- Physician associates were brought in to help doctors and nurses’ daily duties
- Concerns are growing about errors by PAs – some with just two years’ training
A young mother died earlier this year from aggressive breast cancer after delays caused by a misdiagnosis from a physician associate (PA) at her GP surgery, this newspaper has learned.
Colleen Howe was 34 years old and eight-months pregnant with her second baby in August 2021 when she visited her Suffolk GP practice after discovering a lump in her right breast.
The photographer and business owner from Bury St Edmunds believed she was seeing a doctor – but her appointment was in fact with a PA who carried out an examination and reassured her the lump was simply ‘a blocked milk duct’, giving her the impression that there was nothing to worry about.
PAs are NHS staff brought in to help doctors and nurses in their daily duties. They have two years of training, but are not permitted to treat patients and it is illegal for them to prescribe medication.
By the time Colleen was finally diagnosed on October 20 later that year – having recently given birth – her breast cancer was incurable and tumours had spread to her liver, pelvis and spine.
Colleen Howe was 34 years old and eight-months pregnant with her second baby in August 2021 when she visited her Suffolk GP practice after discovering a lump in her right breast
She received multiple cancer treatments, including chemotherapy, radiotherapy and even an experimental trial drug which had severe side effects. However, the cancer continued to spread around her body. Colleen passed away on April 9 this year, surrounded by her family.
In July 2022 – while she was still alive – the NHS opened an investigation into her misdiagnosis. It concluded that the advice she was given by the PA was in line with official guidance. Colleen had been told to take paracetamol and return for another appointment if the lump worsened or persisted after giving birth.
However, the review also reported that GPs at the surgery said ‘usual practice’ would have been to arrange a follow-up appointment within two weeks for a pregnant woman with a breast lump – which did not happen.
Colleen’s devastated mother, Catherine, 60, contacted us last week to share her shocking story in support of The Mail on Sunday’s Health campaign to Rein In The Physician Associates.
Yet the Government plans to enlist thousands more PAs over the next decade in order to plug dire NHS staff shortages. Doctors overwhelmingly say the move, as it stands, is a risk to patient safety.
PAs are permitted to take patients’ medical histories, perform physical examinations and analyse test results, all under the supervision of a doctor. They can also fill in forms and carry out basic checks which can sometimes clog up GPs’ workloads.
In recent weeks, though, we have received numerous reports that they are operating far beyond this remit – seeing patients with little supervision, bending the rules to write prescriptions and performing risky procedures.
That’s why we are urging Ministers and health chiefs to intervene and limit the medical tasks that PAs are allowed to undertake.
Still reeling from the loss of her daughter, Catherine, a retired NHS clerk, says: ‘Five weeks after giving birth, Colleen was told she had terminal cancer and could have just months to live. It was horrific and we still can’t believe she’s gone.
The government plans to enlist thousands more physician associates (PAs) over the next decade in order to plug dire NHS staff shortages. Doctors overwhelmingly say the move, as it stands, is a risk to patient safety
‘Would it have made any difference if she had been diagnosed sooner? It plays on my mind. She first saw the PA on August 2, 2021, and due to the misdiagnosis her cancer treatment didn’t start for another three months.
‘An oncologist who knew my daughter’s case said during the safety review that the delay meant there were fewer options.’
She adds: ‘We didn’t even know what a PA was before this all happened. You just go along with what you’re told and Colleen thought she’d been given advice by a doctor.
‘We’ve been told the PA who first saw Colleen is devastated by what happened, but she’s not as devastated as we are. We feel so angry – we keep asking ourselves, “Why did this happen to our daughter?” ’
Perhaps most worryingly is that it might not be an isolated case. Last week the MoS was handed more than 400 reports from doctors who have raised serious concerns about the role PAs play in the NHS. The dossier, collected by Doctors’ Association UK – an organisation that represents NHS doctors – revealed a disturbing number of cases where PAs had put patients in danger.
One incident involved a PA who was asked to perform defibrillation using a device that gives a high-energy electric shock to the heart of a patient in cardiac arrest. The report states the PA failed to follow correct procedures and ended up shocking another staff member who was forced to take time off work with a heart condition caused by the incident.
