Latest news with #patientssafety
Telegraph
6 days ago
- Business
- Telegraph
Physician associates to be renamed
Physician associates are to be renamed by the NHS to clarify their role as doctors' assistants following widespread public confusion. Wes Streeting, the Health Secretary, ordered a review into the role following a series of patient safety incidents involving physician associates (PAs), which included the deaths of people who thought they had been treated by a doctor. Prof Gillian Leng, the president of the Royal Society of Medicine, is yet to write her report but it is understood changing the PA title will be a key recommendation when it is finalised later this month. Doctors have been raising concerns about the growing number of PAs in the workforce for a number of years with around 3,500 currently employed and the NHS planning to treble this within the decade. Unlike doctors, PAs have no medical degree and must only undergo a two-year postgraduate course following a non-medical undergraduate degree. They are paid more than resident doctors – formerly known as junior doctors – at the beginning of their careers, which has been a key argument from the British Medical Association (BMA) as they reballot members on strike action over pay. Mr Streeting is expected to accept Prof Leng's recommendation for a title change, with it likely to revert to a 'physician assistant', which is what the role was called when it first emerged more than 20 years ago and more accurately describes the job of assisting doctors. Mistaken identity The Telegraph has revealed a series of scandals involving PAs either causing patient harm, acting beyond what they are qualified to do or being used in place of doctors. Earlier this year, a dossier of more than 600 incidents compiled by the BMA revealed egregious examples of PAs and anaesthetist associates (AAs) misdiagnosing cancer, impersonating doctors and illegally prescribing medication and ordering scans. PAs have also been implicated in several high-profile patient deaths. Emily Chesterton, a 30-year-old actress, died in 2022 after she was misdiagnosed twice by a PA whom she thought was a GP. She was told she had an ankle sprain when she had a blood clot that later travelled from her leg to her lung and killed her. Her parents recently began a legal challenge against the General Medical Council, which regulates doctors and now associates, alongside a group called Anaesthetists United. Earlier this year, a coroner said the PA who diagnosed Pamela Marking with a nosebleed, before she died aged 77 at East Surrey Hospital in 2024, 'had a lack of understanding of the significance of abdominal pain and vomiting, and had undertaken an incomplete abdominal examination'. A Department of Health and Social Care source told the Guardian: 'It's clear there's a legitimate problem of patients not knowing who they are seen by, which is their basic right. It is likely the review will make recommendations to address this problem, including changing the titles of PAs.' A spokesman for the department said: 'The Secretary of State asked Professor Gillian Leng to produce an independent review into PAs and AAs that will provide certainty to patients and staff across the NHS. 'We will consider its findings in full once it has been completed.'
News.com.au
03-06-2025
- Business
- News.com.au
Health regulator crackdowns on cosmetic injectables industry
Healthcare regulators in Australia have brought in new guidelines for dentists and nurses who perform non-surgical cosmetic injections, aiming to safeguard the public from practitioners who prioritise profits over patient safety. On Tuesday, the Australian Health Practitioner Regulation Agency (AHPRA) released new rules requiring healthcare practitioners to undergo additional education and training before conducting cosmetic procedures such as botulinum toxin injections (Botox) and filler injections. They also introduce minimum experience requirements for nurses wishing to work with injectables, saying that they must have at least one year's full-time experience as a nurse outside of non-surgical cosmetic procedures. For years, nurses and dentists have operated in the billion-dollar cosmetic injectable industry without needing to complete any formal extra training or education before injecting patients with neurotoxins such as anti-wrinkle injections. While many practitioners in the industry operate safely and comply with existing laws, regulators have flagged rising concerns about unqualified providers and inadequate oversight in some sectors. Crackdown on influencer testimonials and ads The new changes also stipulate that advertisements for cosmetic injectables must include the details of the registered practitioner who will perform the procedures. Targeted ads directed at minors will also be banned, along with testimonials from social media influencers, who will no longer be eligible for free or discounted cosmetic injectable treatments. Justin Untersteiner, CEO of AHPRA, noted that not all cosmetic injectors would be pleased with the stricter regulations and he expected some would decide to leave the industry, according to ABC. 'There will be others who have to modify their business models and modify their practices to meet these guidelines,' he said. 