased scrutiny over high-profile errors.
One example was the death of 30-year-old Emily Chesterton, who was misdiagnosed twice by a PA before dying of a blood clot in 2022.
In its guidance, the BMA states that MAPs should not be responsible for the initial assessment or diagnosis of patients and should be closely monitored when seeing patients who have already seen a doctor.
They should also refrain from using terms such as “I am a member of the medical team” without indicating their job title, it added.
It recommends that MAPs should operate a traffic light system, with green indicating they can perform a task alone, amber meaning they require supervision and red for a task they are not allowed to perform.
BMA Board Chairman Prof Philip Banfield said the need for national guidance setting out what MAPs can do safely is of paramount importance.
He said: “Our guide has been written by doctors, for doctors, to explain to the medical profession what MAPs should and should not do together with their doctor colleagues.
“But it is also intended to help patients, to improve patient safety. With the government’s clear intention to increase the number of MAPs in the medical workforce, but without clarity on the scope of their skills and responsibilities, it is even more important that patients need to know who is treating them and what skills and capabilities the doctor has. .”
Last month, Conservative MP and working doctor Dr Dan Poulter shared his experience with a mistake that could have been fatal. He told the House of Commons he had to intervene when a PA failed to properly treat a paracetamol overdose.
He said: “The medical officer incorrectly told me they did not need what was mentioned NAC treatment because their liver function test was normal, despite the fact that they were over the line of treatment due to their paracetamol overdose.
“Of course the patient’s liver function tests were normal at the time, they would not have been that way for long, and the consequences of that diagnostic decision by the resident physician could have been fatal.”
Banfield said MAPs “work in roles that increasingly cross the line into situations that more appropriately require a practitioner’s expertise”, and the BMA guide set out what it “considers safe practice that protects patients and enables the NHS to effectively use MAPs to assist medical teams – which was their original purpose.”
He said he hoped the report would “set clear parameters for distinguishing between physicians and MAPs” and put an end to the “creeping replacement of PAs by rostered physicians.”
A BMA survey of more than 18,100 UK doctors found that more than half (55%) had faced increased workloads since the arrival of PAs and AAs. Only 21% of medics who responded to the survey reported a reduced workload, the BMA said. .
A spokesperson for the Department of Health and Social Care said: “Doctors have been working in the NHS for more than twenty years. They appear to be safe, making a positive contribution to the medical and surgical teams and the patient experience, while supporting the workload of the clinical teams. That’s why we’ve expanded the role of PAs in the NHS long-term workforce plan.
“Legislation regulating both PAs and nurse anesthetists has now been passed by Parliament and will be in force by the end of 2024. It will set standards of practice and ensure that PAs meet the standards we expect of all regulated professionals, with the General The Medical Council has strict ‘fitness-to-practice’ procedures and sets expectations for education and training.”