Physician associates ‘illegally prescribe drugs’ after IT error
PHYSICIAN associates have “illegally” prescribed drugs to patients at NHS hospitals, The Telegraph can reveal.
Support staff at Calderdale and Huddersfield NHS Trust prescribed medications including opiates and sedatives to patients on 22 occasions, according to a Freedom of Information request.
Physician associates are healthcare workers meant to assist doctors by carrying out basic clinical tasks. They are only trained for two years and have no legal right to prescribe drugs.
The trust says the prescriptions were the result of an IT blunder that gave physician associates access to the electronic prescribing system for seven months.
The role of physician associates in the NHS is increasingly contentious, with critics arguing that their two-year postgraduate course provides insufficient training and could put patients at risk.
Last night, the hospital trust would not confirm whether any physician associates who prescribed these medications without legal authorisation had lost their jobs as a result.
In nearly all circumstances, it is a serious criminal offence for anyone other than a doctor, dentist, pharmacist or vet to supply controlled drugs under the Misuse of Drugs Act 1971.
The Telegraph understands that the trust has not referred any of the physician associates involved in this incident to West Yorkshire Police.
Baroness Foster, the Conservative peer, said the “practice of physician associates illegally prescribing” uncovered by The Telegraph added to concerns about the risk that the support workers posed to patient safety.
The Telegraph has previously published allegations from doctors at 24 trusts saying physician associates had illegally prescribed drugs and ordered scans with ionising radiation. But this is the first time an NHS hospital group has admitted to inadvertently giving associates the ability to prescribe.
Between July 2023 and January this year, physician associates at the trust – which runs two hospitals – prescribed controlled medications to patients including the opiate painkillers oxycodone and codeine. They also prescribed the sedatives lorazepam, diazepam and midazolam, the latter of which is often used in end-of-life care. The medications are classed as “controlled” by
‘There are very senior clinical managers in the hospital trust who should have been all over this’
the Government because of their risk of harm and addiction. The data was released in response to an FOI request from a member of the public.
Calderdale and Huddersfield said that “a hard control has now been implemented to prevent any further physician associates prescribing incidents” and insisted no patients had been harmed. But the disclosure has fuelled concerns among critics of the amount of power being handed to physician associates.
On Monday, peers will debate a motion that could derail government plans to bring physician associates under the General Medical Council (GMC). Allowing them to be regulated by the GMC could lead to physician associates later being given the authority to prescribe drugs.
Solicitor Sean Caulfield at Hodge Jones & Allen explained that: “If a physician associate has innocently carried out acts of supplying controlled drugs, which they were not authorised to do, it might not be in the public interest to prosecute them.
“However, if anyone, physician associate or otherwise, intended to supply or did supply controlled drugs, knowing it would be illegal, that would be different. In those circumstances the Crown Prosecution Service may think it is in the public interest to prosecute.”
Calderdale and Huddersfield stressed that their physician associates, who work in medicine, surgery and accident and emergency, “are instructed that they are not legally able to prescribe”.
This is not the first time the trust has been criticised over its management of controlled drugs. In 2018, the Care Quality Commission watchdog gave its two hospitals – Calderdale Hospital and Huddersfield Royal Infirmary – a safety rating of “requires improvement” in part because, “medicines, including controlled drugs, were not managed effectively in critical care and the urgent and emergency services”.
At the debate next Monday, Green Party peer Baroness Bennett will be “begging the Government to go back to the drawing board to find a different way forward that has the support of medical professionals, communities and patients”. The British Medical Association wants the draft legislation to be amended so that the Health and Care Professions Council have oversight of physician associates instead of the GMC, claiming licensing doctors and non-doctors together “increases the risk of patients mistakenly believing physician associates care equals doctor expertise”.
Baroness Brinton, the former Liberal Democrat health spokesman, who also opposes GMC regulation of physician associates, said the “very worrying” incident raised serious governance questions: “There are very senior clinical managers in the hospital trust who should have been all over this.”
A Trust spokesman said they “fully understand the prescribing rights for different parts of our workforce” and they “investigate [any issues] and take immediate action under the appropriate policies and procedures”.
The Department for Health and Social Care said GMC regulation of associates had “cross-party support and will boost patient safety” and that the council “will operate strict fitness-to-practice procedures and set education and training standards.”
They added that the role of physician associates is “to support doctors, not replace them” and that the staff “carry out clinical duties such as taking medical histories, carrying out physical examinations, and developing and delivering treatment and management plans.”
West Yorkshire Police said, if made aware of concerns, they would work with trusts “to understand if criminal offences have been committed” and all reports are “assessed according to threat, risk and harm”.