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Autumn date to fix blood transfusion services

Blood testing partnership Synnovis has warned that its hacked blood transfusion services may not be fully functioning again until the autumn.

Its systems fell victim to ransomware hackers and the pathology partnership says, external it has rebuilt many of the 60 which were affected.

The hackers made systems unusable unless a payment was received and caused significant disruption, with hundreds of operations and thousands of appointments cancelled.

Synnovis said the blood transfusion services would "continue to be stabilised over the summer".

The situation is also part of the reason the NHS made an urgent appeal for blood donors after warning stocks had dropped to "unprecedently low" levels.

Synnovis is a partnership between Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospitals NHS Trust and Synlab, a commercial testing firm.

It said more of its laboratories could now be reconnected to systems that enabled the service to receive test orders and return results electronically.

Core chemistry and haematology services have been restored at King’s College and Princess Royal University Hospitals, with Guy’s and St Thomas’, Royal Brompton and Harefield Hospitals to follow "in days". As a result it expected "to be able to increase the numbers and types of tests shortly".

Dr Chris Streather, medical director for NHS London, welcomed the news but said: “It will take further time for this to roll out, but we will soon start to see faster turnaround times for most routine blood tests." He said the delay in restoring blood transfusion services meant "that there will be a continued impact on planned operations and a need for hospitals to help each other by taking patients where needed".

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Source: BBC News, 26 July 2024

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Health regulator not fit for purpose - Streeting

The body responsible for regulating NHS and care services in England is not fit for purpose, the health secretary has said.

Wes Streeting's intervention comes after an independent review found significant failings at the Care Quality Commission (CQC), according to headline findings released by the government.

The CQC inspects everything from hospitals and GP practices through to care homes and dental surgeries, covering 90,000 different services. Wes Streeting said he was “stunned” by the scale of the problems as he announced a set of emergency measures.

The CQC said it accepted the findings in full.

Among the failings identified were:

  • Inspectors lacking the necessary experience – including some being asked to inspect hospitals without ever having been into one before
  • Care home inspectors who had never met a person with dementia
  • A backlog of assessments with one in five services never having been given a rating – this is thought to include new care providers, GPs and private health clinics that have opened in the last five years
  • One NHS hospital having gone more than 10 years since its last inspection
  • A lack of consistency with assessments

The full interim report is due to be published on Friday.

Among the measures being taken is the appointment of Sir Mike Richards, a vastly experienced cancer doctor who has previously worked in government as national director of cancer care and spent four years as the chief inspector of hospitals from 2013, to work with senior leaders at the CQC and conduct a "rapid review" of the watchdog.

The regulator has just appointed an interim chief executive, Kate Terroni, who was deputy chief executive until last month when Ian Trenholm announced he was stepping down as head of the CQC.

Mr Streeting told BBC Breakfast he was also looking to appoint a new chief executive and chief inspector of hospitals who the government "can work with to turn the regulator around."

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Read the Independent review into the operational effectiveness of the Care Quality Commission: interim report

Source: BBC News, 26 July 2024

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Cancer treatment ‘biased against ethnic minorities’

A type of cancer treatment used in the NHS appears to be biased against non white European patients, research has found.

A review by the NHS Race and Health Observatory in partnership with Liverpool University – findings from which have been shared with HSJ –  looked into crucial genetic tests carried out before a type of drugs to treat cancer (fluoropyrimidines) is administered.

If a patient has certain gene variants, using the medicines can harm them, leading to severe side-effects that affect the bone marrow, bowel and skin, and in some cases can cause death. If the variants are present, other treatments have to be used.

However, the research by the RHO found that the NHS is testing for four variants, which are typically found in white Europeans. But the researchers found 53 additional relevant variants, which are not tested for, were present in patients from 12 countries and five ethnic groups – African American, East Asian, Latin American, Middle Eastern and South Asian.

Although their two-year research project is still ongoing, the RHO and Liverpool University team have decided to issue a call for an extension of this type of genetic testing (which seeks to identify a deficiency of the dihydropyrimidine dehydrogenase enzyme). A further recommendation for genetic testing for a variant found in those from African backgrounds is now under NHS review, which could be included in the National Genomic Test Directory, the RHO said.

RHO chief executive Professor Habib Naqvi said, “There is a duty to ensure every patient has access to the best available treatment when they are unwell."

