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The parents of Emily Chesterton, a woman who died after a blood clot was misdiagnosed by a physician associate she believed to be a doctor, have described a recent government-ordered review into NHS physician associates as “a missed opportunity”1.
Background
Emily Chesterton died in November 2022 following a pulmonary embolism. In the weeks before her death, she visited her GP surgery twice and was seen both times by a physician associate (PA) who misidentified her symptoms and prescribed propranolol for anxiety. Emily’s parents, Marion and Brendan Chesterton, say she was unaware she had not seen a doctor. “If she come out and said I’ve seen someone called the physician’s associate I’m sure we would have insisted that, you know, let’s go back and insist that you see a doctor. She never knew,” her father Brendan said.
Review Findings and Recommendations
A government-commissioned review, led by Professor Gillian Leng, president of the Royal Society of Medicine, has made several recommendations on the role of PAs and anaesthesia associates (AAs) in the NHS, including:
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PAs should not diagnose patients who have not already had contact with a doctor for their current illness.
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PAs must not see undifferentiated or untriaged patients but may see adults with minor ailments if triaged according to official guidance.
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National clinical protocols and more detailed guidance should be developed to clarify what work PAs can undertake.
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PAs should be renamed “physician assistants” and have distinctive uniforms to differentiate them from doctors. AAs should become “physician assistants in anaesthesia”.
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Newly qualified PAs should work in hospitals for two years before being allowed in GP practices or mental health settings.
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PAs and AAs should have opportunities for ongoing training, potential career progression, and eventual prescription rights in the future.
The review found that while some patients report satisfaction after seeing a PA, many did not realize they were not being treated by a doctor. It also recorded that six patient deaths have been linked to PAs as reported by coroners in England.
Varied Reactions
Marion Chesterton stated the recommendations could have saved Emily’s life and welcomed many proposals but argued they don’t go far enough. She advocated for a complete ban on PAs prescribing drugs and described her daughter’s death as a “catastrophic” result of such misprescribing.
The British Medical Association (BMA) echoed these concerns. Dr. Emma Runswick, BMA deputy chair, warned that the blurring of roles between doctors and PAs continues to pose safety risks, despite potential improvements from name and uniform changes. “Whilst they continue to be deployed in a way that mimics doctors at the behest of any local employer decision, we have to have ongoing concerns about their safety,” she said.
The union representing PAs and AAs (UMAPs) criticized the changes as undermining their qualifications and stated it could lengthen NHS waiting lists and worsen the impact of strike action.
Ongoing Debate
Professor Leng concluded there are “no convincing reasons to abolish” the PA and AA roles, but also highlighted the need for significant change. The government’s response and subsequent actions will be closely watched by patient safety advocates, families like the Chestertons, clinicians, and NHS staff as the debate on safe staffing and patient care continues.
Disclaimer
This article is based on reporting from Sky News and summarizes the findings and reactions to the recent review on physician associates in the NHS. It is provided for informational purposes and should not be taken as medical or legal advice. For further information or professional guidance, please consult the original source or qualified professionals.
