Many people are deeply confused about the growing number of “physician associates” in the NHS and wrongly assume they are doctors, research suggests.
Around 4,000 physician associates work in the NHS in England. Ministers and health chiefs plan to increase the figure to 10,000 to help plug widespread gaps in the NHS workforce.
However, there is widespread confusion among the public about their role and relationship with fully trained medics, according to a survey commissioned by the British Medical Association (BMA).
A quarter of the representative sample of 2,009 people erroneously believed that a physician associate was a doctor, while a fifth made the same mistake about “physician assistants”.
Many respondents thought that a physician associate was more senior than a junior doctor, even though only the latter have a medical degree.
The NHS first began using physician associates, also called physician assistants, in 2004. They “work alongside doctors providing medical care as an integral part of the multi-disciplinary team”, according to the department of health and social care (DHSC).
Although the DHSC says that “their role and clinical duties are very different to those of a doctor”, they are trained to take medical histories, undertake physical examinations and draw up and also deliver plans to both treat and manage patients. They are meant to be supervised by a doctor. Physician associates train for two years whereas doctors train for four, five or six years.
The DHSC added that physician associates, and their counterparts in anaesthesia, “deliver specific aspects of patient care, increasing the capacity of clinical teams and reducing the workload of other clinicians, including doctors, increasing the capacity of the medical team to deliver care to patients.”
The expansion of physician associates has prompted a backlash by grassroots medics. They fear patients will be misled into thinking they have seen a doctor despite physician associates not having the same skills and training.
The government has moved to try to quell criticism of physician associates by legislating to ensure they are regulated by the General Medical Council (GMC).
That has been overshadowed by concern that hospitals and GP surgeries are deploying “doctors on the cheap” to treat patients.
The BMA survey, undertaken by Walnut, also found that 57% of people have never heard of physician associates, even though they are already widely used. Some 41% said it was not always clear if they were being treated by a doctor or someone else, and 29% were not sure if they had been treated by a physician associate.
Prof Philip Banfield, chair of the BMA council, said that while patients need to know who was caring for them, “what we see instead from this survey is a worrying level of confusion among patients about what a PA [physician associate] is. Nearly a third don’t know if they’ve even been seen by one or not.
“If patients don’t know who is treating them then we risk losing their confidence and trust, which is essential to effective care.”
Concern about the potential risk posed by physician associates has intensified after the death last year of Emily Chesterton, a 30-year-old actor. She had a blood clot but a physician associate at her GP surgery twice misdiagnosed her symptoms as a sprain, long Covid and anxiety. A coroner later said she would probably have survived if she had been referred to A&E.
NHS England defended the use of physician associates. A spokesperson said: “Physician associates are an important part of clinical teams across the NHS, providing support to thousands of patients with appropriate supervision every day, while freeing up other clinicians to care for those patients who need their expertise the most.
“The NHS has been working closely with the GMC on the development and regulation of these internationally recognised roles for many years, which will ensure the highest standards are met as thousands more are trained, alongside a near doubling of medical school and nursing training places over the next 15 years as part of the NHS long term workforce plan.”
Prof Partha Kar, a leading diabetes specialist, recently warned that the rollout of physician associates had been “an unqualified mess” and that their “vague” remit meant their use by hospitals and GP practices was “questionable at best and dangerous at worst”.