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Source: HSJ, 26 July 2024

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Inga Rublite inquest: hospital missed two chances to treat woman dying in A&E

Staff at a hospital in Nottingham missed two opportunities to treat a woman found dying under a coat in a crowded emergency department, a coroner has concluded.

An inquest into the death of Inga Rublite, 39, found she died of natural causes but medical staff failed to recognise “persistent and escalating symptoms of brain haemorrhage” as she waited in A&E for more than eight hours.

Dr Elizabeth Didcock, an assistant coroner for Nottinghamshire, said Rublite should have been assessed by a senior doctor and sent for a head scan when she arrived at Queens medical centre (QMC) just after 10.30pm on 19 January this year.

When Rublite was next assessed by a nurse, at about 2am, and reported to be in severe pain, this should have been escalated to a doctor, she said.

“[Rublite] had persistent and escalating symptoms of brain haemorrhage that were not recognised,” said Didcock, adding that the department was “excessively busy” that night. “There were 76 patients waiting to be seen, and reduced medical staff generally across the department.”

Didock concluded Rublite suffered a second severe bleed on the brain shortly before she was found, which caused her death. “If she had been admitted for close monitoring, as she should have been, she would still have had [a] second rapid and devastating bleed.”

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Source: The Guardian, 25 July 2024

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Tourists heading to Greece warned of Covid variant as hospital rules return

Those going to Greece for their summer holidays have been warned of a spike in Covid cases related to the new FLiRT variant.

The increase has been reported by the Mediterranean country over the last 20 days.

In its latest report Greece’s National Public Health Organization, EODY, said it had seen an increase in hospital admissions, with 669 new Covid patients admitted from July 8 to 14, 2024. The report adds that this was a 44% increase in the average weekly number of new admissions over the previous four weeks. In total 26 Covid deaths were recorded.

Greece has recently struggled with heatwaves that has left many vulnerable people shielding from high temperatures inside. 

Last week the Metaxa Oncology Hospital in Piraeus, the port area of Athens, reintroduced masks and other protective measures within its wards. Visitors are limited to two per patient and there is a 48-hour rapid test requirement for those visiting.

The symptoms of the FLiRT and LB.1 variants are generally like those of earlier Covid-19 strains. Common symptoms include fever, cough, fatigue, loss of taste or smell, sore throat, muscle or body aches, shortness of breath, headache, and a runny nose.

Last week, the World Health Organization released a statement indicating Covid-19 is still responsible for around 1,700 deaths per week globally. WHO encouraged vulnerable populations to get vaccinated.

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Source: Independent, 25 July 2024

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NMC sets out next steps toward change

The Nursing and Midwifery Council (NMC) has set out the next steps towards change, having accepted all the recommendations of an independent review into its culture.

In the short-term , the NMC will take the following immediate actions, supported by external advice, to help it make the right decisions, address its cultural issues and follow through on change.

  • An external Empowered to Speak Up Guardian is now in place to support NMC staff to raise concerns and ensure they get independent support from a trained professional.
  • The NMC has invested in a partner to help improve psychological safety within the organisation, starting in Professional Regulation directorate.
  • It has started the process of appointing an equality, diversity and inclusion (EDI) advisor to its executive board, to support decision making.

It has also made some immediate commitments:

  • The NMC will co-opt one or more senior independent advisers to the Council to increase the challenge and support that the Council receives, to ensure the necessary cultural changes are delivered and to prevent a recurrence of the findings in the report.
  • It has committed to increasing the diversity of its executive board.
  • It will double the amount it spends on staff learning and development so that by October 2024, it can roll out improvements in leadership, line management, safeguarding, casework and tackling poor behaviours identified in the report.
  • It will develop a competency and behaviour framework, to launch in September, that will support recruitment, career progression and performance management.
  • It will offer extended decompression support to staff working on sensitive casework.

In the medium term, the NMC is reviewing its existing plans in light of the independent report’s recommendations. It is also working to enhance its approach to safeguarding, people and equality, diversity and inclusion (EDI). In the longer term, the organisation will focus on wider culture change, including the full implementation of Nazir Afzal and Rise Associates’ recommendations over a projected two-year period.

Helen Herniman, Acting Chief Executive and Registrar, said, “The independent report on our culture made difficult reading for everyone at the NMC and for many outside our organisation, including our stakeholders, the professionals on the register and members of the public who have engaged in our regulatory work. We are sincerely sorry to everyone we have let down. We are committed to delivering a change programme rooted in the report’s recommendations, and we are confident this will help us to make a step change in both culture and performance."

