Government launches investigation into ‘cheap’ doctors: Heath Secretary Wes Streeting says doctor’s staff could face more training and stricter rules

Doctors’ staff could face more training and stricter regulations as part of a review ordered by the Health Secretary today.

Wes Streeting confirmed that the role of controversial physician associates (PAs) and anesthetists (AAs) will be scrutinized over patient safety concerns.

The announcement comes amid unrest over its increasing use within the NHS, with several recent high-profile cases of people dying after consultation by PAs.

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

The findings will be reported in the spring and will include recommendations on how new roles should work in the future.

Mr Streeting said: ‘Many junior doctors provide great care and give doctors the freedom to do the things only doctors can do.

“But there are legitimate concerns about patient transparency, scope of practice and physician replacement.

‘These concerns have been ignored for too long, leading to a toxic debate in which doctors feel ignored and PAs feel demoralized.

‘This independent review, led by one of Britain’s most experienced healthcare leaders, will establish the facts, get to the bottom of the issue and ensure we get the right people in the right place, doing the right thing .’

PAs have two years of postgraduate training and can examine, diagnose and treat patients under the supervision of physicians.

The NHS employs around 3,500 PAs and 180 AAs in England. But plans to increase these numbers to 10,000 and 2,000 respectively to help plug labor shortages have raised concerns among critics.

The Academy of Medical Royal Colleges wrote to Mr Streeting in September calling for a review of PAs and AAs amid “increasing concerns” from doctors about the roles.

Concerns about patient safety have ‘increased dramatically’ as the number of PAs and nurse anesthetists (AA) has increased, with increased scrutiny due to high-profile errors.

Last week Roy Pollitt told how his wife died after a PA accidentally left a drain in her abdomen for 21 hours and accused the NHS of using ‘cheap labour’.

Susan Pollitt’s inquest concluded that her death at the Royal Oldham Hospital in 2023 was caused by an ‘unnecessary medical procedure caused by neglect’.

Meanwhile, Emily Chesterton, 30, died from a pulmonary embolism in 2022 after being misdiagnosed twice by a PA when she visited her GP practice in north London.

She had been under the impression that she was going to a GP, but both times the PA could not detect the pain in her leg and the shortness of breath was a blood clot, which eventually traveled to her lungs.

A coroner later ruled that she should have been “immediately referred to a hospital emergency room,” where she would likely have been treated for a pulmonary embolism and survived.

The NHS stipulates that PAs must work under the supervision of a doctor, but may make diagnoses, take medical histories, carry out physical examinations, see patients with long-term conditions, analyze test results and develop management plans.

Most employees work in general practices, acute medicine and emergency medicine.

The Royal College of GPs has previously issued its own guidance stating that PAs should not see patients who have not been examined by a GP, and should only carry out work delegated to them by and agreed with their GP supervisor.

The review will examine how to ensure that patients know they are being seen by a member of staff and the reasons for this.

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 is vital that we have a comprehensive review of the role of PAs and AAs.

‘This is about recruitment and training, practice size, supervision and professional regulation.

‘As I carry out this review, I look forward to speaking to a wide range of stakeholders and gathering evidence from the UK and abroad so that we can build a shared understanding of these roles and their place in wider healthcare teams. ‘

Amanda Pritchard, CEO of NHS England, said: ‘Doctors and anesthetists are important members of the NHS workforce – they come to work every day to help care for patients and therefore deserve to be treated with the same respect as anyone else who comes. to work at the NS.

‘While we have always been clear that they are not a replacement for doctors, there are clear and ongoing concerns that we are listening carefully and taking action to address. This independent assessment marks our commitment, together with the government, to get this right. ‘

The British Medical Association (BMA), which produced its own guidelines while pushing for stricter regulation of the role, said it had become a ‘postcode lottery’ with patients not knowing whether they are being treated by the right professionals.

The union has argued that PAs should never be responsible for a patient’s initial assessment or diagnosis and that they should be closely monitored when caring for those who have already seen a doctor.

They must make it clear that they are not doctors or medical students and that they should not be placed on doctors’ rosters, which the union says is happening more and more often due to staff shortages.

BMA council chairman Prof. Phil Banfield said: ‘This government has recognized and accepted the concerns of doctors that there is a safety issue in the employment of junior doctors. Now the NHS must tell us how they are going to keep patients safe while this review is carried out.

“You don’t fly an aircraft under safety review, you ground it. So we need to know what immediate safety measures the NHSE will take, how quickly they will pause their PA expansion plans, and in the meantime whether they will adopt the BMA’s own guidance to start protecting patients now.”