'This is a growing industry and, I've got to say, what we do see in some cases is that there are people out there putting profit before patient safety.' Nurses and dentists will need to implement the changes before September to ensure they are compliant with the new rules, which are in line with those already in place for doctors. '(After that) we will be identifying those that are doing the wrong thing and we will take action where we need to,' Mr Untersteiner said. Increase in 'dodgy' Botox There has been a recent spike in cases involving unregistered practitioners and clinics using off-brand or outdated dermal fillers and anti-wrinkle injections on patients, resulting in multiple hospitalisations after patients fell ill with botulism. In January, three people were treated in intensive care for suspected botulism, a potentially fatal illness, after reportedly receiving unregulated anti-wrinkle treatments at a home. Dr Jeremy McAnulty, Executive Director of Health Protection at NSW Health, issued a health warning to those thinking about anti-wrinkle injections, highlighting the risks and side effects associated with unregulated cosmetic injections. In March, a cosmetic clinic in Sydney received a health warning due to its 'highly concerning' infection-control practices. The NSW Health Care Complaints Commission (HCCC) advised clients to undergo testing for possible exposure to bloodborne viruses, including hepatitis B, hepatitis C, and HIV. Speedy telehealth calls The new federal guidelines mark the latest action by state and federal regulators, who have been ramping up their stance on cosmetic injectable providers. Many injectable businesses across the country are operated by nurses who administer the injections, often stock prescription fillers and anti-wrinkle injections like anti-wrinkle injections on-site, and organise telehealth consultations for their patients so doctors can remotely prescribe the products. A report by The Age in March revealed that these telehealth consultations saw doctors spend as little as 52 seconds with patients before writing a script for anti-wrinkle injections and fillers. While the new guidelines don't specify how long doctors and nurses must spend talking with patients before prescribing injectables, they do state that practitioners must conduct detailed evaluations, including assessing the patient to ensure expectations are realistic. They should also discuss alternative options with patients and complete a lengthy checklist to confirm that patients have provided proper consent. Peak body for cosmetic plastic surgery in Australia responds Dr Lily Vrtik, a specialist plastic surgeon and President of the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), welcomes the change but argues that more needs to be done. 'Non-surgical cosmetic procedures are growing rapidly in popularity, yet regulation and clinical standards have not been keeping pace,' Dr Vrtik said. While ASAPS 'welcomes the call by AHPRA for the requirement of appropriate education, training, experience, and ongoing education,' they need to crack down further on Continuing Professional Development (CPD) requirements. 'CPD is a condition of health professional registration,' she explained. 'Practitioners who perform cosmetic injectable procedures should undertake regular, evidence-based training updates that are specific to cosmetic medicine and that include a strong emphasis on ethical practice. 'These new guidelines now stipulate that CPD should be in the area of their practice (i.e. cosmetic medicine), but alarmingly, there is no minimum quality standard for the CPD educational activity and no plan for enforcement.'
Irish Times
18-05-2025
- Health
- Irish Times
Oireachtas health committee must hear from HSE on Portiuncula maternity services, says Opposition
The Oireachtas health committee will need to examine and hear from Health Service Executive officials about maternity services at Portiuncula University Hospital in Co Galway , Opposition TDs have said. The Irish Times revealed last week that a further external review into maternity care at the Ballinasloe hospital has begun following the death of a baby in recent weeks. It is the 10th review to take place into the care given to women and babies at the hospital. The new Oireachtas health committee will meet for the first time on Wednesday. Sinn Féin 's health spokesperson David Cullinane said it is 'important that all of the reviews are completed and that maternity services are safe at Portiuncula'. READ MORE 'This is an important issue of patient safety, and the Oireachtas health committee will need to examine it.' Labour 's health spokesperson Marie Sherlock said the committee 'needs to hear from the HSE as to the status of those reviews'. 'Questions need to be asked now about what exactly is going on here,' she said. 'The delay in the reporting of the reviews and the addition of yet another review could certainly prompt a crisis of confidence in services at Portiuncula, which we don't want to see happen,' she said. [ Death of baby at Portiuncula Hospital leads to new review Opens in new window ] Ms Sherlock said she was 'really taken aback' when she heard 'yet another review' had to be initiated. 'Ultimately, confidence in our maternity services right across the country depends on people being updated as to what's happening when there have been successive issues in one particular maternity unit.' Nine external reviews were announced in January, after six babies delivered in 2024 and one in 2025 had hypoxic-ischaemic encephalopathy (HIE) – a reduction in the supply of blood or oxygen to a baby's brain before, during or after birth. Six of these babies were referred for neonatal therapeutic hypothermia known as neonatal cooling. Two stillbirths occurred at the hospital in 2023, the circumstances of which are also being reviewed externally. An external management team remains in place at the hospital to oversee all elements of maternity and neonatal care. Stephen McMahon, chairman of the Irish Patients Association , a patient advocacy group, said that, with 10 reviews ongoing at the hospital, the matter needs to be 'independently investigated up to and beyond the board of the HSE'. Mr McMahon said the association would like to know if there have been any formal interim reports or updates on the process. A spokesperson for Minister for Health Jennifer Carroll MacNeill said she is 'very aware of the very sad death of a baby who was recently born at Portiuncula University Hospital and that an external review has commenced'. 'She extends her deepest condolences to the family at this devastating time,' the spokesperson said. The Minister understands a number of other external reviews ongoing at the hospital are expected to be completed 'soon', the spokesperson said, adding that these reports will be shared with the families and other stakeholders, including the Minister, once complete.