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Read The Nursing and Midwifery Council Independent Culture Review (9 July 2024)

Source: Nursing and Midwifery Council, 24 July 2024

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Quarter of social care staff leave within three months, watchdog finds

A quarter of social care staff in Scotland leave their jobs within three months, while vacancies are at their height, a report has found.

The bodies responsible for delivering health and care services across the nation, known as Integration Joint Boards (IJBs), are grappling with a projected funding gap that is up by 187 per cent.

The Accounts Commission, a watchdog, has warned of “unprecedented pressures” on IJBs amid dwindling funds and surging demand for services.

IJBs play a crucial role in planning and commissioning essential community-based health and care services across Scotland. Their remit includes supporting disabled adults, social work with the elderly, GPs, pharmacists, mental health care and drug and alcohol services.

The report also underscored an “unsustainable” dependence on Scotland’s estimated 800,000 unpaid carers.

Colin Poolman, Scotland director of the Royal College of Nursing (RCN), said: “This damning report sets out the challenges facing community health and social care services. Too often, the focus is on the crisis in acute hospitals, but hospital overcrowding is a symptom of the lack of investment and prioritisation of community services. The whole system is at breaking point.”

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Source: The Times, 25 July 2024 (paywalled)

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Trust launches probe after cyber attack

One of the NHS’s least digitised teaching hospitals has been forced to carry out “a full forensic investigation” after a cyber attack last week, HSJ has learned.

Norfolk and Norwich University Hospitals Foundation Trust said the incident occurred last Wednesday. It was unrelated to the Microsoft outage, which disrupted some NHS IT systems, mostly in general practice, at the end of last week, the trust said.

A trust spokesman told HSJ: “No patient systems are compromised, and [at] this point in the investigation, we do not have any evidence of compromise of patient data. However, the investigation is ongoing and is extremely complex.”

NNUH chief digital information officer Ed Prosser-Snelling said the attack had been “detected and terminated [and] all emergency care, elective and outpatient services at our hospitals are continuing to run as normal.”

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Source: HSJ (paywalled), 24 July 2024

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Eight-year ADHD backlog at NHS clinics revealed

It would take more than eight years for the NHS to see all adult patients waiting for ADHD assessments in many parts of the UK, a BBC investigation has found.

Through Freedom of Information requests, the BBC has identified 24 services in that position, and nearly 200,000 people waiting.

The Royal College of Psychiatrists said no-one should be made to wait years for life-changing care. The new Labour government says delays to ADHD diagnosis are part of a “broken NHS” - which it is working to fix.

The long waits have been caused by rising demand - referrals have increased fourfold since 2019 - and three trusts have closed their waiting lists completely.

The BBC found one trust, Sheffield, has a waiting list of more than 6,000 people and assessed only three patients last year. Only two providers look able to work through their backlogs in less than a year. All four governments in the UK say they are working to improve matters.

There is no official list of adult ADHD service providers in the UK, but the BBC understands there are 70. Sixty-six responded to our request for information and 44 gave the BBC enough information to calculate their backlog.

“We’re seeing more people than ever seeking support from ADHD services which are struggling to meet this demand,” the Royal College of Psychiatrists told the BBC.

NHS England says it has “launched an independent expert taskforce which will investigate the challenges facing ADHD services and help them manage the rising numbers of referrals.”

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Source: BBC News, 25 July 2024

Further reading on the hub: Long waits for ADHD diagnosis and treatment are a patient safety issue

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Sexual predator NHS doctors target vulnerable medical students during training, campaigners warn

Medical schools have been urged to protect students who face sexual assaults and “sinister” behaviour from senior doctors, who see them as easy targets, campaigners have warned.

Scores of students have come forward with stories of doctors, groping them and making inappropriate comments while they are being trained in hospitals, according to the campaign group Surviving in Scrubs. The group, which aims to address sexual harassment facing medics in the NHS, has raised new concerns over vulnerable students who it says are facing abuse while on training placements in hospitals, It is urging NHS and university leaders to protect vulnerable trainees.

