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News ArticleA five-year-old was left traumatised, bleeding and in severe pain after a physician associate wrongly prescribed her a vaginal pessary, according to a damning report by the health ombudsman. The parliamentary and health service ombudsman (PHSO) said there were “multiple failures” in the care of the girl, who saw a physician associate (PA) at a GP practice in the East Midlands after complaining of itching and vaginal discharge. The PA suspected thrush and recommended a vaginal pessary and cream. The five-year-old’s mother, who believed her daughter was being seen by a GP, questioned the treatment and the size of the pessary, but was reassured that it was appropriate. PAs do not have prescribing rights and their work must be supervised by a doctor who approves the prescription. But the ombudsman found there was no discussion between the PA and GP before the GP authorised the prescription, even though vaginal pessaries are not suitable for prepubescent children and the girl’s symptoms were consistent with vulvovaginitis, not thrush. There was also no questioning of the prescription by the pharmacy that dispensed it. The mother said that after inserting the pessary, her daughter began to bleed and scream in pain, while the cream burned the girl’s skin. She took her to see an out-of-hours doctor. However, the girl was so distressed and in pain that she asked the doctor not to examine her internally, causing the GP to raise concerns about possible sexual abuse and to contact safeguarding services. Although it was established the girl’s symptoms were caused by the pessary and cream, not sexual abuse, the mother said the experience was distressing, embarrassing and further added to her trauma. She said: “I had huge guilt for doing what the PA, who I thought was a GP, told me and feeling as if I had inflicted this trauma on my daughter. “But I trusted what [they] told me. How are we meant to trust healthcare professionals now?” Rebecca Hilsenrath, the chief executive of the parliamentary and health service ombudsman, said the “deeply troubling case” was all the more concerning because it could easily have been avoided. “The breakdown in communication meant the checks and balances designed to make sure patients are treated appropriately and kept safe were not followed.” Read full story Source: The Guardian, 5 June 2026
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Content ArticlePhysician Associates were supposed to ease doctor’s caseloads. Instead they’ve been accused of stealing jobs, confusing patients and failing to prevent at least four deaths. Are their days numbered? Dr Phil Whitaker gives his prognosis in this Times article. You’ve probably phoned your local surgery — or filled in the online form — only to be told the GP can’t fit you in, but a physician associate can see you. Or perhaps you’ve been to A&E and been assessed by a scrubs-clad “PA”, introducing themselves as “one of the medical team”. It’s better to be seen by somebody than nobody, you thought, and you trust the NHS to ensure you’ll be seen by someone qualified to help. Together, the words “physician” and “associate” at least sound reassuring. Yet a series of revelations over the past three years, including four coroners’ reports into patient deaths, have raised serious concerns about the way the health service has deployed this type of NHS worker. Some in the medical profession are asking: should the job even exist at all? Maryam Habib was on her way to the waiting room to collect her first patient of the morning when she spotted something odd on her consulting room door: someone had changed her job title. When she’d left for her summer holiday two weeks earlier the sign had identified her as a “physician associate”, as it had done for the three years she’d been working at her GP surgery in Manchester. Now her own door told her she was something else: a “physician assistant”. The change wasn’t just cosmetic for Habib. She noticed that the appointment slots earmarked for her to assist the duty doctor with the day’s urgent workload had been blocked. She was also told by the practice manager that she was now banned from seeing anyone under the age of 16. Young patients she’d been working with for months, building rapport and trust, were abruptly transferred to an unfamiliar GP. “For the first time I didn’t feel welcome in my workplace,” Habib, 27, tells me. “I felt like a lesser colleague.” She started to overthink every decision, feeling acutely vulnerable in case she put a foot wrong. “It went from 0 to 100 really quickly.”
