‘Cut-price doctors’ must NEVER diagnose patients under tough new crackdown sparked by death of actress, 30, whose fatal blood was missed twice

Controversial physician associates (PAs) must be barred from diagnosing patients, leading doctors have warned. 

In fresh guidance issued by the British Medical Association (BMA), the group should also never perform complex or life-threatening procedures or be put on doctors rotas. 

PAs, dubbed ‘cut-price doctors’, do not go to medical school, and instead do two years of post-graduate training on top of a degree in a subject like biomedical sciences.

But concerns over patient safety have ‘dramatically increased’ as numbers of PAs and anaesthesia associates (AA) escalate across the NHS, according to the doctors union. 

In 2022, Emily Chesterton died from a blood clot three weeks after her 30th birthday after a PA dismissed her symptoms as ‘anxiety’.

First introduced in 2003, the role currently allows PAs to take medical histories, perform physical examinations, analyse test results and make diagnoses, but should always work under supervision.

They are not allowed to prescribe drugs or refer patients for procedures.

The NHS employs around 3,200 PAs and 180 AAs in England. But the Government wants to increase their role. 

Plans to increase this to 10,000 and 2,000 respectively to help plug workforce gaps has caused alarm among critics.

In what the BMA claims is the first national guidance on the role, the union has drawn up a traffic light system to clarify suitable tasks and those which should be strictly out of bounds.

It believes the measures — which it wants adopted by NHS employers — will create clear boundaries ‘filling a void that has lasted for over 20 years.’

It come after several recent high-profile cases of harm occurring to patients following consultation by PAs, including three deaths.

Professor Phil Banfield, chair of council at the BMA chair of council, said: ‘Our guide has been written by doctors, for doctors, to explain to the medical profession what medical associate professionals should and should not do alongside their doctor colleagues.

‘But it is also to help patients, to improve patient safety.

‘With the Government’s clear intent to expand the numbers of MAPs in the medical workforce, but without the clarity on the scope of their skills and responsibilities, it is even more important that patients must know who is treating them and the skills and abilities that clinician has.’

Both PAs and AAs are set to be regulated by the General Medical Council, which also oversees doctors.

But with reports of widespread confusion among the public over the role and relationship with fully trained medics, there are fears this will ‘further blur the lines’, the report said.

It has made a series of recommendations designed to clarify what staff in these roles should and should not do for patients under the careful supervision of a doctor.

‘Green’ tasks can be caried out independently, ‘orange’ should be under supervision and ‘red’ –should never be undertaken by these staff, it says.

The BMA said 87 per cent of more than 18,000 doctors expressed concerns PAs and AAs were currently employed in the NHS in ways that were ‘sometimes’ or ‘always’ a risk to patient safety, according to a recent survey.

It called for a halt in recruitment to these roles while their regulation and scope of practice can be reconsidered.

PAs today, however, hit back at the BMA arguing they are not ‘servants to doctors’. 

The United Medical Associate Professionals, a union representing PAs, added: ‘Doctors and PAs have worked together, harmoniously, for the benefit of patients for 20 years. So why all the attacks now?’

In 2022, actress Emily Chesterton, 30, died of a blood clot after a PA dismissed her symptoms as anxiety and gave her pills instead of directing her to A&E.

She wrongly believed she had been seen by a GP at her surgery in North London but had twice been seen by an associate.

The GP practice where Ms Chesterton was seen, the Vale Practice in Crouch End, has stopped employing PAs. 
Her parents are now warning of the dangers patients can face amid plans to expand the use of PAs.
Her mother Marion Chesterton, yesterday, said: ‘To lose a child is terrible but when you find out the death was preventable, should have been prevented, it’s just devastating – it’s torture.
‘All patients should have the right to know who is treating them and have the choice to see a fully-qualified doctor.’
And Norman Jopling, 79 from North London, suffered a serious brain bleed after a PA mistakenly told him that his painful headaches were nothing to worry about. 
His wife Maureen, later accused the NHS of ‘trying to cut corners’ by allowing PAs to carry out ‘complicated tasks they’re not qualified to perform’. 
Last year, the Mail on Sunday also told how 34-year-old Colleen Howe died from aggressive breast cancer following delays in her treatment when her lump was misdiagnosed by a PA as a blocked milk duct. 

In a House of Lords debate, Liberal Democrat peer Baroness Brinton last month said doctors had reported ’70 instances of avoidable patient harm and near misses caused by PAs’, including ‘fatalities, missed diagnoses causing terminal diseases, sepsis and heart attacks’. 

The BMA guidelines cover both the general field of medicine and specialties from anaesthetics to psychiatry.

They state these roles must be seen as ‘an assistant role to doctors’ helping with simple practical procedures, administrative tasks, and working with patients in a supportive and specified role.

In no situation, should they be the first point of contact for patients who are yet to see a doctor and cannot undertake initial assessments or diagnoses.

When seeing patients already triaged by a doctor as appropriate, they must still be directly and closely supervised, they say.

They must also make it clear in all communication to patients and to other staff members that they are not doctors, the report states, should not be on a doctor’s rota nor be in charge of giving any specialist advice.

Statements such as ‘I am one of the medical team’ must not be used unless also stating their own title.

Professor Banfield added: ‘We know that MAPs are working in roles that increasingly cross the line into situations more appropriately requiring the expertise of a doctor, so our report sets out what the Association considers a safe scope of practice that will keep patients protected and allow the NHS to effectively employ MAPs to assist medical teams — which was their original purpose.’