Doctors union the British Medical Association has backed The Mail on Sunday’s calls to crack down on rogue physician associates – after a string of blunders involving the medics who have just two years’ training.
For the past four weeks, the MoS has warned that the Government’s plan to recruit 10,000 physician associates (PAs) over the next 15 years is a risk to patient safety.
We revealed the shocking case of a patient left fighting for his life after being misdiagnosed by a PA, and allegations that PAs were bending strict rules to prescribe medicines to patients.
Hospital insiders told this newspaper that the workers were exploiting a ‘grey area’ in NHS guidelines and asking junior doctors to prescribe drugs on their behalf. Concerned whistleblowers warned that the practice was leading to some patients receiving incorrect drugs or dosages.
After our exposés, the British Medical Association (BMA) joined a growing chorus of concern in the medical community, stating that ‘no junior doctor should prescribe medicines solely at the request of a PA’.
And we have now uncovered evidence that some PAs are being paid as much as £90,000 a year to cover staff shortages in London – a wage three times higher than the average junior doctor’s salary.
Doctors union the British Medical Association has backed The Mail on Sunday’s calls to crack down on rogue physician associates
For the past four weeks, the MoS has warned that the Government’s plan to recruit 10,000 physician associates (PAs) over the next 15 years is a risk to patient safety
My neck was broken – and they just told me to take painkillers
When Michael Nicholson called his local Somerset GP practice in October to request an urgent appointment, he was given a choice: wait a week to see the GP or see a physician associate (PA) the next morning.
The 72-year-old retired gardener, who was diagnosed with advanced prostate cancer two years ago, was experiencing extreme pain in his neck that left him unable to move.
‘Michael was desperate for help, so he saw the PA,’ says his wife Doreen, 76, a retired civil servant.
But the PA did not send Michael for a scan to check for any damage, even though his medical record showed that his cancer had spread to his bones, increasing the chance of breakages. ‘She just told him that it was a muscular problem and he should try taking more painkillers,’ says Doreen. ‘When Michael questioned this, she said she would check with the doctor.
‘A few minutes later she came back and said the doctor had agreed.
‘We thought it was strange because the doctor hadn’t seen Michael, so how could he confirm the diagnosis?’
Nevertheless, Doreen purchased more painkillers for Michael, as well as turmeric oil, a heat wrap, a groove pillow and a brace to try to help ease the discomfort. However, nothing helped.
‘A week later he was screaming in pain,’ says Doreen. ‘I called 999 and an ambulance took him to A&E. They carried out a scan which revealed he had a broken bone in his neck.’
Michael will now need intensive surgery to fit a metal rod and plate into his back. It is likely that this will permanently limit his head movement.
‘It seems absolutely crazy that this PA didn’t send Michael for a scan, given that he has cancer in his bones,’ says Doreen. ‘If the problem had been picked up sooner then it’s possible the damage would not have been so severe and he could’ve avoided life-changing surgery.
‘I worry about all the people who are now regularly seen by PAs. It doesn’t seem safe.’
In light of this, today we launch our campaign to Rein In The Physician Associates – urging health chiefs to step in to sort out the mess before more unsuspecting patients come to harm. We believe PAs should be regulated, as at present they work with next to no guidance. And should something go wrong – as we know it has – the public has no medical body to complain to.
The urgency is clear: over the past fortnight, we have uncovered more cases where patients believe that they have been misdiagnosed by a PA.
One man with advanced prostate cancer was told by a PA that the intense pain he was experiencing in his neck was a muscle strain and was advised to take painkillers, despite his cancer having spread to his bones and making breakages more likely. When his wife eventually took him to hospital a week later, scans revealed a spinal fracture and he needed surgery to repair the damage.
In another case, a woman experienced a life-threatening blood pressure spike after she was wrongly told by a PA to stop taking vital medication.
Last week more than 2,800 doctors expressed ‘grave concerns’ about the lack of regulation governing PAs in an open letter to the General Medical Council (GMC).
It added that current proposals, which include granting PAs the right to prescribe medicine, were ‘unsafe, premature and lacking the necessary safeguards’.
‘We are very concerned about the role that PAs are playing in the NHS,’ says Dr Latifa Patel, a BMA representative.
‘We have had reports of PAs falsely telling patients that they are doctors or that they went to medical school. This is extremely confusing for patients, who have a right to know who is treating them.
‘Meanwhile PAs are getting paid far more than many doctors, despite having next-to-no training. It is creating a hierarchical dynamic where the PA is more senior than a qualified doctor. This means that when PAs put a prescription in front of junior doctors they feel pressured into signing it for them.
‘This is putting patients in danger because they are effectively being diagnosed and treated by an unqualified medic. There is urgent need to regulate PAs before any more harm is done.’
PAs are permitted to take medical histories, perform physical examinations and analyse test results, all under the supervision of a doctor.
They can also fill in forms and carry out basic checks which can sometimes clog up GPs’ workloads. Their training is typically completed after receiving an undergraduate degree in something related to health, such as psychology or sports science.
