New rules to protect patients outlined after death of actress, 30, who saw physician associate twice instead of GP

PATIENTS must stop being fobbed off with under-qualified medics and get diagnosed by proper doctors, the British Medical Association warns.

Ministers and health chiefs are plugging staff gaps at hospitals and GP surgeries with physician associates, who only study for two years compared to up to seven for a doc.

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The BMA fears they are being given too much responsibility and putting patients at risk because they are not medical experts.

Actress Emily Chesterton, 30, died from a blood clot after it was missed by two physician associates she saw at her doctor’s surgery.

Her parents Marion and Brendan said she would still be alive today if the BMA’s new guidelines announced today were enforced earlier.

Speaking at a press conference attended by MPs and members of the House of Lords, Brendan said: “Everyone that we’ve talked to and told them what happened, they say ‘that’s medical class 101’. 

“Someone presents with those particular symptoms, you get them to the hospital to get a prognosis, but that didn’t happen on two occasions.”

Some 3,286 PAs currently work in the NHS assisting healthcare teams.

They are not allowed to prescribe or order X-rays or CT scans but can order ultrasound or MRI scans.

PAs are paid between £44,000 to £50,000 a year.

For comparison, junior doctors are paid between £32,000 and £63,000.

Doctors have raised concerns about an increase in their responsibilities, particularly after Emily’s death.

Tragic case

She visited her doctor’s surgery on October 31, 2022, to discuss the discomfort she felt in her left calf.

She believed she had seen a GP but she was assessed by a PA and was advised to take paracetamol.

On November 7, she saw a second PA, who diagnosed her with a calf sprain, long Covid and anxiety.

After discussing the fact she was struggling to walk more than a few steps and her leg was swollen and hot, Emily was prescribed propranolol – a beta blocker for heart problems, anxiety and migraines.

The PAs did not make it clear they were not doctors in either appointment.

Emily, a musical theatre performer from Greater Manchester who had moved to London, collapsed later that evening and was rushed to hospital.

She died several hours later due to a blood clot in her left leg which triggered a pulmonary embolism – when a clot gets stuck in an artery in the lung.

New guidance

The new guidance from the BMA says PAs should not be allowed to assess patients before a fully-qualified doctor.

They must also never introduce themselves as part of the “medical team” without stating their job title, according to the first-of-its-kind rulebook.

The medics must be closely supervised when seeing patients who have already seen a doctor.

It recommends they should work using a traffic light system, with green indicating a task they can do alone.

Amber means they need supervision and red would be a task they should not do.

Speaking at the press event, Professor Phil Banfield, chair of the BMA, said PAs are currently deployed with varying levels of responsibility across the country.

With the Government’s clear intent to expand the numbers of PAs in the medical workforce, it is even more important that patients must know who is treating them

Professor Phil BanfieldBritish Medical Association

On many occasions this leaves them “out of their depth”, he said.

He said NHS England was “consciously” funding the employment of PAs when “this funding is not available to employ GPs”, leading to tragic consequences such as Emily’s death.

“We had hoped this was an isolated case but, sadly, when we asked doctors, it was not,” he added.

Professor Banfield said: “The need for guidance about what a physician associate can do safely is paramount. 

“Our guide has been written by doctors, for doctors, to explain to the medical profession what PAs should and should not do alongside their doctor colleagues. 

“But it is also to help patients, to improve patient safety.

“With the Government’s clear intent to expand the numbers of PAs in the medical workforce, it is even more important that patients must know who is treating them.”

A spokesman for UMAPS, the physician associate professional group, said: “The BMA has no right to unilaterally redefine the scope of practice of another profession.

“The NHS would not continue with the existence of Medical Associate Professionals (MAPs) if there was any doubt over the efficacy and safety of our work.

“The document published today attempts to grossly reduce the capacity of MAPs to care for patients and significantly changes the job descriptions.

“This will harm patients and increase costs to the NHS.”

A Department of Health and Social Care spokesperson said: “Physician associates have worked in the NHS for over two decades.

“They have been found to be safe, positively contributing to medical and surgical teams, and patient experience, while supporting the clinical teams’ workload – which is why we expanded the role of PAs in the NHS’s Long-Term Workforce Plan.

“The legislation regulating both PAs and anaesthesia associates has now been approved by Parliament and will be in place by the end of 2024. 

“It will set standards of practice, ensuring that PAs meet the standards that we expect of all regulated professionals, with the General Medical Council operating strict fitness-to-practice procedures and setting education and training expectations.”

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