In another case, a diabetic women experiencing chest pain was sent home from a GP surgery by a PA and booked in for a heart scan at a later date. When she arrived at hospital for the scan, medics realised she had suffered a heart attack.
Another reports that a PA working in an intensive care unit accidentally removed a breathing tube from a severely unwell patient who suffered a life-threatening loss of oxygen.
And, shockingly, another claims that PAs at their hospital used doctors’ computer login details to illegally write prescriptions.
About 80 per cent of medics told Doctors’ Association UK they had observed PAs failing to tell patients they were not a doctor or claiming that they were just as qualified.
Roughly two-thirds said they frequently received requests from PAs to write prescriptions or sign-off tests on their behalf.
‘Frontline doctors are really concerned at the growing role PAs are playing in the NHS,’ says Dr Matt Kneale, co-chairman of Doctors’ Association UK.
‘There is a pressing need for clear guidelines and proper supervision of these junior staff if we want to protect patients from danger.
‘We’re calling for an immediate pause on the recruitment of PAs until regulations are in place.’
There are about 2,500 PAs working in the NHS today, but Ministers plan to increase their numbers fourfold by 2037, claiming this radical move is needed to help tackle the unprecedented shortage of NHS doctors. However, Dr Kneale counters: ‘There is scope for using PAs in a limited role – taking bloods and writing notes – but the way they are being rolled out is out of control.
‘They are allowed to practise in hospitals without supervision and are regularly seeing patients one-on-one.
‘A trainee GP will have approximately ten years of training, including medical school. PAs do two years and are let loose in the NHS. It is not safe.’
Experts say the biggest concern is the lack of regulations over what PAs are allowed to do. This also means, should something go wrong, the PAs cannot be held responsible as there is no medical body to complain to.
More than 2,800 doctors earlier this month expressed ‘grave concerns’ about the lack of regulation governing PAs in an open letter to the General Medical Council. Co-ordinated by Doctors’ Association UK, it stressed that current proposals, which include granting PAs the right to prescribe medicine, were ‘unsafe, premature and lacking the necessary safeguards’.
Following these growing concerns, Doctors’ Association UK surveyed its members on whether they agreed with increased recruitment of PAs, receiving nearly 680 responses.
Three out of five reported negative experiences with PAs. Two-thirds also raised concerns that the expanded use of them in hospitals meant junior doctors were not receiving adequate training – because tasks they would normally carry out were being done by associates instead.
‘PAs regularly see patients in A&E while junior doctors are consigned to routine jobs such as rewriting drug charts,’ one junior medic said.
However, senior doctors also warned the use of PAs was particularly widespread in GP practices.
‘They are being used as replacement GPs,’ said one. ‘I’ve seen PAs misdiagnose a sexually transmitted infection as a urinary tract infection, and a heart problem as acid reflux. Often they are not correcting patients who call them a doctor.’
Recalling the day Colleen had her first appointment with the PA, Catherine says: ‘She had a face-to-face appointment with someone she believed at the time was a doctor. She called me afterwards and told me not to worry, that the lump was just a blocked milk duct. She’d been told to take paracetamol and was relieved – we both were.’
The NHS investigation concluded the PA was qualified to carry out ‘this type of consultation’ and stated a GP was available that day if the PA needed ‘advice or a second opinion’. This meant the PA was ‘supervised’, according to NHS guidance.
It also advised that patients should be routinely booked in for follow-up appointments if needed. But the PA who treated Colleen never enquired if the lump had resolved itself because they had moved to another surgery soon after seeing her.
Catherine says: ‘Colleen was our only child. She has left us two beautiful grandchildren so a part of her is here, but we miss her terribly. Her elder daughter asks us about her. She knows that her mummy is in the sky, in Heaven. When the little one is old enough, we’ll tell her how wonderful her mum was.
‘As far as we know, the PA who made the misdiagnosis is still treating patients.
‘I hope it will stop her making another mistake.’
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