Latest news with #PhysicianAssociates
Times
a day ago
- Health
- Times
‘Junior doctors are right to be unhappy with NHS'
Junior doctors are right to be unhappy about the way the NHS treats them, the head of a landmark review into physician associates has said. Professor Gillian Leng, the president of the Royal Society of Medicine, said that there was 'resentment and hostility' felt by some younger doctors towards other healthcare staff. Anger about NHS plans to expand the use of physician associates (PAs) has contributed to 'general unhappiness' driving the British Medical Association to call a five-day strike, she said. Leng was asked by Wes Streeting, the health secretary, to examine the NHS rollout of PAs, amid a bitter row within the medical profession over whether they are replacing doctors. Her review was published on Wednesday and found that PAs have been used as a 'substitute' for fully trained doctors and GPs, despite having only two years of postgraduate training, which is 'risky and confusing' for patients. In an interview with The Times, Leng revealed she found cases including of a PAs 'acting as a GP' at a practice in London, and seeing patients inside a consulting room behind a 'door with their name on'. Leng said: 'The GP practice had clearly tried to appoint GPs but they couldn't. So the physician associate was fulfilling the role.' • Doctors could have student loans written off to avert strikes Leng recommended changes including banning PAs from diagnosing patients, renaming them 'assistants' and ensuring they wear uniforms to distinguish them from doctors. The debate over PAs had become 'toxic' over the past two years, with reports of bullying and harassment on wards, as opposition to PAs has been led by leaders of the BMA. Leng said that the level of 'online hostility' meant she deleted social media while carrying out the review. 'When I started doing the review, I was told to come off social media. I think that was the right thing to do, because I would have been targeted,' she said. PAs have been working in the NHS for two decades, but a row over their roles was ignited by plans in the 2023 NHS Long Term Workforce Plan to expand the PA workforce from 3,000 to 10,000. While carrying out her review, Leng spoke to more than 1,000 people and visited hospitals and GPs around the country, where she was struck by the poor working conditions of young doctors and the contrast with PAs. Doctors have to move around the country and face 'lengthy training, antisocial hours and numerous exams', with thousands finding it difficult to secure jobs in the NHS after completing their foundation training. Meanwhile, PAs have set working hours and stable jobs, meaning they can become valued members of a team. Leng said this contrast was 'undoubtedly one of the reasons why the debate has become so impassioned'. Leng said: 'It's fair enough that doctors are unhappy about the way their training works. It's like being a widget in a factory. You don't have much control where you move around. You are put on a conveyor belt. • Six patient deaths linked to use of physician associates by NHS 'Resident doctors move around so much they don't have a chance to build that relationship [with consultants]. I've been racking my brains to think of any other careers that you might go into where you are one of the brightest members of the system and you'd be treated like that.' Resident or junior doctors — who are launching a five day strike next week — are also furious that PAs start on a salary of £47,000 a year, while a first-year junior doctor earns £39,000. Leng said that this resentment had contributed to the BMA's strike action. 'When you look at some of the big national strikes that we've had in this country — miners, train drivers — it's never just about pay. These issues are always pay plus general unhappiness with terms and conditions. So I don't think this is any different. You've got resident doctors unhappy with the way that their training has become a number on a conveyor belt, and they feel they don't have a team structure.' Leng's 134-page report stressed that evidence regarding the safety and effectiveness of PAs was 'poor', and she said much of the evidence submitted by organisations including the BMA was 'anecdotal' and 'could not be verified'. Leng, who qualified as a doctor at the University of Leeds in 1987, was formerly head of the National Institute for Health and Care Excellence, and became president of the Royal Society of Medicine last year. • Robert Colvile: Striking doctors are really capitalists — and may have a point Streeting said: 'We're accepting all of the recommendations of the Leng review, which will provide clarity for the public and make sure we've got the right staff, in the right place, doing the right thing. Patients can be confident that those who treat them are qualified to do so. 'Physician assistants, as they will now be known, will continue to play an important role in the NHS. They should assist doctors, but they should never be used to replace doctors.'