Becky Cox, a GP and founder of Survivors in Scrubs, told The Independent: “When they’re out on placement qualified doctors will make inappropriate comments about their appearance and more sinister behaviours, there was a student who was sexually assaulted in the car on the way to the placement. The power dynamic is much greater for students. By and large, this is senior doctors perpetrating this. Medical students are right at the bottom of the food chain, and we feel they are specifically targeted and because the perpetrators know there is very little the students can do to challenge the behaviour, they’re unlikely to raise a concern.”

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Source: The Independent, 24 July 2024

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Pregnant women suffer racist and discriminatory abuse at NHS trust, says inquiry head

Expectant mothers at a scandal-hit NHS trust have experienced “discriminatory and racist behaviour” including staff mimicking their accents and refusing to provide interpreters, according to the head of an inquiry into its failings.

As part of the largest inquiry into a single service in the history of the NHS, Donna Ockenden’s team is conducting a review with more than 1,900 families who have experienced stillbirth, neonatal death, maternal death or babies diagnosed with brain damage at Nottingham University hospitals NHS trust (NUH).

Ockenden, a senior midwife, said she had concerns about reports of racist behaviour uncovered during her interviews with families and 744 staff members who have come forward to participate in the review.

“Both family and staff are reporting discriminatory and racist behaviour,” Ockenden told the Guardian. “Local women of Asian origin are reporting white women in the bed opposite being treated more kindly. They have had their accents mimicked, their facial movements mimicked, have been made fun of and seen staff laughing at them."

Ockenden said women were often not able to give informed consent to difficult procedures as they were told they “understood enough” when they asked for an interpreter. She added that she had found women from the most deprived backgrounds, of all races, were “certainly reporting to me very negative experiences of maternity services.”

Anthony May, the chief executive of NUH, said: “I want to apologise to these women and families for the shortcomings identified and pain caused. I also apologise to anyone who has experienced racism in our hospitals."

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Source: Guardian, 24 July 2024

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Faulty pathology system causes ‘significant’ issues for GPs

An ongoing fault with an acute trust’s new pathology system has left GPs with ‘significant’ workload issues and ‘anxiety’ for patient safety. 

At the start of this month, University Hospital Southampton (UHS) trust transferred to a new pathology IT system which resulted in issues with processing blood tests and communicating results. 

Wessex LMCs said the trust has shown a ‘distinct lack of understanding’ of general practice, which has caused ‘large issues’ and ‘an enormous associated workload’ for GPs.

GPs in the area told Pulse that there was immediately a ‘massive backlog’ from 1 July, as blood test requests were sent using the ‘old forms’ which the lab could not process quickly enough. 

However, one GP partner, who wished to remain anonymous, said there was ‘absolutely no communication with primary care’ to clarify that the old forms should not be used. 

As a result of this backlog, UHS introduced a ‘temporary measure’ which told GP practices they could only request ‘urgent blood tests’, meaning all routine blood tests were suspended.

This restriction was lifted last week, and UHS has since cleared the initial backlog, however GPs told Pulse that they are still not receiving blood test results, and those they do receive are often not in the correct format. 

Another Southampton GP partner, who preferred to remain anonymous, said that on top of the initial backlog – caused by slow processing of old forms – there has also been a ‘significant proportion of path results that aren’t coming into GP systems’. 

In one surgery, around 70% of bloods requested in one week had not yet received results. The GP partner said that "results are being processed at the hospital" but GPs "can’t see them" as a result of faults with the system.  She continued: "We are trying to make clinical decisions based on results and we’re not seeing them […] It’s causing a significant degree of anxiety and concern for patient safety."

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Source: Pulse, 23 July 2024

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Dementia diagnoses in England reach record high

Record numbers of people in England are being diagnosed with dementia, new figures have revealed.

The data from NHS England, which cover people of all ages, showed that 487,432 people were diagnosed with dementia in June this year. This was almost 5% more than the figure of 465,516 for the same time last year, and 0.65% more than the figure of 484,277 for May 2024.

Dementia diagnosis rates are currently the highest they have been since the start of the COVID-19 pandemic, according to NHS England. It acknowledged that the NHS has more to do to meet its ambition to diagnose 66.7% of the total number of people estimated to be living with some form of the disease.

However, dementia diagnosis rates have yet to return to prepandemic levels. The estimated dementia diagnosis rate fell by 5.4% between March 2020 and February 2023, from 67.4% to 62%.

