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Found 88 results
  1. News Article
    A union has criticised a hospital trust for “jeopardising patient safety” by issuing “highly inappropriate” instructions for resident doctors to approve prescription requests from physician associates. The British Medical Association has written to University Hospitals Plymouth Trust to raise “serious concerns about the apparent unsafe and unprofessional working arrangements” between resident doctors and physician associates at the trust. The letter comes after a leak on social media appeared to show resident doctors at one of UHP’s departments being instructed to set up a rota to sign off requests for prescriptions and imaging investigations made by a physician associate. The BMA has called for these instructions to be “urgently rescinded”. Guidance from the General Medical Council states that physician associates cannot prescribe medication, even if they held prescribing rights in a previous role. The letter to UHP’s interim chief executive Mark Hackett, from BMA council chair Phil Banfield, said the instructions “contain highly inappropriate directions to resident doctors which, if acted upon, would cause them to breach professional standards set by their regulator, risk their professional indemnity, and jeopardise patient safety. “The rules on prescribing are clear, physician associates are not qualified or legally entitled to prescribe. This is not ‘due to a number of issues’ (as claimed in the instructions) that can somehow be circumvented by the trust – it is a necessary legal restriction put in place to protect patient safety. “Our guidance (and that of the GMC) is clear that no resident doctor should automatically prescribe medications or request ionising radiation on behalf of another practitioner…. That resident doctors have been asked to organise a rota implementing such unsafe practices speaks volumes about the way they are viewed by their employer”. Read full story (paywalled) Source: HSJ, 19 June 2025
  2. News Article
    A woman was imprisoned for falsely pretending to be a psychiatrist with the NHS for more than 20 years has now been asked to pay back over £400,000 to the health service or face even more jail time. The 62-year-old woman, Zholia Alemi was sentenced to seven years in jail after she was found guilty of committing a string of frauds. Alemi had claimed that she got her qualifications from University of Auckland in New Zealand, however, a jury at Manchester Crown Court found that she had forged the degree certificate along with the letter of verification she used in 1995 to register herself with the General Medical Council. The Manchester Crown Court was told that Alemi, who is from Burnley moved across the country to work in a series of positions, which included posts in Greater Manchester to make sure that 'the finger of suspicion' did not point at her. Adrian Foster, from the Crown Prosecution Service, said: "We have robustly pursued the proceeds of crime with the NHS Counter Fraud Authority and have identified all the assets that she has available to pay her order. Alemi had little regard for patient welfare. "She used forged New Zealand medical qualifications to obtain employment as an NHS psychiatrist for 20 years. In doing so, she must have treated hundreds of patients when she was unqualified to do so, potentially putting those patients at risk. "Her fraudulent actions also enabled her to dishonestly earn income and benefits more than £1million, to which she was not entitled. She cheated the public purse and £406,624 will be paid in compensation to the NHS." Read full story Source: Wales Online, 5 June 2025
  3. News Article
    Physician associates in the NHS will be renamed to stop patients mistaking them for doctors after a review found that their title caused widespread confusion. Thousands of physician associates who work in hospitals and GP surgeries across the UK take medical histories, examine patients and diagnose illnesses but are not doctors. However, Prof Gillian Leng, whose government-ordered review is looking into whether they pose a risk to patients’ safety, has concluded that they must be given a new name, so patients they treat are not misled into thinking they have seen a doctor, according to sources with knowledge of her thinking. Doctors who fear the term has created widespread confusion among the public and risks undermining trust in the medical profession will regard ditching it as a major victory. Wes Streeting, the health secretary, is expected to accept Leng’s recommendation and instigate the change, which could lead to physician associates being renamed “physician assistants” or “doctors’ assistants”. She will also specify in her final report, due later this month, that those who perform those roles must make clear to patients that they are assistants, not fully fledged medics. Physician associates have been implicated in several high-profile patient deaths. Earlier this year, a coroner found that in February 2024 a physician associate (PA) in the A&E at East Surrey hospital had misdiagnosed 77-year-old Pamela Marking as having a nosebleed when she had a small bowel obstruction and hernia that required emergency surgery. She returned to the hospital two days later but she died soon after. In her prevention of future deaths report the coroner, Karen Henderson, warned that the term “physician associate” was “misleading to the public” and that there was a “lack of public understanding of the role”. Read full story Source: The Guardian, 4 June 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
  4. Content Article
    Many errors in surgical patient care are caused by poor non-technical skills (NTS). This includes skills like decision-making and communication. How often these errors cause harm and death is not known. This goal of this study was to report how many surgical deaths are associated with NTS errors in Australia by assessing all surgical deaths from 2012 to 2019. Some 64% of cases had an NTS error linked to death. Decision-Making and Situational Awareness errors were the most common. The results of this study can be used to guide improvement and reduce future errors and patient death.