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Content ArticleThe past decade has seen a steady movement towards expanding the roles of different healthcare professionals, including physician assistants, nurses, and pharmacists, driven by the belief that there aren’t enough doctors to cover all the work. This has given other professionals greater scope to take on tasks traditionally performed by doctors. This trend came to a head with the planned expansion of physician assistant roles, which led to pushback from doctors about how it could encroach on their roles, training, and progression. The escalation of the debate prompted the Leng review on the safety and effectiveness of physician associate roles. Seven months on from that review, the Royal College of Physicians hasn’t firmed up its interim document on scope, nor have steps been taken to stop these roles being advertised, although the adverts have declined. It feels as though everyone has ducked their responsibility to implement the review’s recommendations, writes Partha Kar in an opinion piece for the BMJ.
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News Article
NHS cuts use of physician associates over ‘substitute doctor’ fear
Mark Hughes posted a news article in News
The NHS has reduced the use of physician associates after a government review found that they were being used as a “substitute” for doctors, a survey has suggested. The number of physician associates (PAs) averaging more than 11 patient interactions — including consultations, follow-ups, results and referrals — per shift, has dropped since publication of the Leng review in July. More than three-quarters (76 per cent) of PAs said their scope of practice had been restricted in recent months. The findings come from a survey of 457 associates by United Medical Associate Professionals (UMAPs), the physician associates union. Read full article (paywalled). Source: The Times, 29 January 2026 -
News ArticleDoctors, physician associates (PAs) and anaesthesia associates (AAs) must speak up if they spot patient safety concerns, and healthcare leaders must act when issues are raised with them, the General Medical Council (GMC) says as it launches a review of key guidance. The GMC is seeking views on two pieces of its guidance, Raising and acting on concerns about patient safety and Leadership and management. Both pieces of guidance play crucial roles in setting positive workplace culture standards that prioritise patient safety. They make clear the regulator’s expectations on when and how concerns should be raised, as well as how those in management positions should respond. The regulator is ensuring the guidance reflects developments across the UK’s healthcare systems, and wider social changes, while remaining clear, relevant and helpful. It will be the first significant updates since they were published in 2012. Earlier this year results from the GMC’s annual national training survey revealed that more than one in five trainee doctors were hesitant about escalating concerns about patient care, and GMC Chief Executive Charlie Massey warned, in a speech in September, that maternity services were at risk from harmful cultures that put ‘cover-up over candour’ and ‘obfuscation over honesty’. Professor Pushpinder Mangat, Medical Director and Director of Education and Standards at the GMC, said: "Our guidance is there to provide support and confidence, as well as practical help, for people to speak up when necessary. But speaking up is no good in isolation. Leaders and managers have a duty to act when concerns are raised with them. ‘Whenever we update guidance, it is important we hear views from a range of respondents. Their voices and real-life experiences will be instrumental in ensuring our guidance is clear, relevant, and helpful, and reflects the needs of everyone it affects." Read full story Source: GMC, 3 November 2025
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Content ArticleThe Royal College of Physicians (RCP) has published new interim guidance on the scope, supervision and employment of physician associates (PAs) working in the medical specialties (also known as the physician specialties). The interim guidance covers scope of practice for general internal medicine, supervision and employment of PAs, and how PAs should describe their role to patients, employers, other healthcare professionals and the public. It will be reviewed in collaboration with stakeholders, including RCP fellows and members, following the publication of the report of the Leng review. In the guidance, the RCP is clear that: PAs must support – not replace – doctors, have a nationally defined ceiling of practice, and have a clearly defined role in the multidisciplinary team (MDT). PAs must never function as a senior decision maker, nor should they decide whether a patient is admitted or discharged from hospital. Resident doctors are not, and must not be expected or asked to be, responsible for the clinical supervision of PAs. PAs should only be supervised by consultants, specialist or associate specialist doctors. PAs cannot prescribe medications regardless of any prior healthcare background while working as a PA. PAs must clearly explain their role to patients, their families and carers, as well as colleagues and supervisors, and provide details of their educational and clinical supervision when required.
