BMA redefines role of 'Physician Associates' after actresses' death

Doctors’ body, the BMA, has issued guidelines amid mounting concern that support staff are handling situations beyond their qualifications and ability.

Physician associates (PA) should be banned from diagnosing patients and renamed “doctor’s assistants”, according to healthcare leaders, after the death of a woman whose blood clot was misdiagnosed as anxiety. 

The British Medical Association (BMA) has released national guidelines for medical associate professions amid mounting concern about underqualified staff and the risk posed to patients. 

Professor Phil Banfield, BMA council chairman, said: “The public does not understand that physician associates work as doctor’s assistants, or that they have increasingly been placed in positions with inadequate supervision and with huge local variation in what they are expected to do.” 

Physician associates were referred to as “assistants” until 2014 when their title changed. Phil Banfield said that the confusion surrounding their title and role in the health service had led to preventable harm and patient deaths. 

He added: “We already have doctors who are ‘associate specialists’, these are senior doctors working at a level of hospital consultants. Having physicians and aesthetic associates as a title has sadly led to more confusion. Medical associate professionals have not been to medical school, they are not doctors.”

Medical associate professions were introduced to the NHS in the early 2000s to improve patients’ access to care, but they have faced increased scrutiny due to high-profile mistakes.

The ambiguity surrounding their role and scope has led to reports of physician associates illegally prescribing controlled drugs and requesting test results beyond their authority, such as x-rays. 

Marion Chesterton, the mother of an actress, 30, who died after an unsupervised PA misdiagnosed a pulmonary embolism in November 2022, said that her daughter Emily had not been informed by her GP practice that a physician associate was treating her. 

She said: “We believe that the present title of physician associate is confusing and inaccurate and sounds rather grand, indeed grander and superior in qualifications and status to a general practitioner. It should be changed to doctor’s assistant.”

The BMA said in its guidance that patients must consent to an appointment with a physician associate rather than a GP and that other medical associate professions should refrain from using terms such as “I am one of the medical team” without stating their job title.

The guidance recommends that their role be defined using a traffic light system, with green indicating a task they can do alone, amber meaning they need supervision, and red to indicate a task they should not.

Phil Banfield added that the need for national guidance outlining what associates could do safely was paramount.  He said: “Our guide has been written by doctors, for doctors, to explain to the medical profession what associates should, and should not, do alongside their doctor colleagues.”

As part of its long-term workforce plan, the government plans to increase the number of physician associates from about 3,250 to 10,000 by 2036. 

The BMA polled 18,000 doctors and found that 87 per cent had observed associates working in ways that were always, or often, a risk to patient safety. 

The publication of the guidance was criticised by the United Medical Associate Professionals union, which said they were “yet another attack on hard-working NHS staff.” 

It said: “Once again the BMA will denigrate physician associates. The BMA is drawing up their “dream job” for another group of NHS staff. This mainly looks like servants to doctors.”