‘Little evidence’ to suggest employing physician associates in the NHS is safe or improves patient care, review finds
There is little evidence that employing physician associates (PAs) in the NHS is safe or that they improve patient care, a review from Oxford University has found.
Experts said studies relating the role of PAs and anaesthetic associates (AAs) were severely lacking, despite more than 3,500 people being employed in these roles in the health service. Among the issues raised was that the available research was too ‘sparse’ and, in some cases, ‘outdated’ and of ‘variable quality’.
Writing in the British Medical Journal (BMJ), they found no studies have examined safety incidents relating to PAs, while others have concluded PAs seem ‘to struggle’ when working in GP surgeries.
While some research has suggested PAs could support the work of hospital ward teams and A&E when appropriately deployed and supervised, ‘the number of individuals and settings studied was small, and those findings should be considered preliminary’.
Furthermore, the researchers found some NHS staff had concerns about the competence of PAs and AAs ‘to manage undifferentiated, clinically complex, or high dependency patients… or prescribe’.
The review continued: ‘No evidence was found that physician associates add value in primary care or that anaesthetic associates add value in anaesthetics; some evidence suggested that they do not.
‘The UK literature on physician associates and anaesthetic associates is sparse and of variable quality, and some is outdated.
‘In this context, the absence of evidence of safety incidents should not be misinterpreted as evidence that deployment of physician associates and anaesthetic associates is safe.’
There is little evidence that employing physician associates (PAs) in the NHS is safe or that they improve patient care, a review from Oxford University has found. Pictured: File photo
PAs have hit the headlines in recent years over a spate of patient deaths linked to misdiagnosis. One high-profile death involved Emily Chesterton (pictured), 30, in November 2022 from a pulmonary embolism
PAs have hit the headlines in recent years over a spate of patient deaths linked to misdiagnosis.
Last week, a coroner said the PA who treated Pamela Marking before she died at East Surrey Hospital last year ‘had a lack of understanding of the significance of abdominal pain and vomiting and had undertaken an incomplete abdominal examination’.
Mrs Marking was seen by the PA and told she had a nose bleed before she was sent home, with her son believing she had been cared for by a doctor.
Witnesses from the East Surrey trust gave evidence to her inquest that a PA was ‘clinically equivalent to a Tier 2 resident doctor’ but there was no evidence to back this up, the coroner said.
Another high-profile death involved Emily Chesterton, 30, in November 2022 from a pulmonary embolism. She was misdiagnosed by a PA on two occasions.
PAs are graduates – usually with a health or life sciences degree – who have undertaken two years of postgraduate training.
According to the NHS, they should work under the supervision of a doctor and can diagnose people, take medical histories, perform physical examinations, see patients with long-term conditions, analyse test results and develop management plans.
Most associates work in GP surgeries, acute medicine and emergency medicine and there are NHS plans to recruit more.
Ms Chesterton (right, with mother Marion, centre, and sister Jasmine, left) was misdiagnosed by a PA on two occasions
In November the Government launched a review of the role of PAs and AAs led by Professor Gillian Leng, president of the Royal Society of Medicine.
Her report is expected to be published in spring.
For the latest work in the BMJ, 29 research studies on PAs and AAs were examined but were found to be scant on data.
The total number of physician associates studied was ‘very small’, especially in GP surgeries, researchers said, and no studies reported direct assessment of AAs.