ABC News
18-05-2025
- Health
- ABC News
Medicinal cannabis prescribing practices under scrutiny after scripts issued 'every 4 minutes'
Australian medical practitioners are writing scripts for high-strength medicinal cannabis products with alarming speed, raising concerns some are putting "profit over patient safety", according to the regulator. Since medicinal cannabis was legalised in 2016, the industry has exploded, with cannabis telehealth clinics fuelling a rapid increase in prescriptions of products that contain THC, the psychoactive substance that causes a "high". More Australians are accessing medicinal cannabis in smokable flower form with THC content of between 20 to 98 per cent, for conditions such as insomnia, chronic pain and anxiety. That is despite what some experts describe as "surprisingly weak" clinical trial evidence that high-strength THC products are the most suitable treatments for those conditions. New data from the Australian Health Practitioner Regulation Agency (AHPRA) revealed eight medical practitioners appeared to have issued more than 10,000 scripts each for the highest THC-strength products over a six-month period. The agency said one doctor appeared to have issued more than 17,000 scripts in six months, equivalent to a script every 4 minutes in a working day. Using multiple data sources, AHPRA's analysis also identified one pharmacist who dispensed 959,000 cannabis products in one year, which equates to more than 2,600 products per day — for 365 straight days. The data also revealed a nurse practitioner who appears to have issued 31,000 scripts over a year. AHPRA's Executive Director, Regulatory Operations, Kym Ayscough said the findings amounted to evidence some prescribers were dealing in volumes where it was "very difficult to understand how they could be meeting their professional obligations". "It does seem unusual to see those very high volumes of prescriptions and dispensing from a small number of practitioners," Ms Ayscough said. The Therapeutic Goods Administration (TGA) collates figures related to medicinal cannabis applications and approvals from doctors but the figures don't reflect the number of individual patients who ultimately received scripts. AHPRA combined data from the TGA with dispensing data from state and territory poisons regulators to find treatment was initiated for 441,000 new patients for the strongest category five cannabis products between July and December 2024. High-strength THC products are of particular concern to regulators because they are schedule eight medications like opioids and have greater risks for abuse and harm. AHPRA says the high volumes are being fuelled by a rise in telehealth prescriptions — in some cases, provided after only a brief consultation with either a doctor or a nurse. An increasing number of clinics operate a one-stop-shop model that pays the doctors who write the scripts — before selling and shipping the prescription cannabis products to patients. The system presents an obvious conflict of interest for doctors who are required to act in the best interest of patients. "It is very clear in the codes of conduct for registered practitioners that patient safety is to be their number one concern." A 7.30 investigation found multiple medicinal cannabis clinics advertise free phone-only consultations and some patients are prescribed high-strength THC-containing cannabis by doctors they've never spoken to after brief phone consultations with a nurse. Claire Noonan, a GP from Orange in NSW, was looking for more flexible work when she decided to sign up to be a medicinal cannabis prescriber with a telehealth company in late 2022. There were red flags from the moment she got her contract. She wrote to the company saying she was concerned that pay was contingent on writing scripts. "I didn't think it was conducive to ethical medical practice," Dr Noonan explained. She negotiated for the contract to be changed and started doing telehealth consultations with patients around the country. Her prescribing mantra was to start low and go slow, usually starting patients with cannabidiol or CBD, a cannabis compound that doesn't cause a high. "Some patients expressed a strong preference for THC preparations and would try and convince me to prescribe those for them, which, yeah, I didn't want to do on a first visit," Dr Noonan said, adding that some patients also "seemed to have a careful script" for how to try and get certain medications. She said on one occasion, after she declined a patient request for a THC prescription, she received a call from the telehealth company asking her to reconsider because the patient had complained. "We had to have a discussion about how I wasn't prepared to prescribe against my own clinical judgement. Dr Noonan quit soon after. She doesn't want to name the company, which didn't respond to requests for comment from 7.30. She said the CEO of the company wasn't a doctor and couldn't be blamed for wanting to run a profitable business. While Dr Noonan said she sees a place for medicinal cannabis in health treatment, she's concerned other doctors, especially young graduates and those without specialist GP training, might be more easily pressured to make poor prescribing decisions. While AHPRA regulates individual medical practitioners and the TGA regulates the advertising of medicinal cannabis, these businesses are operating in a regulatory grey area. While medicinal cannabis is legal, most products are still categorised as "unapproved medicines" which means