PATIENTS should always be seen by a doctor in their first appointment when they’re being diagnosed, leading doctors claim.
Ministers have been hiring thousands of fast-tracked medics called physician associates to help plug gaps in NHS staff and address unparalleled demand.
Emily ChestertonEmily Chesterton, 30, tragically died from a blood clot that was missed by two Physician Associates[/caption]
Lily BarnesIn a first appointment, she believed she had seen a GP but she was assessed by a PA[/caption]
But new guidance from the British Medical Association states 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.
It comes after it was revealed actress Emily Chesterton, 30, tragically died from a blood clot that was missed by two PAs she saw at her doctor’s surgery.
Professor Phil Banfield, chair of the BMA, 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.”
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.
Doctors have raised concerns about an increase in their responsibilities, particularly after the death of Ms Chesterton.
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 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.
The guide follows a BMA poll of more than 18,100 UK doctors.
It found more than half had experienced a higher workload since PAs and AAs had been brought in.
Only 21 per cent of medics who responded to the survey reported a decreased workload, the BMA said.
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.”
Emily ChestertonEmily was rushed to hospital where she died within hours[/caption]
What does the new guidance state physicians associates should be allowed to do?
General principles for PAs:
This is an assistant role to doctors helping with simple practical procedures, administrative tasks, and working with patients in a supportive and specified role.
This does not extend to seeing undifferentiated patients in any situation.
When seeing differentiated patients (those already triaged by a doctor as appropriate, or already assessed, diagnosed, and on a treatment plan by a doctor), MAPs must be directly and closely supervised.
PAs/AAs/SCPs must not make independent management decisions for patients nor be responsible for initial assessments of patients and diagnosis.
MAPs must make it clear in all communication to patients and to other staff members that they are not doctors and be clear about their specific role.
Statements such as ‘I am one of the medical team’ must not be used unless also stating their own title.
Source: The BMA