An independent review suggests that Physician Associates (PAs) and Anaesthesia Associates (AAs), who support doctors in GP surgeries and hospitals, should be referred to as “assistants” to prevent patient confusion. The review proposes that PAs and AAs should wear standardized attire and badges for easy identification, and they should only interact with patients under specific conditions.
Health Secretary Wes Streeting announced the government’s acceptance of all recommendations from the review, which was initiated following a contentious debate. While the British Medical Association (BMA) felt that the recommendations did not go far enough, the union representing PAs and AAs expressed concerns that the proposals might lead to longer waiting lists.
Professor Gillian Leng, the author of the review, conducted consultations with doctors, patients, and the public to gather insights on the safety and efficacy of PAs’ and AAs’ roles. She highlighted that when these roles were introduced in 2000, there was a lack of a clear vision and no national strategy in place for integrating these new positions into existing healthcare teams. This resulted in confusion regarding their responsibilities.
Furthermore, Prof. Leng emphasized that in instances where local services faced capacity constraints, PAs sometimes filled in medical gaps without adequate training or supervision. She also listened to families of individuals who had unfortunate experiences after being treated by PAs under mistaken beliefs about their qualifications.
The review underscored that concerns related to PAs often revolved around diagnostic accuracy and initial treatment decisions. It stressed the importance of minimizing risks associated with overlooking uncommon diseases or conditions during patient care.
In one tragic case highlighted in the review, Emily Chesterton was misdiagnosed by a PA, leading to her untimely death from a blood clot at age 30. Another incident involved Susan Pollitt, whose health deteriorated due to an error made by a PA while she was being treated in a hospital.
The review puts forward several recommendations for physician associates, including renaming them “physician assistants” to better reflect their supportive role within medical teams. Additionally, it suggests that PAs should not see new patients until they have been assessed as having minor ailments, should have substantial hospital experience before working in certain settings, and should operate under senior doctor supervision. It also advises clear differentiation through badges and attire to distinguish them from doctors.
Moreover, anaesthesia associates are recommended to be named “physician assistants in anaesthesia” or PAAs. Patients are encouraged to receive comprehensive information about the role of PAs while establishing standards for training through a dedicated faculty representing PAs.
Mr. Streeting affirmed his confidence in the qualifications of those treating patients post-implementation of these recommendations. He emphasized that Physician Assistants play an essential role within the NHS but should complement doctors rather than replace them.
Introduced in the early 2000s to alleviate doctors’ workloads within the NHS, both Physician Associates (PAs) and Anaesthesia Associates (AAs) have faced scrutiny over safety concerns, role ambiguity, and impacts on junior medical staff training.
PAs are authorized to conduct medical history assessments and physical examinations but are not permitted to prescribe medications. On the other hand, AAs provide support to surgical teams but constitute a smaller group compared to PAs.
With over 3,000 PAs and AAs currently operating in England, projections suggest this number could increase significantly by 2036 according to NHS workforce plans. Prospective PAs and AAs must complete a two-year postgraduate course and hold either a science-related undergraduate degree or be registered healthcare professionals.
Regulated by the General Medical Council since December 2024 – similar to doctors – concerns have been raised about potential overlaps between their responsibilities with those of doctors within healthcare settings.
While some groups have voiced opposition against employing PAs and AAs for tasks beyond their intended scope amid growing social media campaigns casting doubt over their abilities.
The report noted ongoing discussions within medical circles regarding defining clear boundaries for their roles within healthcare teams while acknowledging that further reforms are necessary to ensure effective collaboration across all medical professionals working within the NHS.