Latest news with #Gillian Leng
Telegraph
5 days ago
- Health
- Telegraph
Doctors to supervise physician associates
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.'
The Guardian
6 days ago
- Health
- The Guardian
NHS physician associates should not diagnose untriaged patients, review finds
NHS physician associates should be banned from diagnosing patients who have not already been seen by a doctor, a government review has concluded. The review calls for the government to overhaul the role of physician associates (PAs), who it says have been substituted in for doctors to fill staffing gaps despite having significantly less training. The health secretary, Wes Streeting, ordered the review of the more than 3,500 PAs and 100 anaesthesia associates (AAs) working in the NHS after six high-profile deaths of patients who were misdiagnosed by PAs. Prof Gillian Leng, the president of the Royal Society of Medicine, spoke to more than 1,000 people for the review and concluded there were 'no convincing reasons to abolish the roles of AA or PA' but there was also no case 'for continuing with the roles unchanged'. She wrote in the report: 'Despite the significantly shorter training, PAs and to a lesser extent AAs have sometimes been used to fill roles designed for doctors. The rationale for doing this is unclear, and was probably one of pragmatism and practicality, relying on medical staff to provide the additional expertise when required. 'This lack of planning may have been responsible for driving the resentment felt by some resident [doctors] and potentially exposed patients to unnecessary risk.' One of her main recommendations is that PAs should not see 'undifferentiated or untriaged patients', meaning those who have not yet been diagnosed by a doctor. Leng recommended further work to establish which patients they should be able to see and to set clinical protocols that would enable PAs to diagnose patients with mild ailments. '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,' she said. Leng recommended PAs should be renamed 'physician assistants' and AAs 'physician assistants in anaesthesia' to ensure that patients and their families are clear on whether they have been seen by a doctor. She observed that this confusion was the core concern voiced by the bereaved families she had spoken to, who believed it was a contributing factor in their loved ones' death. She noted in her report that despite the role's rapid expansion since it was introduced in the early 2000s, there was limited data and evidence on whether PAs were safe or unsafe. Most concerns related to PAs being the first clinician to see patients unsupervised. 'Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic,' she said. The report found that 'relatively few doctors felt it was appropriate for PAs to diagnose illness' and it identified disparities between the tasks PAs considered right for them to carry out and what doctors thought. Leng recommended that newly qualified PAs work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts, enabling them to start their careers where there are more training opportunities and supervision. She also recommended more leadership training for doctors, who shared concerns about the lack of preparation for supervision duties, and better career development for PAs and AAs. She suggested a named doctor supervise each PA, while uniforms, lanyards, badges and staff information should be standardised to 'distinguish physician assistants from doctors'. Dr Tom Dolphin, the chair of the British Medical Association, said the report 'laid bare the catastrophic failures in NHS leadership that have put patients at serious risk of harm', but he argued the recommendations did not go far enough on national patient safety standards. 'Prof Leng has succeeded in exposing how NHS England introduced these roles and encouraged their expansion without any robust evidence of their safety,' he said. 'The report reveals inadequate national leadership, no accountability and no attempt to listen to the concerns raised by doctors, patients and coroners. 'The blurring of lines between doctors and non-doctors, aided and abetted by the GMC [General Medical Council], has been an unfolding disaster for all to see, and many doctors today will be relieved to see that they were right to raise the alarm,' Dolphin said. Dr Naru Narayanan, the president of the hospital doctors' union, the HSCA, said: 'Safety concerns will continue until a properly defined national scope is established. The review acknowledges this by calling for standardised job descriptions and clinical protocols. This work needs to be fast-tracked. 'Given how poorly these roles have been defined, and the fact physician assistants earn more after a couple of years of clinical training than resident doctors do after nearly a decade in medicine, it's not surprising there's been tension. We've got a shortage of medical training places and a limited supply of trainers. Additional support and time for senior doctors, as recommended by Prof Leng, are essential.'