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Content ArticleThis was a debate in the House of Lords on the 5 December 2024 considering what the review, announced by the Secretary of State for Health and Social Care on 20 November, of the physician associate (PA) and anaesthetist associate (AA) roles will cover and what actions they plan to take in advance of the outcome. Key points raised by peers in this debate included: The remit of the review, and whether this should extend to consider the impact of the PA role on training opportunities for resident doctors and the “taskification” of medicine. With the Government having announced that the review will be published in spring 2025, wherever any interim measures will be put in place in the meantime to address patient safety concerns relating to PA and AA roles. A suggestion that it is time to pause the recruitment of PA and AA roles and to halt the expansion of their numbers, particularly until after the Government review reports. Concerns that individual cases have been cited to then equate the lack of patient safety with all PAs or AAs. The value of the NHS undertaking a refreshed national public campaign to raise awareness of PAs and what they do. Responding to comments in the debate on behalf of the Government, Baroness Merron (Parliamentary Under-Secretary of State for Patient Safety, Women's Health and Mental Health) stated the following points: The Government review will cover training, recruitment, day-to-day work, oversight, supervision and professional regulation. It will assess the safety of the PA and AA roles relative to existing professions, the contribution that the roles can make to more productive use of professional time in multidisciplinary teams and whether the roles deliver good-quality and efficient patient care in a range of settings. All the above matters, among others that peers have raised in this debate today, will be considered as part of the review. On interim action, she noted that NHS guidance remains in place on PA and AA deployment while the review is ongoing. Furthermore, NHS England continues to engage with NHS organisations to ensure that this guidance is adhered to. You can watch the debate in full here. Related reading Government launches independent review of Physician and Anaesthesia Associate professions (20 November 2024) Physician associates: What are the patient safety issues? An interview with Asif Qasim (12 November 2024)
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Content ArticleRecent guidance from both the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) has sparked significant discussion about Physician Associates (PAs) in general practice. While headlines might seem concerning, this blog aims to break things down for primary care managers.
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Content ArticleUpcoming regulation will hold physician associates and anaesthesia associates to higher standards, ensuring safer patient care and stronger accountability while addressing doctors’ concerns on team integration; however, there is still more to be which requires our collective energy to find solutions that deliver for all those who work in our health services, and ultimately for all those who rely on them for their care.
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Content Article
In this interview, Helen Hughes speaks to Asif Qasim, Consultant Cardiologist and Founder of MedShr, about the role of physician associates (PAs) in the NHS. They discuss the patient safety issues arising from inappropriate use of PAs in both primary and secondary care and outline concerns about the planned rapid increase in the number of PAs working in the healthcare system. Asif describes the risks associated with PAs being employed to fill gaps in the doctor workforce and discusses how the lack of clarity for patients has contributed to serious patient safety incidents. He highlights the need for regulation, a clear scope of practice and a consistent level of supervision to ensure that patients receive safe care from PAs. Related reading Physician associates House of Commons debate in relation to the death of Emily Chesterton (6 July 2023) Prevention of future deaths report: Susan Pollitt (8 August 2024) Partha Kar: We need a pause to assess safety concerns surrounding Physician Associates A transcript of the interview is attached below. Join the conversation We'd love to hear your perspectives on the patient safety issues raised in this interview. Perhaps you are a healthcare professional with insights to share or a patient who has been seen by a physician associate? If you have an experience you would like to share with us, please do get in touch. You can join the conversation by commenting below (you'll need to sign up first) or get in touch with us directly by emailing [email protected]- Posted
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News Article
GMC approves 36 courses to teach more than 1,000 NHS physician associates
Patient Safety Learning posted a news article in News
