Concerns grow over way physician associates are used in NHS

In your hospital or your GP surgery,  there could be a member of staff most people have never heard of  – physician associates.

There are 4,500 in the UK on the voluntary register and there are plans to expand their numbers.

They have two years’ post-graduate training and  can examine, diagnose and treat patients under the supervision of doctors. But in February, NHS England made it clear:  PAs are not doctors and cannot and must not replace them .

Yet, we have freedom of information figures that show of the 145 trusts who responded, 11 said they had used PAs to cover rota gaps, mainly for newly qualified or resident (formerly junior) doctors. Fourteen trusts worryingly said they did not keep the data.

It is not clear if the PAs are being asked to replace doctors.  Some trusts said additional PAs may be employed to support the medical workforce where there are vacant gaps on the medical rotas.

There have been some high profile deaths, including Emily Chesteron, who believed she was seeing a GP but was twice seen by a PA.  She died of a blood clot after the warning signs were missed.

Dr Philip Banfield, chair of the BMA Council, said:  “It’s an appalling state of affairs, given the instruction that went out many months ago to stop such practices, and the observation that this is still taking place makes you wonder whether this is the tip of the iceberg.

“It needs to stop, and therefore we’re calling on a kind of immediate halt to the practice of physician associate expansion, because this is a clear risk to patient safety.”

At the same time, there has been a sometimes vitriolic campaign against PAs.  An anonymous doctors’ online group has described them as “clowns” and “a joke” and  one wrote: “Tell them to bugger off back to whatever hellhole they came from.”

Stephen Nash, chief executive officer of United Medical Associate Professionals, told us: “I think there is evidence been found over the last year, very small amounts where employers have tried to push physician associates and they haven’t had that strength to be able to say no, and that’s where we’ve seen things go wrong.

I think that’s where regulation comes in. I think that’s where good governance comes in, and I think that’s where employer responsibility comes in as well.”

The Royal College of GPs and the BMA GPs committee have now voted against them being used in GP surgeries.

And Channel 4 News understands the government is set to order a rapid review of the use of PAs, including safety and efficiency.

The Department of Health and Social Care said:  “Physician associates play an important role in the NHS, as they have for over two decades, but we are clear they should be supporting, not replacing, doctors and should receive the appropriate level of supervision by healthcare organisations.”