Telegraph
4 days ago
- Health
- Telegraph
Physician associates ‘should be banned from diagnosing patients'
Physician associates should not diagnose patients, a government-commissioned review has said. The review examined six patient deaths that coroners' reports had directly linked to physician associates (PAs). The report's author said misdiagnosing patients and giving them the wrong treatment plan was 'catastrophic'. The review found there was 'inconclusive' evidence that physician associates were safely deployed in the NHS, but equally none to suggest it was so unsafe that the role should be abolished. It said the role should be renamed as 'physician assistant' to reduce confusion among the public who have often mistaken them for doctors. The review proposes giving all NHS staff, including the renamed physician assistants, their own uniforms and lanyards that clearly state their job, because of the vast range of roles operating within the health service, and a tendency for PAs to wear doctors' scrubs and stethoscopes. The recommendations make up part of an independent review of PAs and anaesthesia associates (AAs) by Prof Gillian Leng, the president of the Royal Society of Medicine. Wes Streeting, the Health Secretary, ordered the review last year after a series of scandals involving PAs either causing patient harm or death, practising beyond what they are qualified to do, or being used in place of doctors. Doctors have also criticised the NHS plans to increase the around 3,500 PAs employed to more than 10,000 as an attempt to replace them.
Yahoo
4 days ago
- Health
- Yahoo
Physician associates ‘should be banned from seeing patients without review'
Physician associates (PAs) should be banned from seeing patients who have not been reviewed by a medic to prevent the risk of 'catastrophic' misdiagnoses, a Government-ordered report has found. The study suggests a major change to the role of PAs after it acknowledged they have been used as substitutes for doctors, despite having significantly less training. More than 3,500 PAs and 100 anaesthesia associates (AAs) are working in the NHS and there have been previous calls for an expansion in their number. But a general lack of support for the roles from the medical profession – plus high-profile deaths of patients who were misdiagnosed by PAs – led Health Secretary Wes Streeting to order a review. Presenting her findings, Professor Gillian Leng, president of the Royal Society of Medicine, said: 'Crucially I'm recommending that PAs should not see undifferentiated or untriaged patients. 'If (patients) are triaged, they (PAs) should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs.' She said more detail was needed on which patients can be seen by PAs and national clinical protocols should be developed in this area. She added: 'Let's be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients.' Prof Leng also recommended PAs should be renamed 'physician assistants' to position them 'as a supportive, complementary member of the medical team', while AAs should be renamed 'physician assistants in anaesthesia'. Newly qualified PAs should also work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts. The study said safety concerns in relation to PAs were 'almost always about making a diagnosis and deciding the initial treatment, particularly in primary care or the emergency department, where patients first present with new symptoms.' It added: 'It is here that the risk of missing an unusual disease or condition is highest, and where the more extensive training of doctors across a breadth of specialties is important. 'Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.' Despite the shorter two years of training for PAs, where local NHS services have struggled with filling roles, 'the easy option in some cases was simply to fill gaps in medical rotas with PAs', the report went on. 'This seems to have been done without taking into account the more limited training of the PAs and how the roles would interact, other than with the caveat that they would be supervised by doctors. 'This lack of planning may have been responsible for driving the resentment felt by some resident (doctors) and potentially exposed patients to unnecessary risk.' The study noted concerns in the medical profession about the impact on training and employment of resident doctors when PAs take on tasks. When it comes to the safety of PAs and AAs, Prof Leng said the 'evidence is poor', with 'no compelling evidence' in published research 'that PAs were safe to work as doctor substitutes in primary care'. She also said the evidence was poor when it came to cost effectiveness. The report said that while research suggests patients are satisfied after seeing a PA, some did not know they were not seeing a doctor. Many doctors also told the review they were concerned about the time required to supervise PAs and AAs and the lack of training for supervisors about the role of PAs. A survey conducted for the report found 'relatively few doctors felt it was appropriate for PAs to diagnose illness', with only 29% of those working with PAs in primary care backing this, and 14% in secondary care. The survey also found 'marked differences in which tasks were considered appropriate in primary and secondary care, with PAs significantly more likely than doctors to believe that certain activities were appropriate for them to carry out'. When it came to AAs, there were also questions over whether the role was actually needed as fully qualified anaesthetists already face tough competition to find a job. Prof Leng concluded there were 'no convincing reasons to abolish the roles of AA or PA' but there is also no case 'for continuing with the roles unchanged'. She recommended that both PAs and AAs should have the opportunity for ongoing training and development, with potential to prescribe medicines in the future, and they should also should have the opportunity to become an 'advanced' PA or AA. A named doctor should take overall responsibility for each PA, while clothing, lanyards, badges and staff information should be standardised to 'distinguish physician assistants from doctors'. Six patient deaths linked to contact with PAs have been recorded by coroners in England. One high-profile death involved Emily Chesterton, 30, who died from a pulmonary embolism. She was misdiagnosed by a PA on two occasions and told she had anxiety. Unison head of health, Helga Pile, said: 'By working closely with doctors and other healthcare professionals, these roles can make a real difference to the improvement of services and reduction of waiting lists. 'Clearer identification of physician associates and anaesthesia associates will give patients a greater understanding of who's delivering their care and what they can expect. ' Dr Tom Dolphin, chair of BMA council, said the review 'laid bare the catastrophic failures in NHS leadership that have put patients at serious risk of harm' but said its recommendations 'do not adequately protect patients'. He added: 'Despite correctly recommending that assistants shouldn't be the first person seeing patients coming straight through the doors in GP practices or in A&E, the report then contradicts itself by saying that PAs can act as a first point of contact in primary care for minor and common conditions. 'It is not clear how these two recommendations can coexist, and this must be urgently clarified. Minor complaints are only minor in retrospect and serious conditions can present in subtle or unusual ways. 'No doubt doctors will look back at this report as a moment when historic failures could have been addressed and patients finally protected – but sadly will see this as an inadequate response to what is a patient safety scandal.'
