Hospitals told to drop physician associates

NHS England has ordered hospitals to stop using physician associates on doctors’ rotas.

Officials wrote to trusts this week to say that physician associates (PAs) are “not substitutes” for medically trained professionals – and should never be used as “replacements” to cover doctors’ shifts.

The move comes as can reveal that the rotas at more than 30 hospitals show physician associates taking on doctors’ shifts.

Ministers and NHS executives have repeatedly claimed that PAs and anaesthesia associates (AAs) are not being used to replace doctors. But

has seen leaked rotas and other documentation from 31 NHS hospitals in England that uncovers a widespread practice of placing non-medics on rotas traditionally reserved for doctors.

Despite only receiving two years’ training and being unable to prescribe, both PAs and AAs can be seen picking up similar shifts to medics, in some cases reviewing patients independently.

At 13 hospitals, doctors’ work appears interchangeable with those of associates, with the A&E department at St George’s Hospital advising that new junior doctors and PAs “can all swap with one another”.

The leaks show 10 hospitals used PAs and AAs to fill gaps in the medic roster caused by sickness. Nine used them as on-call senior house officers (SHOs) – junior doctors with at least one year’s experience – and two even gave them emergency “bleeps” to respond to potentially life-threatening situations.

In 10 hospitals, PAs counted towards the minimum safe number of medics on shift. NHS trusts have a legal duty to provide enough suitably qualified staff to meet patients’ needs, but there is no set formula to calculate the required doctor-patient ratio.

Whistleblowers claim that any substitution of doctors is a risk to patient safety, especially out of hours.

The roster for Hospital of St Cross in Rugby reveals that yesterday the “on-call cover anaesthetist” shift will be filled not by an anaesthetic doctor, but an anaesthesia associate.

In response to findings, NHS England has written to trusts warning that “PAs should not be used as replacements for doctors on a rota”.

The letter said: “It is important to emphasise that PAs are not substitutes for doctors; rather, they are specifically trained to work collaboratively with doctors and others as supplementary members of a multidisciplinary team.”

has previously revealed that PAs had prescribed controlled drugs including opioids without legal authorisation.