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NHS physician associates should not diagnose untriaged patients, review finds

NHS physician associates should be banned from diagnosing patients who have not already been seen by a doctor, a government review has concluded.
The review calls for the government to overhaul the role of physician associates (PAs), who it says have been substituted in for doctors to fill staffing gaps despite having significantly less training.
Prof Gillian Leng, the president of the Royal Society of Medicine, spoke to more than 1,000 people for the review and concluded there were “no convincing reasons to abolish the roles of AA or PA” but there was also no case “for continuing with the roles unchanged”.
She wrote in the report: “Despite the significantly shorter training, PAs and to a lesser extent AAs have sometimes been used to fill roles designed for doctors. The rationale for doing this is unclear, and was probably one of pragmatism and practicality, relying on medical staff to provide the additional expertise when required.
“This lack of planning may have been responsible for driving the resentment felt by some resident [doctors] and potentially exposed patients to unnecessary risk.”
One of her main recommendations is that PAs should not see “undifferentiated or untriaged patients”, meaning those who have not yet been diagnosed by a doctor. Leng recommended further work to establish which patients they should be able to see and to set clinical protocols that would enable PAs to diagnose patients with mild ailments.
The report found that “relatively few doctors felt it was appropriate for PAs to diagnose illness” and it identified disparities between the tasks PAs considered right for them to carry out and what doctors thought.
Leng recommended that newly qualified PAs work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts, enabling them to start their careers where there are more training opportunities and supervision.
She also recommended more leadership training for doctors, who shared concerns about the lack of preparation for supervision duties, and better career development for PAs and AAs. She suggested a named doctor supervise each PA, while uniforms, lanyards, badges and staff information should be standardised to “distinguish physician assistants from doctors”.
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Source: The Guardian, 16 July 2025
Related reading on the hub:
Physician associates: What are the patient safety issues? An interview with Asif Qasim Partha Kar: We need a pause to assess safety concerns surrounding Physician Associates
Patient Safety Learning

Mental health care ‘being rationed’ over failure to cut spiralling waiting list, top doctor warns

Mental health care is being rationed because the government is failing to tackle the spiralling waiting list, the UK’s top psychiatrist has warned, with 48,000 people facing delays of more than two years for treatment to start.
Nearly 1.7 million people were waiting for community care, such as a psychologist or psychiatrist appointment, for treatments including everything from severe depression to serious personality disorders at the end of December 2024.
That is up from 1.3 million in March 2024 and is in addition to the 7.4 million people on the countrywide NHS waiting list, which only counts patients with physical health problems.
Dr Lade Smith, president of the Royal College of Psychiatrists, said the figures proved that mental health care was being downgraded in favour of other services.
She said: “It’s very clear that there has been a prioritisation of services; mental health care is not one of those services. As far as I’m concerned, it’s been rationed for years. It’s not been prioritised, full stop. I say that because we’ve got 1.7 million people who were waiting for mental health services.
“They are not being prioritised and so there is rationing of mental health care, full stop.”
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Source: The Independent, 14 July 2025
Patient Safety Learning

Many cancers no longer 'a death sentence' as treatment on 'cusp of golden era', NHS England medical director says

Many people with a cancer diagnosis "should be confident that it's not a death sentence and that more treatments will become available", according to the outgoing medical director of NHS England.
In his final interview before retiring, Professor Sir Stephen Powis said our understanding of the genetics of cancer and how it can be targeted is being "revolutionised".
Sir Stephen, 64 and a kidney specialist who has been the national medical director since 2018 and throughout the COVID pandemic, told The Times: "We are at the cusp of a golden era in terms of the way we treat a range of cancers.
"For many cancers now, people should be confident that it's not a death sentence and that more treatments will become available."
"We can't prevent all cancers, but there are cancers that we can certainly prevent," he said, adding that he hopes lung cancers will become "a lot rarer".
Cancer treatment, he said, would be "driven by genetics" to become more individualised with the increased ability to pinpoint mutations in cells.
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Source: Sky News, 14 July 2025
Patient Safety Learning

Late attendance 'driving trust’s high stillbirth rate'