Dr Jeremy Isaacs, national clinical director for dementia, NHS England said, "NHS staff have worked hard to recover services with the number of people with a diagnosis rising significantly over the last year, and now at a record level."

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Source: Medscape, 23 July 2024

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Hope for cancer patients as NHS tracking system could prevent treatment delays

Cancer patients could be spared the devastating consequences of their tissue samples being lost thanks to a new tracking system being tested in the NHS.

The loss of tissue samples can mean vulnerable patients are forced to redo biopsies, therefore delaying diagnosis and treatment. Lost samples cost the NHS an estimated £157m in claims every year.

However, losing samples could soon be a thing of the past in the NHS, as one of the UK’s largest health trusts tests a new tracking system its inventors hope will lead to a rollout in hospitals worldwide.

Leeds Teaching Hospitals NHS Trust, which deals with tens of thousands of cancer cases every year, will trial a real-time tracking system for cancer tissue samples.

The system is based on radio frequency identification (RFID) technology that is widely used in the retail and logistics industry to track assets and has been specially adapted to help improve treatment for people with serious and life-threatening conditions.

Dil Rathore, the trust’s biomedical scientist and pathology innovation lead said, "The stress and anxiety felt by patients awaiting a potential cancer diagnosis can be made much worse if they are told their sample has been lost. Unfortunately, this ‘never-event’ happens more often than is acceptable. That’s why we came up with a real-time system to track the precise location of each sample and its movement through our histopathology department. The interpretation of changes in tissue forms the foundation of successful cancer treatment.”

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Source: inews, 21 July 2024

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NHS finances so dire that whole service may collapse, says spending watchdog

The NHS’s finances are so dire that the whole health service may break unless it receives a massive cash injection, Whitehall’s spending watchdog has warned.

Years of underfunding have left the NHS in England so cash-strapped that it cannot treat patients quickly enough, and the rising tide of ill-health will make matters worse, the National Audit Office (NAO) said.

The NAO does not specify how much extra funding the health service needs to get it back on its feet and ensure trusts that provide care can balance their books. But a leading thinktank recently put that figure at £38bn more a year by the end of this parliament.

Its grim conclusions raise serious questions about whether Keir Starmer’s government can fulfil its ambitious pledges to rescue the NHS, and again meet key waiting time targets on surgery and A&E care, without spending significantly more money.

The NAO said: “When we consider how the health needs of the population look set to increase, we are concerned that the NHS may be working at the limits of a system which might break before it is again able to provide patients with care that meets standards for timeliness and accessibility. There is a wider question for policymakers to answer about the potential growing mismatch between demand for NHS services and the funding the NHS will receive. Either much future demand for healthcare must be avoided, or the NHS will need a great deal more funding, or service levels will continue to be unacceptable and may even deteriorate further.”

A Department of Health and Social Care spokesperson said, “Not only has this government inherited the worst economic circumstances since the second world war, but also an NHS in deficit. Getting the NHS back on its feet is our priority, but it will take time."

Read the National Audit Office report NHS financial management and sustainability 2024 on the hub

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Source: Guardian, 23 July 2024

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First-of-its-kind guidance aims to ensure safety and dignity of trans patients

A first-of-its-kind set of guidelines for the care of transgender people before and after general surgery has been created.

The guidelines recommend gender-inclusive language and consideration of whether a patient should be accommodated in a single room rather than on a ward.

The guidance, created independently of the NHS, is said to have been put together amid a “dearth of knowledge and confidence amongst anaesthetists when caring for transgender and gender-diverse patients”.

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Source: Independent, 24 July 2024

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Pregnant women suffer racist and discriminatory abuse at NHS trust, says inquiry head

Expectant mothers at a scandal-hit NHS trust have experienced “discriminatory and racist behaviour” including midwives mimicking their accents and refusing to provide interpreters, according to the head of an inquiry into its failings.

As part of the largest inquiry into a single service in the history of the NHS, Donna Ockenden is speaking with more than 1,900 families who have experienced stillbirth, neonatal death, maternal death or babies diagnosed with brain damage at Nottingham University hospitals NHS trust (NUH).

Ockenden, a senior midwife, said she had concerns about reports of racist behaviour uncovered during her interviews with families and 744 staff members who have come forward to participate in the review.

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Source: The Guardian, 24 July 2024

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Weight-loss drug approved for heart problems in UK

Weight-loss treatment Wegovy has been approved by the UK's medicines regulator, for reducing the risk of serious heart problems in overweight and obese people.

