Physician associates accused of illegally prescribing drugs and missing diagnoses
Physician associates have attempted to illegally prescribe drugs at dozens of NHS trusts and missed life-threatening diagnoses, a dossier claims.
Doctors working across the country claim patients’ lives have been put at risk by physician associates (PAs) who they say have failed to respond appropriately to medical emergencies – alleging more than 70 instances of patient harm and “near misses”.
The Telegraph has seen responses from more than 600 doctors to a survey on PAs run by Doctors’ Association UK (DAUK), a campaign group.
The data suggest that at over half of England’s hospital trusts, doctors are being replaced by PAs on the rota, despite associates only completing a two-year postgraduate course and having no legal right to prescribe.
A spokesperson from the Department of Health said their role “is to support doctors, not replace them”.
Missed diagnoses
This Telegraph has interviewed more than a dozen surveyed doctors, as well as other clinicians worried about patient safety.
At Dudley Group NHS Trust, one junior doctor said a PA had missed an “obvious heart attack” on an ECG, having “just signed it as if it was normal”.
A clinician in primary care alleged PAs repeatedly misdiagnosed a patient’s metastatic cancer as muscle ache – despite blood results that were “tantamount” to a cancer diagnosis.
They said: “The patient could have been saved eight months of pain; their life could have been prolonged.”
Scrutiny of the role has intensified since last July when a coroner attributed the death of 30-year-old Emily Chesterton to the failings of the physician associate she consulted.
But this dossier is the first indication of the potential scale of the problem.
Several peers, including Lord Lansley, the former health secretary, have voiced concern at The Telegraphs’s findings, with two members intending to raise them in Parliament.
The British Medical Association (BMA) said ministers’ plan to regulate PAs alongside doctors is “dangerous”, but that there is “still time” to stop it.
Surveyed doctors at 24 trusts in England claim to have witnessed associates prescribing medications and requesting X-rays that use ‘ionising radiation’ – both of which would be illegal.
And at a third of hospital trusts, doctors report seeing PAs introduce themselves as ‘doctor’, or not correct those who wrongly identify them as such.
Dr Matt Kneale, DAUK’s co-chair, said: “Despite being introduced to alleviate the burden on doctors, the survey reveals that PAs have done the opposite.”
After the Commons approved draft legislation to enable the General Medical Council (GMC) to regulate PAs last Monday, campaigning doctors are calling for a last-minute intervention from peers.
Citing patient safety concerns, they want the order amended so PAs are regulated by the Health and Care Professions Council (HCPC) responsible for physiotherapists and paramedics.
Baronesses Foster of Oxton and Fox of Buckley both said they would raise The Telegraph’s revelations on Feb 6, when the statutory instrument is put to the Lords.
Baroness Foster said the dossier was further evidence that PAs “should not be licensed with the GMC”, while Baroness Fox said it showed the legislative change was “much bigger than [ministers] are letting on”.
‘Assistant vs associate’
Lord Lansley proposed reverting to physician assistant as a title, as it better indicated to patients that a PA is “in a supervised position, rather than the clinician responsible for their care.”
At Birmingham Children’s Hospital, a junior doctor told the newspaper they felt “very unsafe” when one of just four doctors covering inpatient wards at night was replaced by a PA.
“We are talking about the sickest of the sickest children who have had major cardiac surgeries, multi-organ transplants,” said the doctor, who separately alleged having to physically intervene to prevent an associate from writing a prescription.
The children’s hospital confirmed that PAs are on the doctors’ rota, but said it will investigate the claim of attempted prescription misuse.
A clinician at Dudley Group NHS Trust also expressed fury over a PA using their GMC credentials to prescribe: “When I confronted him he said, ‘Well, you’re going to sign it for me anyways’.”
BMA chair Professor Phil Banfield said: “Regulating doctors and non-doctors together is potentially dangerous, as it increases the risk of patients mistakenly believing PA care equals doctor expertise. It does not.
“It is shameful for this fundamental change to patient care to have been carried out by a legislative back door, but there is still time to stop it.”
The Department for Health and Social Care (DHSC) said that “patient safety is paramount, and while these incidents are rare, any harm caused is unacceptable”.
They added that regulation will “boost patient safety” and the GMC would “operate strict fitness-to-practice procedures and set education and training standards.”