Delays in seeking help among women from deprived communities or with poor English are a major contributor to high stillbirth rates, according to a review by a trust trying to reduce deaths.
A report by the Calderdale care partnership quality group, part of West Yorkshire Integrated Care Board, said that in Calderdale and Huddersfield Foundation Trust’s two maternity units “reduced foetal movements is a significant cross cutting theme… [and] delay in attendance to the hospital to seek midwifery support and advice”.
It said delays were more common among women who lived in areas of higher deprivation or where English was not their preferred language. They were less likely to contact a hospital midwife and more likely to reach out to their GP or family when they were concerned during pregnancy.
Benash Nazmeen, an assistant professor of midwifery at Bradford University and a co-founder of the Association of South Asian Midwives, warned trusts against “making assumptions” about communities without understanding “the realities of their lives”.
She said: “For example, worse outcomes for Black and Asian mothers and babies have previously been attributed to higher levels of deprivation and complex care needs.
“Recent MBRRACE reports and the 2022 Confidential Inquiry into Maternal deaths show that these disparities persist even in affluent areas and that complex care needs are not exclusive to any one ethnic group.
”We cannot continue to rely on outdated assumptions. Instead, we must work collaboratively with communities to build trust, relationships and locally informed solutions to address the barriers which remain poorly understood.”
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Source: HSJ, 14 July 2025
Patient Safety Learning

Full-body scans of 100,000 people could change way diseases are detected and treated

Scientists expect to gain unprecedented insights into human ageing and the earliest signs of disease after scanning 100,000 people from head to toe in the world’s largest whole body imaging project.
The completion of the decade-long task means qualifying researchers worldwide will have access to 1bn de-identified images of the hearts, brains, abdomens, blood vessels, bones and joints of volunteers alongside medical histories and rich data on their genetic makeup, health and lifestyle.
Subsets of the images compiled by UK Biobank, which follows the health of half a million people in Britain, have already underpinned breakthroughs in how the heart influences psychiatric disorders and shown that the scans can predict dozens of future diseases. They also suggest no amount of alcohol consumption is healthy.
“Researchers now have an incredible window into the body,” said Naomi Allen, the chief scientist at UK Biobank. “For the first time, researchers can study how we age and how diseases develop in stunning detail and at a massive scale.”
“We hope that the findings … will change the way the world detects and treats disease before people get sick,” she added.
UK Biobank is now re-scanning 60,000 volunteers to see how people’s brains, bodies and bones change in the years after their first scan. Louise Thomas, a professor of metabolic imaging at the University of Westminster, has looked at body scans taken two years apart. “The results were shocking. The amount of visceral fat, the bad fat in the abdomen, had increased,” she said. Muscle also becomes more fatty. “As we get older, we become more and more marbled,” she said. “We’re becoming wagyu beef.”
Medical advances made from the images are expected to transform procedures in the NHS. One of Thomas’s colleagues automated the detection of aneurysms – life-threatening bulges in blood vessel walls. While men are already screened for them, women are not, even though they are more serious in women. “We can do lots of things we weren’t able to do before. It’s quite extraordinary,” Thomas added.
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Source: The Guardian, 15 July 2025
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UK worst in G7 for MMR jab rates, as 30m children worldwide not fully immunised

Millions of children worldwide are at growing risk of serious illness and death due to declining infant vaccination rates, experts have warned, while the UK ranks worst of major western economies for MMR immunisation.
Figures released by the World Health Organization and Unicef show that more than 30 million children worldwide are not fully immunised against measles, mumps and rubella and 14.3 million children have not received a single routine infant vaccination.
While the figures show that measles coverage improved slightly last year, reaching 2 million more children than in 2023, vaccination rates have gone backwards in some middle- and high-income countries and stagnated in other regions, leaving children increasingly vulnerable to outbreaks of the disease.
Across 53 countries in Europe and central Asia, vaccination coverage dropped by an average of one percentage point on 2019 levels. In 2024, more than half of the countries in the region did not meet the 95% vaccination rate required to reach herd immunity for measles. Almost a third reported coverage below 90%.
Unicef warned that without concerted action, millions more children could die or fall seriously ill from measles. Ephrem Tekle Lemango, the chief of immunisation at Unicef, said while more children were being vaccinated overall and global coverage was “inching upward”, progress was “not keeping pace with the threat”.
He said: “In 2024 alone, over 20 million children globally missed their first measles dose and nearly 12 million missed their second – leaving dangerous immunity gaps that continue to fuel outbreaks.
“Measles is one of the most contagious viruses we face. Even small declines in coverage, especially in communities affected by conflict, displacement or weak health systems, can trigger devastating surges. To protect every child, we need to reach 95% coverage with two doses in every district, in every country. Until we do, millions of children remain at risk of serious illness or death from a disease we have the tools to prevent.”
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Source: The Guardian, 15 July 2025
Patient Safety Learning

