The NHS in England should slow down or completely scrap the recruitment of physician associates (PAs) and ban them from seeing patients one-on-one, medical groups are urging ministers.
The Royal College of Physicians (RCP), which represents hospital doctors, has called for a reconsideration of government plans to increase the number of PAs from 3,000 to 10,000 by the mid-2030s.
They should also not run clinics on their own, without a senior doctor present, as without supervision they could pose a risk to patient safety, the RCP added.
“We are calling on NHS England to slow the expansion of the PA role (and) review its forecasts for PA workforce growth,” an RCP spokesperson said.
While the council is not proposing exactly how many additional PAs the NHS should train and hire in the coming years, it ‘believes their growth should be carefully managed’ and NHS England should take ‘a more measured approach’ to recruiting and deploying them .
The decision comes weeks after Wes Streeting commissioned an independent inquiry into the role and competence of PAs, following a series of cases in which patients they treated suffered harm. This includes Emily Chesterton who died after her blood clot was misdiagnosed as a calf strain by a PA.
The health secretary said the review, by Prof Gillian Leng, was necessary because “there are legitimate concerns about transparency for patients, the scope (of PAs’ role) and the replacement of (them by) doctors. These concerns have been ignored for too long.”
However, the British Medical Association (BMA) wants to take tougher action than the RCP. It demanded an immediate halt to the recruitment of PAs, who assist doctors but have only two years of medical training.
“As the RCP says, the planned expansion of PAs within the NHS needs to be reconsidered,” said Prof Philip Banfield, chairman of the BMA council.
“But in the short term, while the Leng review is underway and potentially unsafe practice continues within the NHS, we need to pause PA recruitment and ensure those we have practice to qualification and no further . You don’t fly an aircraft under safety review, you ground it.”
Banfield welcomed the publication of a series of documents that provide guidance about which tasks PAs are and are not allowed to perform. He particularly welcomed the conclusion that no PA should see patients alone unless a senior doctor is present to provide immediate supervision.
The major expansion of PA numbers was set out in the NHS long-term workforce plan, which was published in June 2023 under the Conservative government. However, a revision of that plan that Street work announced It is highly likely that the past week will lead to a reduction in their planned numbers, given the significant concern that the increasing role of PAs in the NHS has caused among medical organisations.
Analysis of vacancies posted by NHS trusts in England shows that fewer people have been hired recently, almost certainly due to growing concerns that they could compromise patient safety.
In its guidelines, the RCP makes it clear: “PAs are not doctors. They should not be considered a substitute for physicians, and they should never replace a physician on a roster.”
PAs can safely perform CPR, assess a patient upon arrival at hospital, educate patients about their treatment and insert cannulas, the RCP says. But “a PA should never function as a senior decision maker. (And) a PA should never independently undertake outpatient clinics.” They must be supervised by a senior doctor, such as a consultant, at all times.
The Department of Health and Social Care said: “Many doctors working together provide great care and give doctors the space to do things that only doctors can do.” But there are “some concerns” about the limits of their powers, the spokesperson added.
Leng’s review will be published in the spring.