There are about 2,500 PAs working in the NHS today, but Ministers plan to increase that fourfold by 2037. They say this radical move is needed to help tackle the unprecedented shortage of NHS doctors. According to the BMA, the NHS needs another 46,000 hospital doctors and 17,000 GPs.
The Government has also committed to increasing the number of doctors and nurses in the NHS by training thousands more over the coming 15 years, but experts say that it will take time for these medics to qualify.
‘A medical student who begins studying this year won’t be qualified to become a GP for another decade,’ says Dr Dean Eggitt, a Doncaster-based GP. ‘So it’s no surprise that the NHS is desperate to hire anyone who can look after patients, even if they’ve only had two years’ training.’
Experts say that, already, a lack of doctors has meant PAs are being asked to carry out complicated hospital tasks they are not qualified to do.
Last month, Dr Jatinder Hayre, a London-based junior doctor, revealed to this newspaper that PAs were regularly doing spinal taps – also known as a lumbar puncture – a procedure which involves inserting a needle between the bones in the spine.
He also claimed he had seen PAs instruct junior doctors to write prescriptions for patients – despite the fact the doctors had not seen the patients themselves – and that he had witnessed cases where a PA had ‘altered a doctor’s prescription’ after it had been written.
Readers of The Mail on Sunday have also written in with stories of worrying encounters with PAs.
One, Roland Clews, said he had been misdiagnosed by a PA who told him the intense pain in his left arm was nothing to worry about.
‘After ten weeks of continual pain, I saw a physiotherapist who referred me for a scan,’ says Roland. ‘It showed that I had torn the bicep ligaments in my left arm. I will possibly need an operation to reattach them.
‘The PA who made the original diagnosis should be removed from their position.’
Another reader to fall foul of a PA is Annette Wallman, 73, from South London, who was incorrectly told by a PA to stop taking her blood pressure medication.
Annette, a landlady, was diagnosed by her GP with high blood pressure last year and prescribed a medicine called bisoprolol to control the problem. But in March, during an appointment for an unrelated health issue, Annette was told by a PA to stop taking the tablets.
‘She looked at my medical records and said bisoprolol was an “unusual choice”. She told me she disagreed with the GP and was going to change my prescription to a drug called amlodipine.’
While bisoprolol and amlodipine are both prescribed for high blood pressure, they work in different ways and are not necessarily alternatives for each other.
Within days of swapping medication, Annette’s blood pressure rocketed and her heart started beating incredibly fast.
‘It felt like I was going to have a heart attack,’ she says, ‘so I called 111.
‘The on-call GP I spoke to said the PA had made a mistake and I needed to start taking my old medication immediately.’
Annette’s blood pressure is now healthy again, and she says she won’t accept an appointment with a PA in the future.
‘I’d rather wait weeks than see a PA – or I’ll go private to see an actual doctor,’ she says.
The BMA has previously called for physician associates to be called ‘physician assistants’ to better reflect their junior role and reduce confusion for patients.
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‘PAs could benefit the NHS if they are used as assistants who help doctors with administrative tasks such as taking a patient’s medical history,’ says the BMA’s Dr Patel.
‘But this isn’t happening. Instead, PAs are taking on the role of junior doctors, diagnosing patients and carrying out procedures. We were told that the introduction of PAs would make our jobs easier, but instead it’s making it harder as we have to double-check that they have made the right decisions.’
Dr Eggitt added: ‘It feels as though there is a lack of understanding about what PAs can and can’t do.
‘Once these boundaries have been set, it’s likely the relationship between PAs and doctors will improve.’
In their letter to the GMC, doctors also urged the council to set out a ‘clearly defined scope of practice’ for PAs, so local hospitals could not decide for themselves what PAs were allowed to do.
‘The GMC should also be duty-bound to ensure that the public can easily find out whether they are being treated by a PA or not,’ says Dr Patel.
Experts have also expressed outrage at the wages of some PAs, who have a starting salary of about £43,000 a year, compared with £32,000 for new doctors. It is estimated it takes doctors eight years to catch up.
But this newspaper has discovered that some PAs are making considerably more.
An online advert, posted last week, reveals that an unnamed London GP practice is looking for a temporary PA – also known as a locum PA – to help cover shifts throughout the week. The role, which requires only one year’s GP experience, will pay between £68,000 and £90,000 – nearly three times the salary of the average junior doctor.
‘It’s an absurd amount of money for someone with so little experience,’ says Dr Eggitt.
‘But it reflects the fact that we have a severe work force shortage in the UK. GP practices are desperate for staff.
‘This is why it’s so crucial we regulate PAs as soon as possible. It’s currently too easy to become a PA. Why train for a decade to become a GP when you could train for just two years, become a PA and make far more money?
‘Regulating the role and ensuring that PAs are up to a certain standard would improve the quality of care they provide and limit the risk of mistakes occurring.’