BBC News
4 days ago
- Health
- BBC News
Physician associates need new job title, says review
Physician associates (PAs) and anaesthesia associates (AAs), who assist doctors in GP surgeries and hospitals, should be known as "assistants" to avoid confusing patients, an independent review review recommends PAs and AAs wear standardised clothing and badges to distinguish them from doctors, and that they should not diagnose patients. Health Secretary Wes Streeting announced the review last year, following a heated debate over the roles and responsibilities of the healthcare doctor's union, the BMA, says the review should have gone further. Review author Prof Gillian Leng talked to doctors, patients and the public to collect evidence on the safety and effectiveness of the roles of PAs and said a clear vision "was largely missing" when they were introduced in 2000 and there was no national plan for how the new roles would fit into existing teams, resulting in growing "confusion about the roles' purpose and remit". "Where capacity was limited in local services, gaps in medical posts were sometimes covered by PAs, without taking into account their more limited training or ensuring that supervisors had the necessary understanding of the roles and the time and skills required to provide appropriate oversight," Prof Leng also listened to families of relatives who died after being treated by PAs, believing them to be qualified Chesterton was told the calf pain she was experiencing in October 2022 was a sprain but it was in fact a blood clot. She died, aged 30, after being seen twice by a physician Pollitt, 77, was being treated by a PA in hospital two years ago after a pump was left in her stomach for 15 hours longer than it should have been. She died from an infection two days daughter Kate says the family have never blamed the PA involved but want more clarity. "As a family, when you've got someone in hospital, you don't think straight because you're just worried about your relative," she says."Even though people are telling you who they are, you're not registering it. So I do think it needs to be made clear, with the uniform and the badges and the name. So we do welcome that," Kate other cases, patients said they were satisfied after seeing a PA and felt listened to, the review says. The review recommends physician associates should:be renamed "physician assistants" to reflect their supportive role in medical teamsnot see new patients in primary or emergency care or make a diagnosishave at least two years' hospital experience before working in a GP surgery or mental health trustbe part of a team led by a senior doctor wear badges, lanyards and clothing to set them apart from doctorsAnaesthesia associates should be renamed "physician assistants in anaesthesia" or addition, patients should be given clear information about the role of a PA and there should be a faculty to represent PAs and set standards for training. Physician associates (PAs) and anaesthesia associates (AAs) were introduced into the NHS in the early 2000s to ease doctors' their numbers grew, concerns were raised about the safety of the roles, the lack of clarity around their responsibilities and the impact they had on junior medics' work and are not authorised to prescribe medication but they can order certain scans, take medical histories and conduct physical associates (AAs) support surgery teams and are a much smaller are now more than 3,000 PAs and AAs in England but the NHS workforce plan envisages that increasing to 12,000 by PAs and AAs have to complete a two-year postgraduate course. To be eligible they need to have either a science-related undergraduate degree or be a registered healthcare professional Academy of Medical Royal Colleges said there was a growing campaign against their use, fuelled by unsubstantiated claims on social media. It requested an independent review to set out the jobs they can safely and AAs have been regulated by the General Medical Council, the body which also regulates doctors, since December training takes many years longer, and anti-social hours and exams are a regular British Medical Association has said PAs and AAs were being asked to do tasks they were not meant to do and the lines with doctors were getting blurred. Dr Emma Runswick, from the BMA, says the name change to physician assistants is "positive" but doctors haven't got everything they wanted and more still needs to be done."Patients can know who they are seeing, but it does not make the key changes that we are looking for in terms of setting out what they can and cannot do.""But we would be a fool to say that it wasn't some progress."Dr Hilary Williams, incoming vice president of the Royal College of Physicians, said the review was "thoughtful" and "thorough", and showed that "reform is urgently needed" to ensure safe teamworking in the NHS.
