Patients must only see PAS with their consent, says BMA
Union says physicians’ assistants should also not work in A&E unless doctor reviews every single case
NHS patients should not be given GP appointments with a physician associate (PA) unless they have consented, the British Medical Association has said.
The doctors’ union has called for an end to the practice of GP appointments being provided by PAS if patients have not been diagnosed by a doctor first and without clear patient consent.
The guidance was drawn up in consultation with the parents of Emily Chesterton, who died after a PA – who she thought was a family doctor – misdiagnosed a fatal blood clot, twice.
The 30-year-old is just one example of “serious patient safety incidents involving PAS” the BMA said as it published a document with roles and responsibilities for PAS to “work safely”.
There are around 3,250 PAS working in England, the majority of which work in general practice, but the NHS plans around 10,000 within 12 years.
The BMA’S recommendations use a traffic-light system to outline what a PA can do alone, need supervision for, and should not do under any circumstances, because they have two-year postgraduate degrees or apprenticeships rather than the medical degrees and the training a doctor has. In general practice, for example, PAS are told they should not be seeing “undifferentiated patients” at all, which has become a common practice and is when someone presents to the GP surgery with symptoms for the first time and has not been assessed by a doctor.
Less than half of all GP appointments are delivered by a family doctor, the latest data shows. While the recommendations state that PAS can undertake a number of health checks, observations and tests under the supervision of a named GP, they should not see paediatric patients under the age of 16 at all.
It also states that they should not refer patients for hospital care or advice and guidance unless a GP has reviewed the decision, or in any way be left alone to work in the clinic or in charge of triaging patients. It says that they should not see any patient that has not “been clearly informed at the point of booking that the appointment is with a PA rather than a GP” and then “subsequently consented”.
The BMA said its “scope of practice” should apply to all medical associate professionals (MAPS), including PAS and anaesthesia associates and be adopted by NHS Employers and medical Royal Colleges alike.
The union’s proposals extend to all areas of healthcare where PAS and other associates currently work including surgery, medicine, and maternity.
It says PAS should not work in A&E unless a doctor reviews every single case in person, which was something that a coroners’ inquest into the death of Ben Peters, 25, identified as not having taken place, when a heart complication was misdiagnosed as a panic attack.
PAS should not say they “are part of the medical team”, be on the doctors’ rota, lead ward rounds, carry out post-operative reviews, or discharge patients, among a litany of other things outlined by the BMA.
The profession has been used in the NHS for around two decades, but has never been regulated, increasingly an issue as the role has expanded.
The BMA is also among the groups lobbying for the doctors’ regulator, the General Medical Council not to regulate associates, which is due to come into effect later this year, on the grounds it will only increase confusion between PAS and doctors among the public.
Prof Phil Banfield, chairman of the BMA council, said national guidance on PAS was “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. But it is also to help patients, to improve patient safety,” he said.
“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.”
‘It is even more important that patients must know who is treating them and the skills they have’