More than 1,000 physician associates (PAs) could begin their careers in the NHS every year after regulators approved dozens of courses to teach them. The General Medical Council (GMC) said it had given 36 courses formal approval to teach PAs and anaesthesia associates (AAs). Overall, these courses had capacity for up to 1,059 PAs and 42 AAs to qualify each year. The GMC said approving training courses would mean that “patients, employers and colleagues can be assured that PAs and AAs have the required knowledge and skills to practise safely once they qualify”. Prof Colin Melville, the GMC’s medical director and director of education and standards, said: “This is an important milestone in the regulation of PAs and AAs and will provide assurance, now and in the future, that those who qualify in these roles have the appropriate skills and knowledge that patients rightly expect and deserve. “As a regulator, patient safety is paramount, and we have a robust quality assurance process for PA and AA courses, as we do for medical schools. We have been engaging with course providers for several years already, and we only grant approval where they meet our high standards.” Read full story Source: The Guardian, 30 April 2025 -
News ArticleCampaigners who are taking the General Medical Council (GMC) to court alleging failure to properly regulate physician associates (PAs) and anaesthesia associates (AAs) have been cleared to submit new patient safety evidence. A judge has granted Anaesthetists United’s bid to submit two reports that were published after it began its legal case, and which the GMC had argued were inadmissible, for a judicial review in the High Court on 13 and 14 May. One report is a systematic review published in The BMJ in March 2025, which found little evidence supporting the safety and efficacy of PAs and AAs in the UK.1 The other is a coroner’s regulation 28 “prevention of future deaths” report published in February 2025, regarding the death in 2024 of Pamela Marking, who was seen by a PA and died after having a nosebleed misdiagnosed. Read full story (paywalled) Source: BMJ, 10 April 2025
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News ArticleA coroner has issued a warning about the role of physician associates in NHS hospitals after a woman with severe abdominal problems was wrongly diagnosed as having a nosebleed and died four days later. The family of Pamela Marking, 77, were under the mistaken impression she had been seen by a doctor when she was examined in an emergency department, rather than a physician associate (PA) with far less training. Surrey assistant coroner Karen Henderson has written to 12 health leaders or bodies including the UK health secretary, Wes Streeting, and NHS England expressing concerns about the “limited training” PAs have and the lack of public understanding about their roles. In a prevention of future deaths report, Henderson said Marking was taken to East Surrey hospital in Redhill on 16 February last year after she vomited blood-stained fluid and had a tender abdomen. The coroner said the PA who saw her had “a lack of understanding of the significance of abdominal pain” and sent her home the same day. Marking deteriorated, returning to the hospital two days later. She underwent surgery for complications arising from a femoral hernia but died on 20 February 2024. Henderson said the PA had acted independently in the diagnosis, treatment, management and discharge of Marking without independent oversight by a medical practitioner. The coroner said: “Given their limited training and in the absence of any national or local recognised hospital training for physician associates once appointed, this gives rise to a concern they are working outside of their capabilities.” Read full story Source: The Guardian, 27 February 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 Prevention of future deaths report: Susan Pollitt (8 August 2024)
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News Article
BMA challenge to GMC on 'medical professionals' term goes to court
Patient Safety Learning posted a news article in News
A legal challenge brought by leading doctors against the medical regulator amid rising concerns over the use of physician associates is due to reach court. The British Medical Association (BMA) is bringing a case at the High Court in London against the General Medical Council (GMC), accusing the regulator of abandoning its responsibilities to patients' safety by blurring the lines between doctors and non-doctors. The BMA claims the GMC has been using the term "medical professionals" to describe all those it regulates – doctors as well as physician and anaesthesia associates (PAs and AAs). The association says the term should only be used to refer to qualified doctors. The BMA maintains that PAs and AAs are neither doctors nor medically qualified, with the distinction crucial to patient safety. It says there is evidence of widespread confusion in the public as to the roles of associates. The GMC has stated that each profession type is prominently labelled on its public-facing registers, and in search functions, meaning that when patients search its registers it will be clear whether someone is a doctor, a PA, or an AA. Read full story Source: Medscape, 12 February 2025 Further 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 -
Content ArticleThis debate was requested by Barbara Keeley MP of Worsley and Eccles South, following the death of Emily Chesterton, the daughter of her constituents Marion and Brendan Chesterton. Emily died in November 2022 after suffering a pulmonary embolism. She was just 30 years old when she died. The conclusion of the coroner was: “Emily Chesterton died from a pulmonary embolism, a natural cause of death. She attended her general practitioner surgery on the mornings of 31 October and 7 November 2022 with calf pain and shortness of breath, and was seen by the same physician associate on both occasions. She should have been immediately referred to a hospital emergency unit. If she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived.”
