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Sky News
2 days ago
- Health
- Sky News
Family of woman who died after misdiagnosis by 'substitute doctor' criticise govt review
Why you can trust Sky News The parents of a woman who died after her blood clot was misdiagnosed by someone who she thought was a doctor have called a government-ordered review "a missed opportunity". Marion and Brendan Chesterton have welcomed many of the recommendations in Professor Gillian Leng's review of the role that physician associates (PAs) perform in the NHS, but say "they don't go far enough". Emily died in November 2022 after suffering a pulmonary embolism. She went to see her GP twice in the weeks before her death - and on both occasions was seen by a physician associate who missed the blood clot and instead prescribed propranolol for anxiety. She had told her worried parents that she had been seen by a doctor, but she had not. Her father Brendan told Sky News: "If she come out and said I've seen someone called the physician's associate I'm sure we would have insisted that, you know, let's go back and insist that you see a doctor. She never knew." Now a government-ordered review led by Prof Leng, president of the Royal Society of Medicine, has recommended NHS physician associates should be banned from diagnosing patients who have not already had contact with a doctor for their illness. The report suggests a major change to the role of PAs after it acknowledged they have been used as substitutes for doctors, despite having significantly less training. More than 3,500 PAs and 100 anaesthesia associates (AAs) are working in the NHS and there have been previous calls for an expansion in their number. But a general lack of support for the roles from the medical profession - plus high-profile deaths of patients who were misdiagnosed by PAs - led Health Secretary Wes Streeting to order a review. Presenting her findings, Prof Leng said: "Crucially I'm recommending that PAs should not see undifferentiated or untriaged patients. "If (patients) are triaged, they (PAs) should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs." She said more detail was needed on which patients can be seen by PAs and national clinical protocols should be developed in this area. She added: "Let's be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients." Prof Leng also recommended PAs should be renamed "physician assistants" to position them "as a supportive, complementary member of the medical team" - and have standardised uniforms to distinguish them from doctors - while AAs should be renamed "physician assistants in anaesthesia". Newly qualified PAs should also work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts. The report said that while research suggests patients are satisfied after seeing a PA, some did not know they were not seeing a doctor. Prof Leng concluded there were "no convincing reasons to abolish the roles of AA or PA", but there is also no case "for continuing with the roles unchanged". She recommended that both PAs and AAs should have the opportunity for ongoing training and development, with potential to prescribe medicines in the future, and they should also have the opportunity to become an "advanced" PA or AA. Six patient deaths linked to contact with PAs have been recorded by coroners in England. Emily's mother Marion said some of the review's findings were significant and her daughter would still be alive if the recommendations had been in place when she fell ill. She said: "I think so, yes, which is so important, which is why we're so pleased that this review has been made." But Mrs Chesterton added that more could have done, including stopping all PAs from prescribing drugs. "We feel it's a missed opportunity. It could have gone all the way there and cleared things up totally. Our daughter died. She was prescribed a drug that she should not have been prescribed. And it had absolutely catastrophic circumstances. She died for goodness sake." The Chestertons' concerns are shared by the British Medical Association (BMA). Dr Emma Runswick, BMA's deputy chair, said: "It is definitely a problem that the roles of doctors and now physician assistants has been blurred and it's positive that their name is going to change, that there will be a uniform. "But whilst they continue to be deployed in a way that mimics doctors at the behest of any local employer decision, we have to have ongoing concerns about their safety." But UMAPs, the trade union which represents both PAs and AAs, has warned the changes will undermine their qualifications and their role, lengthen waiting lists and worsen the impact of any strike action. "By trying to placate them, at a time when they're striking - and they want their strikes to bite the hardest by taking us out of the workforce - we're now putting patients at risk," said Steve Nash, general secretary of UMAPs. "I think the biggest patient safety risk, out there right now, is the BMA," he added.