Wegovy contains the drug semaglutide, which is already prescribed on the NHS to help some people with a body-mass index (BMI) above 26 lose weight.

And it now becomes the first anti-obesity drug to be used to control heart attacks and strokes in people with established heart problems and a similar BMI.

A trial of 17,600 people suggested weekly semaglutide injections for up to five years reduced major cardiovascular events by 20%.

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Source: BBC News, 23 July 2024

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Exclusive: Lack of surgery capacity adding to risk for babies and mothers

A lack of surgery capacity at dozens of maternity units is adding to risk of serious harm to mothers and newborn babies, HSJ has found.

An investigation established that at least 33 units nationally have no second dedicated obstetric theatre for emergency Caesarean sections and found evidence this was delaying operations beyond the safe period in some cases.

HSJ also found multiple examples of safety incidents linked to C-sections delayed due to a lack of quick access to staffed theatres and regulatory concerns.

Read full article (paywalled)

Source: HSJ, 24 July 2024

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GP industrial action may hit all services, ICBs and trusts warned

Integrated care boards and trusts should develop plans to deal with potential “whole system” impact of GP “collective action” from next week, NHS England has warned.  

In a letter to ICB and trust leaders this evening, NHSE asked systems to make a “best estimate” of the knock-on effects across urgent and emergency care, electives and discharge, and community and mental health.

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Source: HSJ, 22 July 2024

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Dementia diagnoses in England hit a record high, NHS data reveals

The number of people in England being diagnosed with dementia is at a record high as the NHS begins to recover from a post-pandemic dip, according to figures.

The latest data shows a record 487,432 people had a diagnosis in June – up from 77,112 in the same month last year.

While diagnosis rates are at their highest since the start of the pandemic at 65 per cent, the health service said it still has more to do to meet its ambition of diagnosing 66.7 per cent of the total number of people estimates suggest are living with a form of the disease.

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Source: Independent, 22 July 2024

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Woman died after begging GP for help - inquest

A young woman died months after begging her GP for help with her chronic fatigue syndrome, an inquest heard.

Maeve Boothby-O’Neill, 27, had written to her doctor asking for help with feeding as she was hungry.

Ms Boothby-O’Neill had been diagnosed with myalgic encephalomyelitis (ME). She died at home in Exeter, Devon, in October 2021.

The inquest, which is scheduled to last two weeks, continues.

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Source: BBC News, 22 July 2024

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Babies died after hospital neglect - inquest jury

Two premature babies died within weeks of each other after neglect by a hospital, an inquest jury has found.

Westminster Coroners’ Court heard Elena Ali and Sunny Parker-Propst were both given sodium nitrite instead of sodium bicarbonate in 2020 while under the care of staff at Chelsea and Westminster Hospital.

On Monday they returned verdicts of unlawful killing contributed to by neglect for baby Sunny, and accidental death contributed to by neglect for baby Elena.

Lesley Watts, chief executive of Chelsea and Westminster Hospital NHS Foundation Trust, said: “We apologise unreservedly for the failings in care provided to Elena and Sunny."

Ms Watts added: “We took immediate action to put measures in place to prevent such tragic incidents from happening again.”

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Source: BBC News, 22 July 2024

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AI could solve ‘disgraceful’ structural problems, says minister

Artificial intelligence could be used to figure out the causes of “disgraceful” structural problems like the higher rates of maternal mortality for black women, a minister told a conference yesterday.

Health minister Karin Smyth said AI could be used not only for clinical and administrative functions but also to “diagnose” issues. She also said the way government funded AI adoption needed to change.

Ms Smyth, a former NHS manager, was giving her first speech as a minister at a Health Foundation conference on AI. The conference also heard from leading tech experts who said the UK was “exceptionally well placed for a global leadership role in health and AI”.

Read full article (paywalled)

Source: HSJ 

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One in five patients don’t know the difference between doctors and physician associates, watchdog warns

Almost a quarter of people do not know the difference between a physician associate and a doctor, according to a new poll.

While 52 per cent of people can differentiate between the two roles, some 23 per cent said they did not know the difference, the survey conducted for Healthwatch England has revealed.

The organisation, which represents the interests of patients across England, has called for more clarity around the role of physician associates (PAs).

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Source: Independent

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