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Content ArticleIn this blog, Dr Nadeem Moghal looks at the recent case of a 30 year-old patient who died after a physician associate (PA) at her GP surgery failed to diagnose her with a pulmonary embolism. He outlines a recent debate about the role of PAs in general practice and why employing them has become an attractive option for GP partnerships, which run as businesses. He highlights the need for PAs to be adequately trained and supervised to ensure patient safety and argues that the role is here to stay as PAs play an important role in tackling gaps in the NHS workforce.
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Content Article
RCGP: Physician Associates update (October 2023)
Patient-Safety-Learning posted an article in GP and primary care
Physician associates (PAs) support doctors in the diagnosis and management of patient. They are often employed in general practice as members of the multidisciplinary team, trained in the medical model. This update outlines the Royal College of General Practitioners' (RCGP's) policy position on PAs. The RCGP sees PAs as having an enabling role to play for general practice, but highlights that they must always work under the supervision of GPs and must be considered additional members of the team, rather than a substitute for GPs. -
Content ArticleThere’s been much discussion in the press and on social media about the role of physician associates and anaesthetic associates. Who exactly are they, and how are they trained? The Department of Health and Social Care says that they’re “trained in the medical model”—but what does this actually mean? Helen Salisbury gives her thoughts in this BMJ opinion piece.
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Content ArticleRecently, in the wake of growing unrest, plummeting morale, and industrial action, doctors have created an increasingly hostile narrative towards physician associates (PAs) on social media and raised repeated concerns about their impact on patient safety and training opportunities. In this BMJ opinion piece, David Oliver looks at the recent history to understand how we got here and discusses why we need a mature debate about these matters otherwise interprofessional solidarity and multidisciplinary team working could be harmed by the degree of vitriol and resentment.
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Content ArticlePhysician associates (PAs) work alongside doctors and form part of the multidisciplinary team. They work across a range of specialties in general practice, community and hospital settings. Anaesthesia associates (AAs), sometimes also known as physicians’ assistants (anaesthesia), work as part of the anaesthetic team. They provide care for patients before, during and after their operation or procedure. This General Medical Council (GMC) page outlines the roles of PAs and AAs and what the regulation will look like.
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Content ArticleThe Medical Protection Society (MPS) is a member-owned, not-for-profit protection organisation for doctors, dentists and healthcare professionals. Here is there response to the Department of Health and Social Care consultation which introduces the regulation for Physician Associates (PAs) and Anaesthesia Associates (AAs).
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Content ArticlePhysician associates (PAs) are healthcare professionals who work as part of a multidisciplinary team under the supervision of a named senior doctor (a General Medical Council (GMC)-registered consultant or GP). While they are not medical doctors, PAs can assess, diagnose and treat patients in primary, secondary and community care environments within their scope of practice. PAs are part of NHS England’s medical associate professions (MAPs) workforce grouping. MAPs add to the breadth of skills within multidisciplinary teams, to help meet the needs of patients and enable more care to be delivered in clinical settings. PAs do not fall under the allied health professions (AHPs) or advanced practice groups. The Faculty of Physician Associates has created this guidance to provide clarity around the role of PAs. It provides practical examples of how physician associates should describe their role and is aimed at increasing understanding for patients, employers, other healthcare professionals and the public. It is important that PAs take all reasonable steps to inform patients and staff of their role and to avoid confusion of roles. This includes considering the potential for verbal and written role titles to be misunderstood and taking the time to explain their role in any clinical interaction.
