Wes Streeting has commissioned a review of what physician assistants (PAs) do in the NHS, amid growing alarm in the medical profession over patient safety.
It will examine how safe their role is and how patients should be made aware that, despite their titles and ability to diagnose diseases, they are not doctors and can only perform certain tasks.
The Health Secretary has appointed Prof Gillian Leng, an expert in evidence-based healthcare and former CEO of the National Institute for Health and Care Excellence, to lead the review.
Around 3,500 PAs and around 100 equivalents working in anesthesia – called nurse anesthetists – work in hospitals and GP practices in England. All told, the number of ‘medical associate professionals’ (MAPs), as they are known in the NHS, will triple to around 10,000 by 2037 under the service’s long-term workforce plan.
PAs can take a patient’s medical history, perform physical examinations, analyze test results, diagnose diseases and help develop the plan for managing a person’s condition. They complete two years of medical training, much less than a doctor.
But their efforts have raised concerns that their limited medical knowledge could lead to patients receiving poor care and also being confused about whether or not they have seen a doctor. There have been repeated calls to change their title to make it clear that they are not medical professionals.
Streeting said many PAs provided good care and “gave doctors the space to do the things that only doctors can do,” which was the role originally assigned to them.
“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 physicians feel ignored and PAs feel demoralized,” Streeting added.
The risk to patients that PAs can pose and the confusion they can cause was illustrated by the death in 2022 of Emily Chesterton. The 30-year-old actor died after a PA at a north London GP practice – who she thought was a doctor – twice wrongly diagnosed the pain in her calf as being due to a strain rather than a blood clot .
The British Medical Association (BMA), which has played a key role in the medical profession’s growing fears about the dangers PAs can pose, welcomed the review as vindication of its repeated warnings about their alleged risks to patient safety. But he said the assessment did not go far enough.
“You don’t fly an aircraft under safety review; you ground it. So we need to know what immediate safety measures NHS England will put in place now (and) how quickly they will pause their PA expansion plans,” said Prof Philip Banfield, the leader of the doctors’ union.
“The NHS has failed to make employee employment safe for patients. By giving everyone free rein about what PAs can and cannot do, hospitals have become a postcode lottery in which patients do not know whether they are being seen by a professional with the right skills.”
Leng said she would undertake a comprehensive review of the role doctors and anesthetists play in the NHS, “to promote patient safety and strengthen the NHS workforce”.
NHS Employers, which represents NHS trusts, said the review would help health bosses and senior doctors respond more fully when questioned about the concerns raised.
“Leaders in the NHS, independent healthcare organizations and medical representative organizations have struggled to find constructive and coherent ways to respond to the public’s concerns about the clinical work of doctors and anesthetists, who make up a small proportion of the overall healthcare workforce. sector,” said Danny Mortimer, CEO of the organisation.
“Sometimes the responses lacked civility and compassion, especially for people in these professions.”
Chesterton’s parents, Marion and Brendan Chesterton, have joined campaign group Anesthetists United in taking legal action against the General Medical Council (GMC), which oversees doctors and will start regulating MAPs from next month.
They claim the GMC has failed to properly distinguish between doctors and physicians and anaesthetists.
The BMA has launched a second, separate lawsuit against the GMC for referring to doctors and MAPs as ‘medical professionals’, which it says ‘blurs the boundaries between doctors and their assistants’.