'Cut-price doctor' physician associates and anaesthesia associates acting illegally in one in eight NHS trusts

25 June 2024, 16:15

A busy hospital with staff busy at work in an accident and emergency ward in a British hospital
A busy hospital with staff busy at work in an accident and emergency ward in a British hospital. Picture: Alamy
Connor Hand

By Connor Hand

Physician associates and anaesthesia associates have been found to have acted illegally in one in eight NHS trusts, LBC has uncovered.

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Yesterday, the British Medical Association launched legal action against the General Medical Council (GMC) over the regulation of these roles, neither of which require either a medical degree or postgraduate medical training.

Under the terms of their employment - therefore, physician associates (PAs) and anaesthesia associates (AAs) are not allowed to perform acts which are the preserve of clinicians. On paper, their main duty is to lessen the burden on doctors by helping to manage patients and reduce the demands on their time.

But LBC has found that PAs and AAs have acted beyond their purview in one in eight NHS trusts, attempting to prescribe medication and commission ionising radiation scans - tasks they have no legal right to carry out.

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The data was obtained via Freedom of Information Requests to over 50 NHS trusts.

The findings have been described as “staggeringly high” by the co-founder of Anaesthetists United, Dr Richard Marks, whose organisation has launched complementary legal action against the GMC over the regulation of AAs.

But speaking to LBC, Dr Marks warned that the figures could be “the tip of the iceberg”.

He said: “It’s a staggeringly high figure for one in eight trusts to admit that people in their organisation are acting illegally - and I stress that it is illegal. There are specific laws on prescribing and ordering X-Rays and ionising radiation.

“I think this is the tip of the iceberg, though, because there are so many ways people get around the regulations. In anaesthetics, people are using Patient-Specific Directives, which is a particular way that doctors can prescribe something to be given by someone else, [with] very strict constraints over the dose, repeated dose and timing.

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“But it’s being used as a bit of a carte blanche to do whatever the associates want - so I think [LBC’s] figures are just the tip of the iceberg.”

Physician associates were first introduced in 2002 with the objective of reducing the number of hours doctors spend doing non-clinical work.

However, the BMA has claimed that there has been a “dangerous blurring of the lines” between consultants and PAs, with many patients being unable to distinguish whether they are being treated by a doctor.

The union claims this issue will be exacerbated if the GMC becomes responsible for regulating doctors, a change that is due to come into effect in December.

Concerns around the use of PAs and AAs have increased after the deaths of three patients were linked to their use, including Emily Chesterton in November 2022, who was assessed twice by a PA she believed to be a GP. On both occasions the PA failed to identify her breathlessness and leg pains as a blood clot.

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In England, the use of PAs is set to rise considerably in the next decade. Currently, there are around 3,500 employed, though that is set to rise to 10,000 by 2036/37.

Despite the concerns around patient safety, both the Health Secretary, Victoria Atkins, and Shadow Health Secretary, Wes Streeting, have defended their use.

Speaking last week, Mr Streeting said: 'I've been really depressed by the state of the debate and discussion around the future of physician associates.

“Depressed because I think physician associates do have a role to play, and that it would be wrong to throw the baby out with the bathwater and just say, because of some legitimate concerns that doctors have, that we're just going to slam the brakes on or end physician associates in the NHS.

“I've met quite a lot of PAs who are doing really valuable work with their patients and appropriate work.”

A spokesperson for NHS England said: "The NHS has been clear that medical associate professions are not a substitute for doctors but are trained roles to support doctors to do their jobs with appropriate supervision. Last month, the NHS issued guidance on the appropriate deployment of these roles".

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