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News Article
Concern after unqualified medics given senior Birmingham hospital roles
Patient Safety Learning posted a news article in News
Medics who are not qualified doctors have been used in senior roles at Birmingham Children's Hospital. Physician associates (PAs) have worked as the responsible clinician in the liver unit with a consultant on call. The RCPCH said it had heard the concerns of its members and the need for a clearly defined physician associate roles and training pathways. The doctors' union, the British Medical Association, called for a delay on recruitment of PAs until the group was properly regulated and supervised. The trust running the hospital said the physician associates did not work in isolation and only did the role with the right level of experience. Introduced in 2003, the PA role involved supporting doctors so they could deal with more complex patient needs. Usually, physician associates have a science degree and do a two-year post-graduate qualification. They are not doctors and are not allowed to prescribe drugs. The role is currently unregulated with the government planning legislation for regulations to be introduced before the end of 2024. PAs have worked at Birmingham Children's Hospital for 10 years but the BBC saw rotas which show them on tier two - normally a rota for senior doctors called registrars. PAs were not allowed to work unsupervised overnight and there were consultants on call at all times to offer advice, they said. Dr Fiona Reynolds, the trust's chief medical officer, insisted the safety and quality of care offered to children, young people and families remained a priority for everyone at the trust and would not be compromised. "Although small in number, [the PAs] skills and dedication to offering the best for our patients complements that of their colleagues in all fields - all of which are hugely valued by our trust," she added. Read full story Source: BBC News, 21 November 2023 -
News Article
BMA calls for immediate pause on recruitment of physician associates
Patient Safety Learning posted a news article in News
The BMA has called for an immediate halt to the recruitment of Medical Associate Professionals (MAPs) in the UK including Physician Associates (PAs) and Anaesthetic Associates (AAs). Doctors from across the UK who make up the BMA’s UK Council have passed a Motion which calls for the moratorium on the grounds of patient safety. They want the pause to last until the government and NHS put guarantees in place to make sure that MAPs are properly regulated and supervised. The move follows a number of recent cases in which patients have not always known they were being treated by a physician associate and tragically have come to harm. Professor Phil Banfield, BMA chair of council, said: “Doctors across the UK are getting more and more worried about the relentless expansion of the medical associate professions, brought into sharp focus by terrible cases of patients suffering serious harm after getting the wrong care from MAPs. Now is the time for the Government to listen before it is too late. We are clear: until there is clarity and material assurances about the role of MAPs, they should not be recruited in the NHS. “We have always been clear that MAPs can play an important part in NHS teams, and doctors will continue to value, respect and support individual staff they work with. But MAPs roles and responsibilities are not clearly defined. We are seeing increased instances of MAPs encroaching on the role of doctors; they are not doctors, do not have a medical degree and do not have the extensive training and depth of knowledge that doctors do. As doctors, we are worried that patients and public do not understand what this could mean in respect of the level of experience and expertise in care they receive. “The General Medical Council is the exclusive regulator of doctors in the UK. Adding staff who are not doctors and do not have a medical degree to the GMC register brings into question the competence and qualification of the whole medical profession. The Government may view this as a price worth paying for a shortcut to solving the workforce crisis they have presided over. We know otherwise. GMC regulation of MAPs will only add to the confusion and uncertainty that patients face. “Ministers may hope that by using secondary legislation, which may not even require the vote of MPs, they can avoid raising the alarm. But patients want doctors to remain doctors, regulated by a dedicated body, and they have a right to have confidence in the expert medical care they receive. There must be no doubt that when a patient goes to see a doctor, they are going to see a doctor. This blurring of roles and the confusion caused to patients must stop now.” Source: BMA, 16 November 2023 -
News Article
GP leaders in England call for a pause in recruitment of physician associates
Patient Safety Learning posted a news article in News
The BMA’s GP committee for England (GPC England) has called for an immediate pause in the recruitment of physician associates (PAs) in general practice. In an emergency motion passed on 2 November the committee expressed “concerns over the increasing trend of PAs being used to substitute GPs” and called on practices and primary care networks to stop PA recruitment “until appropriately safe regulatory processes and structures are in place.” GPs and GP registrars were also reminded that they can refuse to sign prescriptions and turn down requests for investigations made by PAs. Read full story (paywalled) Source: BMJ, 3 November 2023
