Thousands of NHS staff could quit health service over conflict around their role
Thousands of physician associates (PAs) are said to be on the brink of leaving the health service over job security fears and 'hostile' culture
"Thousands" of physician associates working in the NHS could quit the health service because of the hostility towards their role, LBC has been warned.
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Introduced in the early 2003, physician associates (PAs) assist doctors and GPs with tasks like taking medical histories, seeing patients with long-term chronic conditions, and administering vaccines, allowing senior clinicians to spend their time on more complex duties.
However, John, a PA working in Wales who has asked to change his name to avoid further abuse, told LBC he now regrets taking on the role.
He says the volume of vitriolic abuse he received caused him to shut down all of his social media after being called a "killer", "noctor" (non-doctor), and "pretend doctor".
The union for PAs, UMAPs, says John is now among the "thousands" on the verge of leaving the health service - exacerbating the NHS’s staffing pressures.
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Around 5,000 Physician associates work in the UK. With 2-years of postgraduate medical training they help doctors across GP’s and Emergency wards with tasks like taking medical histories, seeing patients with long-term chronic conditions, or administering vaccines.
Another physician associate, Rosie, who works in a GP practice in London, has also told us she's considering leaving because of external pressures and a lack of assurance her job will be safe long-term.
"There's so much uncertainty around the profession, the role, and all the negativity and the hostile environment. It's just been really unpleasant experience… is that where I want to be? Do I want to feel like this in my career? It's put into question my professional identity."
The role attracted controversy after several high-profile fatalities were connected with the role.
An independent report, known as the Leng review, found confusion among patients over the role, potential barriers to care, and the ability of PAs to work safely and effectively in different health environments across GP practices, and A&E wards.
Richard Marking's mother, Pamela, died after being misdiagnosed by a PA. He told LBC that he believes physician associates face an "immense amount of stress" working in "understaffed" A&E wards.
He says he felt unable to challenge the opinions of the PA, who was "at the coalface" and "drained", adding that he did not know what alternative care his mother would have received that night given the pressures on the department.
Another high-profile case relates to the death of Emily Chesterton, a 30-year-old woman who died after being seen by a PA she thought was a GP who misdiagnosed her with a calf sprain which was, in fact, a blood clot.
Emily’s parents Marion and Brendan have told us they only found out Emily had been seen by a physician associate five months after her death, and just weeks before her inquest.
They argue stronger supervision, and easier identification of PAs would give them more reassurance on their safety in practice and improve patients trust in the role, particularly when services are stretched.
They’ve also called for improved clarity around the responsibilities of PAs, arguing a clearer definition on what they can and can’t do would increase safety and trust for both patients and physician associates themselves.
Some of those complaints have been addressed in recommendations accepted by the UK and Welsh governments in the Leng review.
The report called for a name change to “physician assistants” and a uniform change with different coloured scrubs, badges, and lanyards to clearly differentiate them from nurses or doctors.
The review has also recommended that PAs form a part of a redesign of how multidisciplinary teams work, ensuring each member is clear on their role, responsibilities, and ultimately who they are accountable to should errors occur.
Professor Leng added that a named doctor should take responsibility for each PA as their formal supervisor, and that standards for training and credentialing by medical royal colleges should be established.
The UMAPs union, which represents PAs, has told us a rigid scope of practice would limit their role in a way to make them totally ineffectual or have each one "as advanced as possible in every single speciality".
They also argue the role is treated unfairly comparted to others. UMAPs' leader, Stephen Nash, told LBC: "If you look at the way that when something happens and a doctor has done it, it's very much, well, what can we learn from this and how do we make sure it never happens again? In the last 3 years, the moment something happens, it's all physician associates are bad".
While understaffing is a complaint on both sides of the aisle, Dr Dan Jones from BMA Wales has told us having more staff on the wards won't necessarily improve safety.
He's put some blame on employers for how PAs are being used, suggesting medicine is being "broken down into tasks" with many being forced to work "beyond their competence".
A Department of Health and Social Care spokesperson said “Physician assistants play important roles in our health service, and Dr Leng's review was a welcome opportunity - as she said herself - to reset the debate around those roles and enable all staff groups to work collaboratively in future.
“So while we recognise this has been a challenging period for many physician assistants, the goal for all parties now should be to work together in the interests of patient care and safety, and for NHS employers to make all their staff feel valued and supported."
Meanwhile, a Welsh Government spokesperson said: “Physician Associates play an important role as part of multidisciplinary teams across NHS Wales, supporting the work of doctors to deliver safe and effective care for patients. They are not a replacement for doctors.