Daily Mail
4 days ago
- Health
- Daily Mail
Six patient deaths linked to NHS using less qualified physician associates as substitute for doctors, government-ordered review reveals
Physician associates should be banned from seeing patients who have not been reviewed by a doctor to cut the risk of 'catastrophic' harm, a government-ordered review says. Their job title should also be changed to physician assistant to reflect the fact they are supposed to support doctors rather than replace them, it adds. More than 3,500 PAs work in the NHS and there have been previous calls for an expansion in their number. But health secretary Wes Streeting ordered a review last November amid concerns they are being inappropriately used as substitutes for doctors, despite having significantly less training. There have also been a number of high profile deaths of patients who had been misdiagnosed by PAs - sometimes unaware they had not seen a doctor. Professor Gillian Leng, president of the Royal Society of Medicine, was commissioned to lead the review into the safety of the roles and how they can be effectively integrated into a multidisciplinary healthcare team. Presenting her findings yesterday, she said she hopes her report will bring some 'perspective' to what has become a 'heated debate', with some doctors expressing fierce opposition to PAs. Trainee doctors in particular are angry that PAs can earn more than them, work more sociable hours and take some of their training opportunities. Professor Leng acknowledged PAs have been used to plug gaps on doctors' rotas and called for major changes to how they work and are supervised. This includes a requirement to work in a hospital for at least two years before being allowed to practice in a GP surgery or mental health trust and a need to have a named senior doctor as a line manager. PAs must be clearly identifiable from a doctor, using 'standardised measures', such as national clothing, lanyards and name badges, she added. But Professor Leng also called for their scope of practice to be widened with some PAs allowed to prescribe medicines, order MRI scans and train to become more highly paid 'advanced' PAs. She said: 'Crucially I'm recommending that PAs should not see undifferentiated or untriaged patients. 'If (patients) are triaged, they (PAs) should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs.' She said more detail was needed on which patients can be seen by PAs and national clinical protocols should be developed in this area. She added: 'Let's be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients.' Professor Leng recommended PAs should be renamed 'physician assistants' to position them 'as a supportive, complementary member of the medical team', while the 100 anaesthesia associates (AAs) working in the NHS should be renamed 'physician assistants in anaesthesia'. Six patient deaths linked to contact with PAs have been recorded by coroners in England. One high-profile death involved Emily Chesterton, 30, who died from a pulmonary embolism. She was misdiagnosed by a PA on two occasions and told she had anxiety. The Leng Review said safety concerns in relation to PAs were 'almost always about making a diagnosis and deciding the initial treatment, particularly in primary care or the emergency department, where patients first present with new symptoms'. It added: 'It is here that the risk of missing an unusual disease or condition is highest, and where the more extensive training of doctors across a breadth of specialties is important. 'Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.' Despite the shorter two years of training for PAs, where local NHS services have struggled with filling roles, 'the easy option in some cases was simply to fill gaps in medical rotas with PAs', the report went on. 'This seems to have been done without taking into account the more limited training of the PAs and how the roles would interact, other than with the caveat that they would be supervised by doctors. 'This lack of planning may have been responsible for driving the resentment felt by some resident (doctors) and potentially exposed patients to unnecessary risk.' When it comes to the safety of PAs and AAs, Professor Leng said the 'evidence is poor', with 'no compelling evidence' in published research 'that PAs were safe to work as doctor substitutes in primary care'. She also said the evidence was poor when it came to cost effectiveness. When it came to AAs, there were questions over whether the role was actually needed as fully qualified anaesthetists already face tough competition to find a job. Professor Leng, who spoke to around 1,000 people, concluded: 'I could be absolutely clear that the roles are not so unsafe that they have to be discontinued, but neither does the evidence support proceeding with no change.' PAs only have to complete a two year postgraduate course, rather than a medical degree. Some PA courses let students join after studying geography, human resources or English literature. Dr Tom Dolphin, chair of BMA council, said the review 'laid bare the catastrophic failures in NHS leadership that have put patients at serious risk of harm' but said its recommendations 'do not adequately protect patients'. 'A major opportunity has been missed to end the postcode lottery of what PAs can and can't do,' Dr Dolphin added. 'By failing to recommend authoritative, nationally-agreed scopes of practice, Professor Leng has ignored the most urgent demand of the medical profession, and left patients at the mercy of local decisions by employers who can still choose where and how assistants can work.' Dr Dolphin also urged the Government and employers 'not to waste any time' in renaming PAs 'physician assistants', as recommended by the review. The government is expected to respond to the review in a written ministerial statement to Parliament today.