A&E’s staff ‘not trained’ for mental health

Staff working in an understaffed A&E were unsure about who was responsible for the care of patients with mental health issues – potentially putting them at risk of harm, the Care Quality Commission has said.
In a letter to East Suffolk and North Essex Foundation Trust, the CQC warned there was a lack of clarity over who was responsible for patients with mental health issues at Colchester Hospital’s A&E – including over who should be completing their observations.
Inspectors also raised concerns about staffing levels, a lack of training, and monitoring of patients waiting in corridors.
The letter said: “We spoke with staff working in the emergency department who told us they did not have any special training for mental health patients. Staff told us this was concerning as they often cared for mental health patients.”
Staff also told the CQC they did not know what a corridor risk assessment was, despite a number of patients being cared for in corridors. The CQC warned of the problems in moving beds around in the corridor.
“If a patient were to deteriorate, it would be challenging to either take the patient to resuscitation or to get the resuscitation trolley to the patient,” the CQC said. Patients in corridor beds without call bells would not be able to summon help if they deteriorated, it added.
Read full story (paywalled)
Source: HSJ, 14 July 2025
Patient Safety Learning

'My voice box was removed after NHS missed my throat cancer'

Steve Barton is angry, and he has every right to be.
The 68-year-old retired engineer stares at his medical notes that, he says, expose in black and white the moment his life changed forever.
"I have somehow missed… due to my mistake," a doctor writes in one of the notes, after it became apparent that Mr Barton had not been urgently referred to specialists over what later became an aggressive form of throat cancer.
Steve now has a prosthetic voice box and is one of many British patients fighting medical negligence claims after being misdiagnosed.
NHS officials in Scotland are dealing with thousands of cases annually. Meanwhile, Westminster's Public Affairs Committee (PAC) recently disclosed England's Department of Health and Social Care has set aside £58.2bn to settle clinical lawsuits arising before 2024.
Mr Barton, who lives in Alloa near Stirling, repeatedly contacted his doctors after he began struggling with his breathing, speaking and swallowing. His concerns were recorded by the NHS as sinus issues.
As panic grew and his voice became weaker, Mr Barton paid to see a private consultant who revealed the devastating news that a massive tumour had grown on his larynx and required part of his throat to be removed immediately.
"I am angry, I am upset, I don't want anyone else to go through this," Mr Barton told Sky News.
"There were at least four, possibly five, conversations on the phone. He [the doctor] said to me that it sounds like I've got reflux."
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Source: Sky News, 13 July 2025
Patient Safety Learning

Child dies as measles cases surge at Liverpool hospital

A child with measles has died at a Liverpool hospital.
The individual was being treated at Alder Hey Children's Hospital after becoming ill with measles and other health problems.
It comes as the NHS hospital said it is "concerned" about the increasing number of children and young people who are contracting the highly contagious virus.
It said it has treated 17 cases of the effects and complications of measles since June.
"We are concerned about the increasing number of children and young people who are contracting measles. Measles is a highly contagious viral illness which can cause children to be seriously unwell, requiring hospital treatment, and in rare cases, death," the hospital said in a statement to Sky News.
In a separate open letter to parents and carers in Merseyside earlier this month, Alder Hey, along with the UK Health and Security Agency (UKHSA) and directors of Public Health for Liverpool, Sefton and Knowsley, warned the increase in measles in the region could be down to fewer people getting vaccinated.
The letter read: "We are seeing more cases of measles in our children and young people because fewer people are having the MMR vaccine, which protects against measles and two other viruses called mumps and rubella.
"Children in hospital, who are very poorly for another reason, are at higher risk of catching the virus."
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Source: Sky News, 13 July 2025
Patient Safety Learning

Victims of three medical products that caused 'avoidable harm' still awaiting redress