BBC News
14-05-2025
- Health
- BBC News
Emily Chesterton: GMC at High Court over physician associate role
A legal challenge will be heard at the Royal Courts of Justice later on Wednesday about the role of physician associates (PA) in the case has been brought against the General Medical Council (GMC) by retired teachers Brendan and Marion Chesterton, whose daughter Emily died in 2022 after a blood clot was missed in two appointments with a with Anaesthetics United, they are seeking more clarity from the GMC about the scope of the PA role in a bid to improve patient safety amid increasing concern about how PAs and anaesthetic associates (AA) are being deployed in healthcare GMC took over the regulation of physician associates and anaesthetic associates in December. What do physician associates do? Physician associates and anaesthetic associates started working in the NHS in 2003, and it is thought it currently employs more than 5,000 of and AAs qualify after completing a part-funded two-year master's degree. They usually need a bioscience-related undergraduate degree, but that is not always a role includes taking medical histories, conducting physical examinations and developing treatment plans. They are not authorised to prescribe medicines nor to order scans involving ionising radiation, such as X-rays or CT scans. They work as part of a multidisciplinary team with supervision from a named senior doctor. When the government appointed the GMC to regulate PAs and AAs last year, the regulatory body's chief executive Charlie Massey said it would help to ensure they "have the necessary education and training, meet our standards, and can be held to account if serious concerns are raised". 'No more Emilys' Ms Chesterton, from Salford, died after a blood clot was missed in two appointments with a PA whom she had believed was a GP. She was 30 years was seen by the physician associate after she called her GP practice, in Crouch End in north London, complaining of pain in her calf, which had become hard. The PA recommended Ms Chesterton should take her condition became worse. Mrs Chesterton told the BBC that her daughter had "difficulty walking" and "was breathless and lightheaded".She said: "In the second appointment, the PA diagnosed her with a calf sprain, long Covid and anxiety. The PA did not examine Emily's calves, and did not make it clear that she was not a doctor."Ms Chesterton had a blood clot in her left leg, which led to her dying of a pulmonary coroner's conclusion was that she "should have been immediately referred to a hospital emergency unit" and, if she had been seen, it was likely that she would have Chesterton told the BBC: "To lose a child is so very painful. It is not the right order of this world." She added that she hoped the High Court case would mean there will be "no more Emilys". How does GMC regulation work? Government legislation governing PA and AA regulation means GMC registration will not become a legal requirement for PAs and AAs to be able to practise until December that point it will be an offence to practise either role in the UK without registration.A GMC spokesperson said: "Regulation will help to assure patients, colleagues and employers that they are safe to practise and can be held to account if serious concerns are raised."To register with us, physician associates and anaesthesia associates need to show that they have the knowledge, skills and experience to treat patients safely, and that there are no outstanding concerns about their fitness to practise."The GMC said it strongly encouraged those who were not already registered to ensure they do so. There are currently 2,479 physician associates and 109 anaesthetics associates registered with the January, the secretary of state for health and social care started an independent review of the PA and AA roles "to agree recommendations for the future". The Leng review states it will consider "the safety of the roles and their contribution to multidisciplinary healthcare teams". United Medical Associate Professionals (UMAPs), a trade union set up in 2023 to represent PAs and AAs, said in a statement: "We would like to acknowledge the strength and resolve of the Chesterton family. Whilst we may not agree with all of the public positions that have emerged around their case, we admire their determination at a time of profound personal grief."The statement added that PAs were "highly trained healthcare professionals", many of whom had previously held senior roles as nurses, pharmacists or within the clinical continued: "The current judicial review brought by Anaesthetists United against the GMC is of concern, not only because it seeks to impose disproportionately restrictive scope-of-practice conditions on one profession alone, but because, if successful, it would set a dangerous precedent for regulating all clinicians through rigid, written scopes." Mrs Chesterton told the BBC that when she found out her daughter had been seen by a physician associate, she did not know what one was. She said: "To lose a child is absolutely devastating, but to find out your child's death was preventable is heart-breaking."Ms Chesterton's father Brendan said: "It's against protocol that Emily was seen twice by a physician associate for the same issue, and she shouldn't have been prescribing."Her GP surgery, The Vale Practice, told the BBC it was "deeply saddened" by Ms Chesterton's death, and said it now only provided appointments with GPs, nurses and pharmacists after a "thorough" added that staff had been told to ensure that "a patient understands their role at the start of each appointment". 'They should recognise their responsibility' The Chestertons told the BBC that since the GMC took over regulation, the scope of the PA role had not become clearer, despite them being told by the body that "supervision would be more defined".The GMC has said it is not appropriate for it to provide advice on how individual PAs and AAs might develop their skills over time. It said this was "a matter for employers and will vary depending on the clinical context and workforce needs". "We would expect employers to be aware of - and have regard to - relevant guidance on scope of practice produced by the royal colleges and other professional bodies when they are making decisions about deployment." A Department of Health and Social Care spokesperson said: "This is a tragic case and our thoughts are with Emily Chesterton's family and friends."The secretary of state has launched an independent review into [the] physician and anaesthesia associate professions to establish the facts and make sure we get the right people in the right places, providing the right care."Regulation of PAs and AAs by the General Medical Council began in December 2024 to ensure patient safety and professional accountability."For Mrs Chesterton, what she and her husband would like to see happen is straightforward."What we want them (the GMC) to do is to recognise their responsibility," she told BBC London. "They were assigned by Parliament to regulate, so that's what they should be doing and not passing it down to employers."They should be creating a proper scope of practice with a defined structure for supervision for patient safety, so there are no more Emilys."