  5. News Article
    Managers are having to be “re-educated” after losing skills in recent years, the chief executive of NHS England has said. Speaking at the Medical Journalists’ Association’s annual lecture on Thursday, Sir Jim Mackey was asked whether he was satisfied with the calibre of managers in the NHS. He said “generally people that work in the NHS really care about what they do” and that managers were working in highly challenging circumstances, and often in “really horrible jobs where all the risk is managed”. But he also acknowledged a concern expressed by other NHS leaders that many managers had become “deskilled at some things”, in part due to the coronavirus pandemic and how systems have worked in the recovery period since then. Sir Jim said: “We are having to re-skill [and] train people again in things like waiting list management, some stuff on flow and ED management, those sorts of things. “So, they are being rebuilt, and people are being re-coached and re-educated.” Read full story (paywalled) Source: HSJ, 9 May 2025
  6. News Article
    A patient suffering from a perforated bowel had their diagnosis delayed after a junior doctor missed “red flags” during an assessment in A&E. After arriving at the emergency department of an NHS Forth Valley hospital, the patient was initially assessed by a junior doctor who ordered various tests and investigations. They were later moved to the acute assessment unit and diagnosed with a perforated bowel. The patient developed sepsis after undergoing emergency surgery. The patient’s child complained to the Scottish Public Services Ombudsman (SPSO) about their parent’s treatment. Specifically, they complained about the delay in identifying their parent’s condition, which they believe led to a worse outcome. NHS Forth Valley acknowledged that a more senior doctor may have identified the cause quicker, but that the care provided was reasonable, and that the complaint had led to learning and ongoing development. In putting together their report, the SPSO took independent advice from an emergency medicine consultant. It found that there were “a number of red flags” when the patient was admitted and that it did “not appear” they had been reviewed by a senior clinician. Issues were also found in the patient’s documentation; no intimate examination was recorded, and there was a “lack” of documentation around the interpretation of an X-ray. Overall, the report concluded that the initial assessment delayed diagnosis of the perforated bowel and was likely to have had a “significant effect” on the patient’s outcome. Read full story Source: STV News, 29 April 2025
  7. Content Article
    The BMA has submitted its response to Professor Gillian Leng’s independent review of the physician associate (PA) and anaesthesia associate (AA) professions in England. In it's submission, the BMA has urged the Government-commissioned review of physician associates to rename the role and set a national scope of practice.
  8. Content Article
    The General Medical Council (GMC) has submitted its response to Professor Gillian Leng’s independent review of the physician associate (PA) and anaesthesia associate (AA) professions in England. In its submission the regulator emphasised the importance of statutory regulation for PA and AAs because - as with any regulated healthcare profession - PAs and AAs undertake complex work that will pose some level of risk to the public, and regulation mitigates this risk. The submission also highlighted that, as the multi-professional regulator for doctors, PAs and AAs, the GMC is well placed to work with others across the health system to identify and address issues that concern all three professions. For example, the availability of supervisors and student training placements. The GMC also said that regulation is already beginning to raise standards of practice through ensuring that only those individuals with the right clinical knowledge and skills are entered onto the GMC’s registers.
