The NHS in England should slow or scrap altogether the recruitment of physician associates (PAs) and ban them from seeing patients one-to-one, medical groups are urging ministers.
The Royal College of Physicians (RCP), which represents hospital doctors, has called for a rethink of government plans to increase the number of PAs from 3,000 to 10,000 by the mid-2030s.
They should also not be allowed to run clinics on their own, without a senior doctor present, because left unsupervised they could pose a risk to patients’ safety, the RCP added.
“We’re calling on NHS England to slow down the expansion of the PA role [and] review its projections for growth in the PA workforce,” said an RCP spokesperson.
While the college is not proposing exactly how many more PAs the NHS should train and hire in coming years, it “believes their growth should be carefully managed” and NHS England needs to take “a more measured approach” to recruiting and using them.
Its move comes weeks after Wes Streeting ordered an independent investigation into the role and competence of PAs, after a series of cases in which patients they treated came to harm. They include Emily Chesterton who died after her blood clot was misdiagnosed by a PA as a calf strain.
The health secretary said the review, by Prof Gillian Leng, was needed because “there are legitimate concerns over transparency for patients, scope [of PAs’ role] and the substituting of [them for] doctors. These concerns have been ignored for too long.”
The British Medical Association (BMA) wants tougher action than the RCP, though. It demanded an immediate halt to the recruitment of PAs, who assist doctors but have only two years of medical training.
“As the RCP says, the planned expansion of PAs across the NHS needs to be rethought”, said Prof Philip Banfield, the BMA’s chair of council.
“But in the short term, while the Leng review is under way, and potentially unsafe practice continues across the NHS, we must pause PA recruitment and ensure those we have practise to their qualification and not beyond. You don’t fly a plane under safety review, you ground it.”
Banfield welcomed the RCP’s publication of a series of documents offering guidance on what tasks PAs should and should not be able to carry out. He greeted in particular its conclusion that no PA should see patients on their own unless a senior doctor is on hand to offer immediate supervision.
The major expansion of PA numbers was enshrined in the NHS long-term workforce plan published in June 2023 under the Conservative government. However, a review of that plan which Streeting announced last week is very likely to lead to a reduction in their planned numbers, given the high levels of concern PAs’ increasing role in the NHS has generated among medical organisations.
Analysis of job advertisements placed by NHS trusts in England suggests that fewer have been hired recently, almost certainly owing to growing concern that they may threaten patient safety.
In its guidance, the RCP makes clear that: “PAs are not doctors. They should not be regarded as replacements for doctors, and they should never replace a doctor on a rota.”
PAs can safely perform CPR, assess a patient on arrival at hospital, update patients about their treatment and insert cannulas, the RCP says. However, “a PA must never function as a senior decision-maker. [And] a PA should never undertake outpatient clinics independently.” They must be supervised at all times by a senior doctor, such as a consultant.
The Department of Health and Social Care said: “Many physician associates are providing great care and freeing up doctors to do things only doctors can do.” But there are “some concerns” about the limits of their competence, the spokesperson added.
Leng’s review is due to report in the spring.