The dark granite block in a children's cemetery in Bristol tells an incomplete story: "Trelissa Whitbread, born 3rd of Feb 1988. She lived 2 hours."
Deborah Mann has not returned to the grave of her firstborn for 30 years but today has come with her daughter, Branwen, to tell her the story. "It shouldn't have happened," she says quietly.
Ms Mann had four pregnancies. Her first two children, Trelissa and Kaverne, died shortly after birth. Ms Mann believes their deaths were caused by an epilepsy drug she was taking called sodium valproate, prescribed by her GP.
After a long gap she would go on to have two more children, both girls, who were diagnosed with what is now recognised as foetal valproate syndrome, which has left them with life-long physical and neurological problems.
Ms Mann tells Sky News: "I asked so many questions and was told 'this is just the way things are.' It can't be the way things are when you lose two babies. How can it be the way things are?"
Five years ago, valproate was among three medical products including the pregnancy test drug Primodos and medical device pelvic mesh, that were found to have caused "avoidable harm" to patients.
The report was clear that valproate could cause lifelong disabilities to the children of mothers taking the drug when pregnant.
The independent review, chaired by Baroness Julia Cumberlege, strongly criticised the industry and regulators and made a series of recommendations, including the creation of a redress scheme for victims in all three groups.
Five years on there is still no such scheme for any of the campaign groups.
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Source: Sky News, 11 July 2025
Patient Safety Learning

Hospital boards not ready to run population health, says government adviser

Hospital trust boards are not currently in a position to run population health and “very few” acute chief executives “truly understand” primary care, government’s neighbourhood health adviser has told HSJ.
Sir John Oldham, A former GP and a senior adviser to Wes Streeting, told HSJ in an interview: “You can’t just take a hospital trust board and management and think that it will be able to run population health, because the skill set and knowledge set is really quite different.”
The 10-Year Health Plan, published last week, said high-performing trusts would be encouraged to evolve into “integrated health organisations”. Similar to accountable care organisations in the USA, they would take on a population-based budget to run – and commission – a wide range of acute, community, primary and social care services. Some will begin in 2026, and the plan says IHOs will “over time… become the norm”.
There are questions about how it will fit with the planned expansion of primary care-led neighbourhood health work, including two proposed new “neighbourhood provider” contracts.
Sir John, who is leading a new programme implementing neighbourhood health, said “deepening the connectivity with local authorities” was particularly important “when you’re developing IHOs, because if they just become hospital services being delivered in the same way in the community, then it will fail”. 
Read full story (paywalled)
Source: HSJ, 9 July 2025
Patient Safety Learning

Mesh victims ‘still fighting for justice’ five years on from review

Women harmed by vaginal mesh are “still fighting for justice”, campaigners have said on the fifth anniversary of a review into the scandal.
Sling the Mesh, a campaign group representing women harmed by mesh, accused governments of “dragging their feet” on implementing all the recommendations set out in the report.
The review examined how the health service responded to concerns over pelvic mesh – which has been linked to crippling, life-changing complications including chronic pain, infections and loss of sex life; the anti-epilepsy drug sodium valproate – which has been linked to physical malformations, autism and developmental delay in many children when it is taken by their mothers during pregnancy, and hormone pregnancy tests such as Primodos – which are thought to be associated with birth defects and miscarriages.
It concluded that patients came to “avoidable harm” because the healthcare system failed to respond in a speedy and appropriate way when serious concerns were raised about some medical treatments.
The First Do No Harm review, published in 2020, found patients were “dismissed” and “overlooked”, while the healthcare system had a “glacial” and “defensive” response to concerns over treatments.
It set out a series of recommendations, but campaigners have said that to date, some three of the nine recommendations set out in the review have been implemented.
One of the key recommendations of the report was the appointment of a Patient Safety Commissioner, who would be an “independent public leader with a statutory responsibility”.
A commissioner was appointed, but following the Government’s 10-year plan for health last week, it has been confirmed that this role will be transferred into the MHRA.
Ms Sansom said: “Moving the Patient Safety Commissioner role to the MHRA silences the patient voice instead of strengthening it.
“It strips away independence, undermines trust, and betrays the very women this role was created to protect.”
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Source: Yahoo News, 8 July 2025
Patient Safety Learning