they aren't on the Australian Register of Therapeutic Goods nor are they monitored for safety, quality or efficacy by the TGA. That means it's entirely up to doctors to ensure the drugs are prescribed appropriately. Former police officer Rohan Dawson was looking for relief from flashbacks, nightmares and anxiety caused by PTSD after years with the force. Cannabis was a treatment he'd never considered until the keen gardener saw an advertisement for "free cannabinoid therapy consultations" at his local hydroponic gardening shop. "[I] had a 10 or 15-minute phone consult with a lady who wasn't a doctor, and all of a sudden there was dope heading to my door. So it's really as simple as that." Within days, he was shipped a vape and a tub of dried cannabis flower marketed as "slurricane" containing 27 per cent THC. He never spoke to the doctor whose name appeared on his script and had no idea how strong the product was. He stopped taking it when his mental health deteriorated and he went to see his regular GP. "The advice was that THC stuff and your medication are not good bedfellows at all," he said. Despite never having another appointment, he continued to be billed under a subscription model and more cannabis arrived at his door. "I was alarmed by how efficient it is. Like, I thought, 'Shit these companies, they know how to roll this stuff out'. You can't criticise them for not being organised," he said. "I don't know why they would be wanting to have this, you know, Chernobyl-strength stuff sent out to people … it's most probably not necessary unless you're on death's door." The company he used is called Dispensed, and it advertises free consultations through bong shops, tobacconists, and hydroponic stores with appointments booked through iPad kiosks. Store owners told 7.30 they are paid a percentage commission when patients sign up. It's illegal to advertise medicinal cannabis and the TGA has handed out more than 190 infringement notices totalling over $2.5 million in fines since 2020. But many companies use coded language — like "alternative" or "natural" healthcare and plant-based imagery to ensure patients know what they provide. The TGA said it's "aware of, and concerned about, the rise of unlawful advertising of therapeutic goods … including through touch-screen kiosks". Last year, the founding pharmacist of telehealth provider Dispensed, and two of its prescribing doctors, were banned from supplying or prescribing medicinal cannabis after two patients with mental health conditions were supplied medicinal cannabis. One was hospitalised in a psychosis and the other took his own life. In a new statement to 7.30, Dispensed said the action was taken against the practitioners directly and the company "reviewed its systems, including to provide additional support to health practitioners and improve the quality of patient care". Dispensed added that the onus was on doctors and that it "expects practitioners to comply with their legal and professional obligations" and that when deciding whether to prescribe to patients they should consider "the type of medication that may be appropriate (including the strength)". Professor Iain McGregor from the Lambert Initiative at the University of Sydney has been studying the potential for cannabinoid compounds to be used to treat health conditions for more than a decade. He was an early supporter of legalising medicinal cannabis. "Even the initial advocates, the people that urged action back in 2015/2016, are now somewhat perplexed that it's turned into a bit of a commercial monster with the bar set too low for patient access and … some unethical prescribing going on," he said. He points out medicinal cannabis can be a very effective treatment backed by good evidence, especially for patients with epilepsy, chemotherapy side effects and in palliative care, but the research hasn't caught up with the "very large number of conditions where medicinal cannabis is being applied where we don't have high-quality evidence." Do you know more about this story? You can securely contact eliseworthington@ "That's not to say that the evidence won't emerge and there are clinical trials going on all the time, and we're running quite a few of them," he said. It's important to remember medicinal cannabis is generally well tolerated and the vast majority of those using it as prescribed won't see negative side effects, Professor McGregor said. However, he said he was concerned some of the THC products on the market were more than double the strength of home-grown cannabis. "The concern is that within the literature on cannabis, we know that higher THC products appear to be more linked to mental health, adverse outcomes, precipitation of severe anxiety and, paranoia in vulnerable individuals, perhaps schizophrenia and manic attacks." Another factor driving an increasing uptake in medicinal cannabis is that prescription products are now in many cases cheaper than buying illegal cannabis through a drug dealer. That's something Professor McGregor believes isn't necessarily a bad thing from a harm-reduction perspective. "There's the quality control. It means they have to talk to a doctor before they access the product, and it means that they have security of their products over time. "The downside is maybe that doctors don't necessarily want to be servicing the non-medical market. "I think they maybe didn't study medicine to become, you know, a glorified cannabis dealer," he said. Watch 7.30, Mondays to Thursdays, 7:30pm on ABC iview and ABC TV
