Doctors to supervise physician associates

Telegraph

16-07-2025

Doctors will be hauled off the front line so they can supervise physician associates.
Wes Streeting, the Health Minister, has accepted in full the recommendations of a review into physician associates who will have their titles changed to physician assistants (PAs) going forward.
One of the 18 recommendations is to make sure doctors are properly trained in supervising PAs and have enough time to do it.
Some doctors have argued that allocating time to oversee the work of PAs will take away from the time they can spend treating patients themselves.
The government-commissioned review, led by Professor Gillian Leng, president of the Royal Society of Medicine, also said PAs should be banned from diagnosing patients who have not seen a doctor, such as the GP or in A&E, where results of a `.
As well as changing the job title of the 3,500 PAs in the NHS, Mr Streeting has accepted recommendations to make it clearer which staff are which.
The review proposed giving all NHS staff their own uniforms and lanyards that clearly state their job, because of a tendency for PAs to wear doctors' scrubs and stethoscopes.
Concerns ignored for too long
Mr Streeting said: 'Patients should always know who they are being treated by and should always receive appropriate care.
'Legitimate concerns about patient safety have been ignored for too long,' he 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.'
He said physician assistants 'should assist doctors, but they should never used to replace doctors'.
Mr Streeting ordered the review in 2024 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 also criticised NHS plans to increase the number of PAs to more than 10,000 as an attempt to replace them, and some feel that the review hasn't gone far enough to stop this.
Prof Leng said it was just the 'start of the conversation' and the opportunity for a 'reset'.
PAs have no medical degree and must only undergo a two-year postgraduate course following a science undergraduate degree.
Prof Leng and her team reviewed six prevention of future death reports issued by coroners that directly linked the role of a PA to the cause of a patient's death. They spoke to the family members of three of the deceased as part of discussions with more than 1,000 healthcare professionals, patients and other parties.
The report found that there was a lack of evidence that the PA role was either safe or effective, echoing the findings of a University of Oxford review earlier in 2024.
Prof Leng said the lack of a 'clear answer' from existing research meant she had to draw on the perspectives and insights of a range of material and experts, including those from other countries where the profession exists.
'The roles are not so unsafe that they have to be discontinued, but neither does the evidence support proceeding with no change,' she said.
One of the 'crucial' changes recommended is for PAs to be banned from seeing patients presenting at the GP or A&E for the first time.
Risk missing a condition
'PAs should not see undifferentiated or untriaged patients,' she said. 'Moving forwards, we need to provide more detail on what patients can appropriately be seen by PAs.'
However, setting this out will be the responsibility of the Department of Health, NHS and Royal Colleges, to work through.
The report said the 'safety concerns raised in relation to PAs were almost always about making a diagnosis and deciding the initial treatment '.
It said that in GP surgeries and A&Es where patients often arrive with new symptoms that 'the risk of missing an unusual disease or condition is highest'.
'Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic,' Prof Leng said. 'This was frequently flagged as the principal risk of PAs seeing undifferentiated patients.'
Dr Claire Fuller, co-national medical director at NHS England, said: 'Following legitimate concerns raised, it is right this review has gathered expert insight and evidence from across the health service and internationally.
'We will now work with the service and Government to fully consider and implement its recommendations.'