  9. Content Article
    In my third year of medical school, my mother announced she wanted to become a physician associate (PA). I always encouraged her to follow her dreams — until she told me her motivation. “It’s basically the same as being a doctor, but with less time at university,” she said. Her words gave me pause. Despite years of medical training, even I wasn’t entirely sure where the line was drawn between doctors and PAs. And if I was confused, how could patients be expected to understand the difference? For some doctors, the PA role can feel less like a collaborative partnership and more like a threat to their professional identity. The British Medical Association has accused the government of using PAs as substitutes for doctors, compromising patient safety in the process. These concerns are not hypothetical.
  10. Content Article
    On 9 November 2019, a woman who was pregnant with Ida, attended the Royal Lancaster Infirmary Labour Ward in early labour. Ida was a normal child whose death was caused by a lack of oxygen during her delivery. This occurred due to the gross failure of the three midwives attending her to provide basic medical care to deliver Ida urgently when it was apparent she was in distress and contributed to by the lead midwife‘s wholly incompetent failure to provide basic neonatal resuscitation for Ida during the first 3 1/2 minutes of her life that further contributed to Ida’s brain damage. Ida died on 16 November 2019 at the Royal Preston Hospital neonatal intensive care unit. The inquest was one in which Article 2 was fully engaged as a result of the Trust’s clinical governance arrangements, inadequate investigations, a lack of transparency and openness, a failure to respond to a detailed complaint letter, a failure to comply with the Duty of Candour, disputing the findings of the Secretary of State for Health’s independent review panel (HSIB now MNSI), failing to notify external monitoring bodies and failing to comply with internal protocols. The Trust’s lack of compliance with clinical governance requirements in the investigation into Ida’s death had significant similarities with the criticisms made in 2015 of the Trust as set out in The Report of the Morecambe Bay Investigation, otherwise known as the Kirkup Report. [REDACTED] who gave evidence at the inquest, expressed the view that there was a deep seated and endemic culture of defensiveness in respect of maternity incidents at the Trust. [REDACTED] also said that the investigation showed elements of failing to identify significant care issues, brevity, defensiveness and was conducted by unskilled investigators. Matters of Concern A: Culture of Candour [Trust, ICB and DHSC] 1. I am concerned that there is not a culture of candour within University Hospitals of Morecambe Bay NHS Foundation Trust (Trust) and the impact that this has on safety, learning and implementing required changes to prevent deaths. Urgent action is required by the Trust to meaningfully embed the Dury of Candour. 2. [REDACTED]’s evidence to the inquest was that a deep-seated and endemic culture within the Trust leads to denial and a failure to learn. [REDACTED]’s Investigation report was published in 2015, the Trust is ten years on and still issues and themes identified in 2015 were very much in issue in 2019 and still exist at the Trust as identified by Ida’s inquest. 3. The Trust’s approach to the inquest has been one of a lack of transparency and openness, failure to provide relevant information and a failure to identify with candour the defective clinical governance processes that have operated at the Trust from 2019 to present day. 4. The Trust did not disclose that they had failed to notify the external bodies namely the CQC and the then CCG [ICB] via STEIS and the Trust’s internal Serious Incidents Reporting Investigation panel, none of which was noted by the Trust’s Patient Safety Summits .The matter was reported to the Coroner a year after Ida’s death by the family after the Trust took no action to do so, despite being on notice of failures in treatment from the HSIB report Ida’s harm was at no point categorised by the Trust as a harm event that caused “death”. 