How doctors fear unregulated physician associates in the NHS pose risk to patients
NINE out of ten doctors have rejected plans to increase the use of physician associates in the NHS, with 87 per cent fearing they pose a risk to patients.
And a British Medical Association survey this week found that there is widespread confusion among the general public about their role.
Today Sun on Sunday Health explains what they are and how likely you are to see them, and examines why they are cause for concern.
Physician associates are unregulated healthcare professionals being used to plug the staffing shortage in the NHS.
There are currently around 1,500 PAs working in hospitals and 1,700 in general practice.
They can treat patients, review test results and carry out physical examinations — but they have done only a fraction of the training that GPs have and in a BMA survey almost 90 per cent of doctors this week branded them a risk to patients.
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Cases of life-threatening illness and even a death have been reported after signs were missed by a PA.
Dr Partha Kar, a diabetes specialist, recently said that the rollout of physician associates had been “an unqualified mess”.
He warned: “Leaving the scope of these roles vague has meant individual NHS trusts and GP surgeries have used them as they see fit, which is questionable at best and dangerous at worst.”
Sun on Sunday Health’s Dr Jeff said: “Even the best PAs are not doctors. And they are not regulated, so if they make a mistake they cannot be ‘struck off’ or forbidden from working.”
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PAs meet with patients and make decisions alone but they have to work as part of a bigger team, under supervision of a senior doctor, consultant or GP at the hospital or surgery.
They are sometimes the first contact for someone calling their local practice or can work with hospital consultants to treat patients including in A&E.
Dr Jeff added: “They don’t have medical degrees and their two-year period of training — a quarter of the time it takes to train as a GP on average — means their scope of practice is very limited.
“There have also been concerns raised that PAs do not always identify who they are or fully explain what their role is when first seeing patients.
"This can lead to higher levels of patient dissatisfaction with the NHS and a greater chance of serious medical mistakes.”
But they can be useful for tackling more minor conditions, Dr Jeff says.
He added: “PAs are cheaper than doctors and can do many of the simple day-to-day jobs of a doctor, dealing with simple complaints such as a common cold or a urinary tract infection, freeing up GPs and consultants for more complex matters.”
Health chiefs first introduced physician associates in 2004.
The Government now wants to expand the number working to 10,000 in a decade — but 87 per cent of doctors believe it poses a risk to patients.
This week’s BMA survey also found that 57 per cent of people using the NHS had never heard of them and 29 per cent were unsure if they had been treated by one.
New guidance from NHS England, issued in October, instructs PAs to introduce themselves and their role to patients so that they know they’re not a doctor.
Dr Jeff explained: “PAs are an inevitable consequence of a failing medical system.
“We have increasing patient demand, health expectations and medical costs and we have seen, year after year, real-terms pay cuts for doctors, declining working conditions and a feeling of general animosity toward doctors and GPs in particular.
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“PAs have an important role to play but it is essential that their roles are clearly defined and that patients and other clinicians are aware of their abilities and limitations.
“We have to be mindful not to impart too much responsibility or expectation on a brand-new healthcare profession that has less training than the average medical student has before they’ve even finished medical school.”
Q&A by Dr Jeff
TEN QUICK QUESTIONS ABOUT NHS PHYSICIAN ASSOCIATES, ANSWERED BY DR JEFF
What can they do?
They can ask patients about their symptoms, carry out physical examinations, deal with test results and discuss treatments.
What can’t they do?
They cannot request tests or prescribe medication.
Are they in every GP practice and hospital?
Not yet.
Do I have to see one?
You can request to see any healthcare professional you want but you might have to wait longer to see the doctor of your choice if you decline to see a PA.
How do you know if you’re seeing a PA or a doctor?
Whoever is seeing you should identify who they are and what their job is at the start of any consultation. Guidance from the Faculty of Physician Associates states that PAs should inform you they are not a doctor.
If there is any confusion then you should ask for clarity on the medical professional’s name and role.
Are they the same as advanced care practitioners?
No. ACPs tend to be already established nurses, paramedics or other experienced healthcare practitioners.
They undergo a more challenging masters-level training.
How long do PAs train for?
They complete a two-year postgraduate degree.
Many already have healthcare-related degrees but not in medicine.
How long does a GP train for?
Five years in medical school, followed by two years’ junior training then three years’ specialty training if they choose to specialise.
How much do PAs get paid?
The average salary is £43,700 but there are reports of them being paid up to £90,000 to plug staff shortages in London, which is three times the average junior doctor salary.