Medical assistants should be supervised by GPs, says NHS England
Physician Associates (PAs) are “not a replacement” for GPs and must be supervised, NHS England has said.
A new letter to all GP practices, primary care network clinical directors, integrated care council chief executives and regional directors of NHS England says that PAs are “specifically trained to work collaboratively with doctors and others” and that all work involved undertaken by PAs “must be supervised and questioned. with their supervising GP”.
The letter came after concerns were raised about the role of PAs after the death of a patient and other errors in care.
The British Medical Association (BMA) has said its members are concerned about the role of PAs, who they say should be stopped diagnosing patients.
It has published a framework that it says will “improve patient safety”.
The new letter from NHS England was signed by Prof. Sir Stephen Powis, the National Medical Director of the NHS; Dr. Navina Evans, head of human resources, training and education at NHS England, and Dr Claire Fuller, national medical director for primary care.
In relation to supervision, the report said: “It is essential that junior doctor roles are introduced safely and in a supportive environment, ensuring oversight of the supervision and tasks carried out.
“We ask that practices review their processes to ensure they have appropriate oversight in place to support governance and systems. Underlying this is the supervising GP’s confidence in the PA’s competence, based on the knowledge and skills acquired through their training and development.”
The letter also reminded the NHS that “PAs are not able to prescribe medicines” and that every practice should have a comprehensive policy regarding access to and restrictions on electronic health records.
“These policies should include aspects such as appropriate access to patient prescribing, results, referrals and clinical notes, and provide assurance that physicians cannot undertake activities that are outside the scope of their practice.”
Under a section titled “role clarity,” the letter said it was necessary to ensure patients understand who is caring for them.
“All clinical and administrative/clerical staff (e.g. receptionists) should be trained in the PA role and make it clear to patients that they are seeing a PA,” it added.
“As part of good governance processes, all staff should be aware of how patients should be assessed so that they are seen appropriately by a doctor working within their level of competence.”
PAs are graduates – usually with a healthcare or life sciences degree – who have completed two years of postgraduate training.
According to the NHS, they work under the supervision of a doctor and can diagnose people, 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.
In England, NHS England and the government have said they will increase the number of doctors to 10,000 from around 3,300 now.
Emily Chesterton, 30, died in November 2022 from a pulmonary embolism after being misdiagnosed twice by a PA when she attended her local GP practice in Crouch End, north London.
She had been under the impression that she was going to a GP when she went to a PA after being triaged by a practice receptionist. The PA failed to detect her leg pain on both occasions and the shortness of breath was a blood clot, which eventually traveled to her lungs.
Instead, Ms Chesterton was told she was concerned.
A coroner later ruled that she “should have been referred immediately to a hospital emergency room,” where she would likely have been treated for a pulmonary embolism and survived.
Her parents, Brendan Chesterton, 64, a retired maths and ICT teacher, and his wife Marion, 65, a retired languages teacher, support the BMA’s call for much stricter controls on the work of PAs.