NHS physician associates: Consultation launched on regulation

The General Medical Council is looking into how it will regulate physician associates and anaesthesia associates.

Emily Chesterton died from a pulmonary embolism after being misdiagnosed on two occasions by a physician associate
Emily Chesterton died from a pulmonary embolism after being misdiagnosed on two occasions by a physician associate

A medical regulator has launched a consultation into how it should oversee NHS physician associates (PAs), who have been at the centre of controversy following a patient death.

The General Medical Council (GMC) said it wanted to hear from representatives of patients, PAs and anaesthesia associates (AAs), doctors and employers.

The consultation will examine the rules, standards and guidance over how regulation of PAs and AAs by the GMC will be delivered.

It comes after the British Medical Association (BMA) published guidance earlier this month saying PAs should be stopped from diagnosing patients and set out a framework for how they should work in the NHS.

Emily Chesterton (right), who died from a pulmonary embolism after being misdiagnosed by a physician associate, with her mother Marion and sister Jasmine
Emily Chesterton (right), who died from a pulmonary embolism after being misdiagnosed by a physician associate, with her mother Marion and sister Jasmine (Family handout/PA)

It said the move was needed to “improve patient safety” in light of high-profile mistakes.

The framework said associates working in GP surgeries should not refer patients for hospital care, advice and guidance unless a GP has reviewed the decision, and they should not be put in charge of triaging patients.

They should also not see patients under the age of 16, the BMA said.

It comes after Emily Chesterton, 30, died in November 2022 from a pulmonary embolism after being misdiagnosed by a PA on two occasions when she visited her local GP practice in Crouch End, north London.

She had been under the impression that she was seeing a GP when she had been seeing a PA after being triaged by a practice receptionist.

The PA failed on both occasions to spot her leg pain and breathlessness was a blood clot, which ultimately travelled to her lungs.

Instead, Ms Chesterton was told she had anxiety.

A coroner later ruled she “should have been immediately referred to a hospital emergency unit” where she would likely have been treated for pulmonary embolism and would have survived.

Her parents, Brendan Chesterton, 64, a retired maths and ICT teacher, and his wife Marion, 65, a retired languages teacher, back the BMA’s calls for much tighter controls over the work of PAs.

They told the PA news agency in a statement: “Emily was our precious, beloved daughter.

“She had been brought up, as have we, to respect and trust our NHS. She died needlessly; her death was preventable.”

They said Ms Chesterton “was and is cherished and loved, we miss her every minute of every day. To lose a child is so very painful.”

Their statement said the roles of regulation must not be passed down and delegated to different employers “who will write their own guidelines”.

They added: “The problem will be watered down and not solved. We must have one set of regulations for everyone concerned. They must be clearly and concisely written, in plain English, so that everyone can understand them. We like the traffic light system as put forward in the BMA scope document.

“Please listen to doctors. It must be acknowledged that associate physicians are not doctors, have not trained for the same amount of time and do not have their experience and expertise.

“We demand their title be a true reflection of their role and status, namely as assistants.”

Charlie Massey, chief executive of the GMC, said “everyone agrees that regulation is needed and that it will benefit patient safety and public confidence”.

He added: “We are now setting out our proposed approach for how we will regulate these professions.

“This consultation is not about whether the GMC should be the regulator but about how we regulate. The law requires us to take on this role from December this year.

“It is important for us to hear feedback from representatives of patients, PAs, AAs, doctors and employers, as well as other stakeholders and from individuals.

“This consultation will determine how we implement the powers and duties the legislation gives us.”

PAs are graduates – usually with a health or life sciences degree – who have undertaken two years of postgraduate training.

According to the NHS, they 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 general practice, acute medicine and emergency medicine.

In England, the NHS and the Government have said they will increase the physician associate workforce to 10,000 from around 3,300 at present.

BMA chairman Professor Phil Banfield said: “We were very clear that the Government’s decision to regulate PAs and AAs by the GMC as if they were doctors was the wrong one.

“Nevertheless, we will respond to this consultation in the interests of patients and doctors… Patient safety and fairness remains at the forefront of our minds.”

Stephen Nash, founder of United Medical Associate Professionals, said: “We greatly welcome the consultation by the GMC and look forward to contributing to it.

“Regulation by the GMC marks an important step in reassuring the public and patients that PAs work to the highest of professional standards.”