A review into the rise of lower qualified NHS healthcare workers has set alarm bells ringing about patient safety.
The number of Physician Associates (PAs) and Anaesthesia Associates (AAs), who help doctors, are in the process of being rapidly expanded - but the British Medical Association (BMA) has voiced concerns that the lines with doctors are getting blurred.
The review, launched by Health and Social Care Secretary Wes Streeting, will seek evidence from a range of voices - including patients, employers within the NHS, professional bodies and academics. It is being led by Professor Gillian Leng CBE, a former chief executive of the NHS drugs advisory body, the National Institute for Health and Care Excellence, and will look at how PAs and AAs are being deployed and the safeguards needed moving forward.
PAs can work in GP surgeries and hospitals. They can order some scans, take medical histories and conduct physical examinations. AAs, which support surgery teams, are a much smaller group.
Concerns have continued to mount after the tragic death of 77-year-old Susan Pollitt at Royal Oldham Hospital.
The inquest into her death concluded it had been caused by an "unnecessary medical procedure contributed to by neglect". She received treatment from a PA alongside other staff.
Following Mrs Pollitt’s inquest in November last year, coroner Joanne Kearsley warned about the use of PAs. She said there was a lack of regulation and national framework covering training, supervision and competency, and limited understanding and awareness about the role among both patients and other NHS staff. She also said the lack of a distinct uniform and the title "physician" was giving rise to confusion as to whether the practitioner is a doctor.
Adrian Mullen, Partner at Hilary Meredith Solicitors, previously worked in cardiology at some of London’s leading hospitals, before he transferred to law and becoming a solicitor specialising in clinical negligence claims.
Sharing his thoughts, Adrian said: "The PA role is not new in the NHS - it has been around for 20 years.
"What has changed is the speed at which they are being recruited - over the last seven years the numbers have gone from a few hundred to 3,500 currently with a target of 12,000, including AAs, by 2036.
"While it is seen a solution to the chronic shortage of suitably qualified healthcare professionals, doctors themselves have become concerned the lines between professions are getting blurred.
“Despite having 'physician' in their title, physician associates are not doctors. They have around two years of training compared to the ten years of an average fully qualified GP.”
Continued Adrian: "If patients feel they have suffered an adverse outcome or injury they should raise a complaint with their Trust or GP informally in the first instance. If they do not get a satisfactory answer to their complaint, they should escalate this to a formal complaint.”
At which point should patients or the families consider taking legal advice?
“If patients feel they have suffered harm or an adverse outcome, they can contact solicitors to see if they can assist in investigating whether a clinical negligence claim may arise,” added Adrian.
“They can do this at the same time as raising a complaint informally or formally with the Trust or GP but they must be mindful of any limitation date that may be fast approaching.
“If a coroner has ordered an inquest, then we recommend seeking legal advice at the earliest opportunity to assist in possible representation at the hearing for the family and dependents of the deceased."
Concluded Adrian: "There is a very valid debate to be had about whether AAs and PAs are an appropriate use of taxpayers' funds or whether it is healthcare on the cheap at the expense of patient safety. We are asking our clients and the wider public to share their experiences, positive or otherwise.”
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