Both NHS and DHSC spokespeople said PAs should work with appropriate supervision and within their scope of practice, which excludes prescribing.
As horrified as I am at the content, I’m thrilled that this is finally being published.
Non doctors cant doctor? Who the fuck would have thought that!? Wonder who’s bright idea it was to introduce these PAs as a thing in health boards? I’d ask myself this before we go to the polling stations by the end of the year.
The government is hell bent on destroying healthcare in this country. No wonder British doctors are leaving for greener pastures.
They refuse to pay us more but will happily spend money on employing a variety of charlatans and doctors from red list countries (e.g. Nigeria)
[deleted]
I used to think this was a good thing. The suffering seems to have outweighed the benefits, there’s ample evidence suggesting that this doesn’t work and that the entire role needs to be completely reworked or scrapped.
Totally agree. No GP has ever made a mistake or purposefully murdered loads of people….
I might catch flak for this but medicine does need a change, and ‘physician associates’ or at the very least the level of needs to be in place.
The problem, including what’s being highlighted here, is that it’s so I’ll defined, that physician associates are being used interchangeably with doctor.
Right now, for your long term health to be taken care of by someone else through the healthcare system, you need to see a doctor, pharmacist, or the very least a nurse. All three require years of gruelling training, require decently high salaries to compensate, and are overworked.
Issue is, there is a distinct lack of these professionals, and the ones that are there are worked to the bone. Yes, a large reason is government mismanagement, but not entirely. These doctors nurses and pharmacists need adequate support staff. Staff that can do the busy work of being a doctor or pharmacist but without the final say.
IMO, medicine should follow not so much a licensing model, but more a chartership model, with more transparency and standardising. If I’m going in for a low level issue I’m ok with going to a pharmacist or doctor at a ‘fellow level’. However I want to them to be honest and transparent if I mention other symptoms that they haven’t seen before to refer me to a chartered doctor, who may refer me to a chartered specialist.
Not everything need to be seen by a doctor, we need to understand that. But these physician assistants also need to be honest with patients by telling them they aren’t licensed but they are almost certain the issue doesn’t need to go to a doctor.
8 comments
Physician associates accused of illegally prescribing drugs and missing diagnoses
Physician associates have attempted to illegally prescribe drugs at dozens of NHS trusts and missed life-threatening diagnoses, a dossier claims.
Doctors working across the country claim patients’ lives have been put at risk by physician associates (PAs) who they say have failed to respond appropriately to medical emergencies – alleging more than 70 instances of patient harm and “near misses”.
The Telegraph has seen responses from more than 600 doctors to a survey on PAs run by Doctors’ Association UK (DAUK), a campaign group.
The data suggest that at over half of England’s hospital trusts, doctors are being replaced by PAs on the rota, despite associates only completing a two-year postgraduate course and having no legal right to prescribe.
A spokesperson from the Department of Health said their role “is to support doctors, not replace them”.
Missed diagnoses
This Telegraph has interviewed more than a dozen surveyed doctors, as well as other clinicians worried about patient safety.
At Dudley Group NHS Trust, one junior doctor said a PA had missed an “obvious heart attack” on an ECG, having “just signed it as if it was normal”.
A clinician in primary care alleged PAs repeatedly misdiagnosed a patient’s metastatic cancer as muscle ache – despite blood results that were “tantamount” to a cancer diagnosis.
They said: “The patient could have been saved eight months of pain; their life could have been prolonged.”
Scrutiny of the role has intensified since last July when a coroner attributed the death of 30-year-old Emily Chesterton to the failings of the physician associate she consulted.
But this dossier is the first indication of the potential scale of the problem.
Several peers, including Lord Lansley, the former health secretary, have voiced concern at The Telegraphs’s findings, with two members intending to raise them in Parliament.
The British Medical Association (BMA) said ministers’ plan to regulate PAs alongside doctors is “dangerous”, but that there is “still time” to stop it.
Surveyed doctors at 24 trusts in England claim to have witnessed associates prescribing medications and requesting X-rays that use ‘ionising radiation’ – both of which would be illegal.
And at a third of hospital trusts, doctors report seeing PAs introduce themselves as ‘doctor’, or not correct those who wrongly identify them as such.
