Physician associates should be banned from diagnosing patients following the death of a woman whose blood clot was missed twice, the British Medical Association has said.
In a landmark document published on Thursday, the union warned that PAs are “working in roles that increasingly cross the line” into situations that require the expertise of a doctor.
PAs are part of a group of employees called Medical Associate Professionals (MAPs) that were introduced to the NHS in the early 2000s. They assist healthcare teams and carry out tasks such as taking medical history from patients, performing examinations, diagnosing illnesses and analysing test results.
Training usually lasts for two years before staff are qualified.
However, there are fears that patients are becoming increasingly confused over the extent of their responsibilities and medical knowledge.
There are currently 3,286 PAs working across the NHS, according to the latest figures, but ministers hope to increase this to 10,000 by 2036.
Emily Chesterton, 30, was misdiagnosed by a PA twice before eventually dying of a blood clot in 2022.
She had initially called her GP complaining of a pain in her calf, but a PA recommended paracetamol.
In her second appointment, a PA diagnosed her with a calf-sprain, long Covid and anxiety but failed to examine her calves.
Ms Chesterton later died of a pulmonary embolism, but a coroner concluded her life would have been saved if she had immediately been referred to A&E.
In its guidance, the BMA says that PAs and other MAPs should not be responsible for initially assessing or diagnosing patients and must be closely supervised when seeing patients who have already seen a doctor.
It also argues that a “traffic light system” should be established to identify what MAPs might be expected to do on their own (green), what they might do under supervision (orange) and what they must not do (red).
Statements such as “I am one of the medical team” must not be used by MAPs, the document says.
BMA chair of council Professor Phil Banfield said the need for national guidance outlining what MAPs “can do safely” is “paramount”.
“Our guide has been written by doctors, for doctors, to explain to the medical profession what MAPs should and should not do alongside their doctor colleagues,” he added.
“But it is also to help patients, to improve patient safety. With the Government’s clear intent to expand the numbers of MAPs in the medical workforce, but without the clarity on the scope of their skills and responsibilities, it is even more important that patients must know who is treating them and the skills and abilities that clinician has.”
Prof Banfield warned MAPs “are working in roles that increasingly cross the line into situations more appropriately requiring the expertise of a doctor” and the BMA’s guide sets out what it “considers a safe scope of practice that will keep patients protected and allow the NHS to effectively employ MAPs to assist medical teams – which was their original purpose”.
He said that he hopes the report will lay out “clear parameters for the distinction between doctors and MAPs” and put an end to the “creeping substitution of PAs for doctors on rotas”.
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.”
