Physician Associates 'Should Be Banned' From Diagnosing, Study Says

Key Findings and Recommendations from the NHS Review on Physician Associates

A recent review into the role of physician associates (PAs) within the National Health Service (NHS) has proposed significant changes to their responsibilities, highlighting concerns over patient safety and clarity in their roles. The findings suggest that PAs should not be allowed to diagnose patients who have not previously seen a doctor for their condition, marking a major shift in how these healthcare professionals operate.

The Role of Physician Associates

Physician associates were originally introduced to support doctors by performing medical tasks that do not require full medical training. They typically complete a two-year postgraduate program and work under the supervision of a qualified physician. While some PAs specialize in areas like anaesthesia, they are generally expected to assist rather than replace doctors.

Despite their intended role, there have been growing concerns about their use as substitutes for physicians, especially given the shorter training period compared to doctors. This has led to debates among medical professionals and calls for clearer guidelines on their responsibilities.

Patient Safety Concerns

The report highlights several high-profile cases where patient deaths were linked to misdiagnoses by PAs. One such case involved Emily Chesterton, who died from a pulmonary embolism after being misdiagnosed with anxiety by a PA. These incidents have raised serious questions about the appropriateness of PAs handling complex or undifferentiated cases.

Professor Gillian Leng, president of the Royal Society of Medicine and lead author of the report, emphasized the need for clear boundaries. She recommended that PAs should not see patients who have not been triaged, and that they should only handle minor ailments under the guidance of relevant medical bodies.

Recommendations for Change

The report outlines 18 key recommendations aimed at improving transparency and safety in the use of PAs. Some of the most notable include:

• Renaming PAs: Professor Leng suggested renaming PAs to “physician assistants” to clarify their supportive role within the medical team. Anaesthesia associates would be renamed “physician assistants in anaesthesia” or PAA.

• Standardized Identification: PAs should have a distinct dress code, including national clothing, lanyards, badges, and staff information, to differentiate them from doctors and reduce confusion.

• Work Experience Requirement: Newly qualified PAs should spend at least two years working in hospitals before transitioning to GP surgeries or mental health trusts. This is intended to ensure they gain sufficient experience before dealing with primary care patients.

• Supervision by Named Doctors: Every PA must be supervised by a named doctor, who takes overall responsibility for their work. This is meant to address concerns about the adequacy of supervision and the potential risks associated with misdiagnosis.

Addressing Concerns Among Medical Professionals

Many doctors expressed concerns about the time required to supervise PAs and the lack of training for supervisors. A survey conducted as part of the review found that only a small percentage of doctors felt it was appropriate for PAs to diagnose illnesses. This discrepancy in perception between PAs and doctors highlights the need for better alignment in expectations and responsibilities.

Additionally, the report questioned the necessity of anaesthesia associates, noting that fully qualified anaesthetists already face challenges in securing employment. However, it concluded that there are no convincing reasons to abolish these roles but also no justification for keeping them unchanged.

Future Directions

Professor Leng emphasized the importance of ongoing training and development for both PAs and AAs. She suggested that they could eventually be granted the ability to prescribe medicines and advance to more specialized roles. The report also called for clear timelines, funding, and engagement with both medical professionals and patients to implement the recommendations effectively.

Dr. Hilary Williams, incoming clinical vice president of the Royal College of Physicians, welcomed the report and stressed the need for collaboration to ensure its successful implementation. With these changes, the NHS aims to strike a balance between leveraging the skills of PAs and maintaining the highest standards of patient care.