Dr Matt Kneale, DAUK’s co-chair, said: “Despite being introduced to alleviate the burden on doctors, the survey reveals that PAs have done the opposite.”
After the Commons approved draft legislation to enable the General Medical Council (GMC) to regulate PAs last Monday, campaigning doctors are calling for a last-minute intervention from peers.
Citing patient safety concerns, they want the order amended so PAs are regulated by the Health and Care Professions Council (HCPC) responsible for physiotherapists and paramedics.
Baronesses Foster of Oxton and Fox of Buckley both said they would raise The Telegraph’s revelations on Feb 6, when the statutory instrument is put to the Lords.
Baroness Foster said the dossier was further evidence that PAs “should not be licensed with the GMC”, while Baroness Fox said it showed the legislative change was “much bigger than [ministers] are letting on”.
‘Assistant vs associate’
Lord Lansley proposed reverting to physician assistant as a title, as it better indicated to patients that a PA is “in a supervised position, rather than the clinician responsible for their care.”
At Birmingham Children’s Hospital, a junior doctor told the newspaper they felt “very unsafe” when one of just four doctors covering inpatient wards at night was replaced by a PA.
“We are talking about the sickest of the sickest children who have had major cardiac surgeries, multi-organ transplants,” said the doctor, who separately alleged having to physically intervene to prevent an associate from writing a prescription.
The children’s hospital confirmed that PAs are on the doctors’ rota, but said it will investigate the claim of attempted prescription misuse.
A clinician at Dudley Group NHS Trust also expressed fury over a PA using their GMC credentials to prescribe: “When I confronted him he said, ‘Well, you’re going to sign it for me anyways’.”
BMA chair Professor Phil Banfield said: “Regulating doctors and non-doctors together is potentially dangerous, as it increases the risk of patients mistakenly believing PA care equals doctor expertise. It does not.
“It is shameful for this fundamental change to patient care to have been carried out by a legislative back door, but there is still time to stop it.”
The Department for Health and Social Care (DHSC) said that “patient safety is paramount, and while these incidents are rare, any harm caused is unacceptable”.
They added that regulation will “boost patient safety” and the GMC would “operate strict fitness-to-practice procedures and set education and training standards.”
Both NHS and DHSC spokespeople said PAs should work with appropriate supervision and within their scope of practice, which excludes prescribing.
As horrified as I am at the content, I’m thrilled that this is finally being published.
Non doctors cant doctor? Who the fuck would have thought that!? Wonder who’s bright idea it was to introduce these PAs as a thing in health boards? I’d ask myself this before we go to the polling stations by the end of the year.
The government is hell bent on destroying healthcare in this country. No wonder British doctors are leaving for greener pastures.
They refuse to pay us more but will happily spend money on employing a variety of charlatans and doctors from red list countries (e.g. Nigeria)
[deleted]
I used to think this was a good thing. The suffering seems to have outweighed the benefits, there’s ample evidence suggesting that this doesn’t work and that the entire role needs to be completely reworked or scrapped.
Totally agree. No GP has ever made a mistake or purposefully murdered loads of people….
I might catch flak for this but medicine does need a change, and ‘physician associates’ or at the very least the level of needs to be in place.
The problem, including what’s being highlighted here, is that it’s so I’ll defined, that physician associates are being used interchangeably with doctor.
Right now, for your long term health to be taken care of by someone else through the healthcare system, you need to see a doctor, pharmacist, or the very least a nurse. All three require years of gruelling training, require decently high salaries to compensate, and are overworked.
Issue is, there is a distinct lack of these professionals, and the ones that are there are worked to the bone. Yes, a large reason is government mismanagement, but not entirely. These doctors nurses and pharmacists need adequate support staff. Staff that can do the busy work of being a doctor or pharmacist but without the final say.
IMO, medicine should follow not so much a licensing model, but more a chartership model, with more transparency and standardising. If I’m going in for a low level issue I’m ok with going to a pharmacist or doctor at a ‘fellow level’. However I want to them to be honest and transparent if I mention other symptoms that they haven’t seen before to refer me to a chartered doctor, who may refer me to a chartered specialist.
Not everything need to be seen by a doctor, we need to understand that. But these physician assistants also need to be honest with patients by telling them they aren’t licensed but they are almost certain the issue doesn’t need to go to a doctor.