South Africans fear spike in HIV infections as US aid cuts bite

Gugu used to collect her antiretrovirals from a USAID-funded clinic in central Johannesburg.
But when President Trump's cuts to aid funding were announced earlier this year, she and thousands of other HIV-positive patients across South Africa suddenly faced an uncertain future.
Gugu was lucky, the clinic where she got the medication that helps suppress her symptoms contacted her before it closed down.
"I was one of the people who was able to get their medication in bulk. I usually collect a three-month prescription. But before my clinic closed, they gave me nine months' worth of medication."
She will run out of antiretrovirals (ARVs) in September, and then plans on going to her local public hospital for more.
She currently works as a project coordinator for an NGO.
"We help pregnant sex workers get their ARVs, to ensure their children are born HIV-negative. We also do home visits to make sure that the mothers take their medication on time, and to look after their babies when they go for their monthly check-ups."
Many HIV-positive sex workers in South Africa relied on private clinics funded by the US government's now-defunct aid agency, USAID, to get their prescriptions and treatments.
But most of the facilities closed after US President Donald Trump cut most foreign aid earlier this year.
Gugu believes that many sex workers could be discouraged from going to public hospitals for their ARVs if they can no longer get them from clinics.
"The problem with going to public hospitals is the time factor. In order to get serviced at these facilities, you have to arrive at 4 or 5am, and they may spend the whole day waiting for their medication. For sex workers, time is money," Gugu says.
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Source: BBC News, 10 July 2025
Patient Safety Learning

Surgeon banned by private practice is working for NHS

A surgeon banned from working for a private healthcare company, following an investigation into patient safety, continues to work in the NHS, the BBC has learned.
Nuffield Health has stopped the surgeon from working in their hospitals, but he is still operating on patients for the University Hospitals Sussex NHS Foundation Trust.
An NHS patient left with a twisted bowel following an operation he carried out said he should never work again.
In January the BBC revealed concerns had been raised about the surgeon's complication rate and that he was no longer practising at Nuffield Health's hospital in Brighton pending an investigation.
A former employee at the hospital told the BBC that internal data showed one third of the surgeon's patients had experienced a "moderate harm event", where, for instance, a patient had to be transferred to another hospital or re-admitted, over a 12-month period. The figure should be 5%, the BBC was told.
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Source: BBC News, 11 July 2025
Patient Safety Learning

Minority ethnic and deprived children more likely to die after UK intensive care admission

Minority ethnic children and children from deprived backgrounds across the UK are more likely to die following admission to intensive care than their white and more affluent counterparts, a study has found.
These children consistently had worse outcomes following their stay in a paediatric intensive care unit (PICU), the research by academics at Imperial College London discovered.
The study showed they were more likely to arrive at intensive care severely ill, more likely to die after admission, and more likely to stay longer or be readmitted unexpectedly after discharge.
The report, published in the Lancet Child & Adolescent Health, looked at 14 years of UK-wide data between 2008 and 2021, commissioned by the Healthcare Quality Improvement Partnership, on more than 160,000 critically ill children aged 15 and younger.
While previous studies have shown that minority ethnic children have an increased rate of admission to PICUs, this study is the first to look at the health outcomes of these children, and children from more deprived backgrounds, following admission.
More specifically, Asian children were 52% more likely to die following admission to a PICU than their white counterparts. Their mortality rate was 1,336 deaths per 26,022 admissions, compared with a rate of 4,960 deaths per 154,041 admissions for white children, who had the lowest mortality rate overall.
Dr Hannah Mitchell, the lead author of the study from the department of surgery and cancer at Imperial College London, said the reasons behind this disparity were complex and could be due to structural factors such as discrimination and language barriers.
Prof Padmanabhan Ramnarayan, the senior author of the study, said: “These children may face discrimination, both within and outside healthcare, which can lead to hesitancy seeking help or delays accessing urgent care. Language barriers may further complicate access.
“Children from some ethnic minority groups have a higher prevalence of complex or life-limiting conditions, making them more vulnerable. Children living in poverty are more likely to develop serious illnesses such as asthma or traumatic injuries, and may struggle to access timely care due to difficulties getting help from GPs or A&E.”
Patient Safety Learning

Nearly a third of US teens have prediabetes, CDC finds

Nearly a third of U.S. teens are prediabetic, according to new data from the Centers for Disease Control and Prevention.
In 2023, a count found that an estimated 8.4 million adolescents between the ages of 12 and 17 – or 32.7 percent – fell into that category.
The alarming results are a “wake-up call,” Dr. Christopher Holliday, the agency’s top official in charge of diabetes prevention, said in a statement to ABC News. He said that the risk of type 2 diabetes poses a "significant threat" to young people's health.
With prediabetes, a person’s blood sugar levels are higher than normal but not high enough for a type 2 diabetes diagnosis. Having prediabetes increases your risk of developing type 2 diabetes, as well as heart disease and stroke. Diabetes is the seventh leading cause of death in the U.S.
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Source: The Independent, 8 July 2025
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