5. Trust figures to the Board provided in 2025 stated that there were no complaints over 6 months old when the Trust at the time of the inquest have not responded to [REDACTED] and [REDACTED]’s 1 June 2020 complaint. Together with the Trust’s failure to categorise Ida’s death as only “Moderate Harm” (see point 4 above) cause me also to have concern about the reliability of Trust’s data. B: Clinical Governance and Maternity Governance [Trust, ICB and DHSC] 6. I consider the clinical governance arrangements at the Trust require urgent review to ensure the appropriate personnel are in place, with the necessary training and skills to deliver robust clinical governance to ensure patient safety in maternity care. 7. As a result of the Trust’s deficient processes, the Trust did not undertake any examination of its own clinical governance processes, which were a principle area of concern and which was identified to the Trust five months before the inquest commenced. The Trust’s clinical governance arrangements were extracted piecemeal during the course of the inquest. The deficiencies included lack of version control and audit of documents, untrained staff, chaotic clinical governance arrangements, defensive attitudes and inappropriate self- congratulation. The clinicians’ reports to the inquest only answered the questions they were asked rather than trying to assist with a holistic view of the evidence, did not provide relevant information until it was extracted from the witness in testimony, that resulted in rolling disclosure of documents and additional witness evidence. This approach caused additional distress to the family who had to sit through an extended court hearing to address these issues 8. [REDACTED] is now Head of Compliance and Assurance at the Trust but that there has been no investigation into her role in respect of reneging on the Trust’s acceptance of the HSIB report at senior management level and with the family as was indicated by her approval of the July 2021 position statement. Similarly, [REDACTED] is now Head of Midwifery at the Trust and there has been no investigation in respect of her disputing the HSIB findings and submission of challenge to the HSIB report in Ida’s case. 9. All investigations conducted by the Trust to date in respect of Ida’s death have been unskilled, superficial, brief, failed to identify issues and left the family without answers and were all features identified by the 2015 Kirkup Report. In view of the continuing culture at the Trust, this cause a significant concern that issues of safety and safeguarding are not properly considered, transparently engaged with and then addressed formally in respect of a child fatality and serious injury by the Trust. 10. The Trust’s clinical governance capability has been the subject of repeated and often severe criticism in the Flynn Review 2009, Fielding Report 2010, Central Manchester Hospital Report 2011, Price Waterhouse Cooper 2012 and Kirkup Report 2015. [REDACTED] in his evidence to the inquest said that the Trust focus on process, which means that you can comply with the process requirements and still produce an inadequate investigation, rather than focussing on outcome, which measures the quality of the investigation and the patient experience. [REDACTED] noted that the Trusts culture impeded transparent and open investigation. I am told that the Trust now uses the PSIRF model and is to appoint 3 whole time equivalent Response Leads by 30 September 2025. However, I remain concerned that the Trust has not fully engaged with the duty of candour such that I am not satisfied that the work on PSIRF to date has truly addressed the issues in respect of Trust’s investigations. C. Mandatory Training, expired training and remedial training [Trust and ICB] 11. The Band 5 midwife supporting [REDACTED] in Labour had not undertaken her required mandatory training and this fact had not been provided and was only revealed at the inquest as part of the evidence of the Head of Midwifery in March 2025. I was also concerned to learn that in 2025 non-completion of mandatory training was still an issue as [REDACTED] had not completed her mandatory training. 12. It concerns me that the Trust do not have robust systems in place to ensure that any midwife who has not completed her mandatory training is subject to immediate action to ensure that all mandatory training is completed and is in date. 13. There was no remedial training was put in place for either the midwives involved in Ida’s delivery and resuscitation or for the paediatric SHO after Ida’s death. This raises a significant concern that the Trust do not operate a system of remedial training when this inquest has identified remedial training was required for [REDACTED], [REDACTED], [REDACTED] and [REDACTED]. D. Grading of harm for incident reporting: Babies who have sustained hypoxic brain injury and undergo cooling [Trust, ICB, DHSC, NHSE, [REDACTED]] 14. The Trust graded Ida’s level of harm as “moderate”, even after her death. This grading should have been adjusted to “severe” by the Trust before Ida was transferred to Royal Preston Hospital as the consultant paediatrician identified that she had sustained a severe hypoxic ischaemic encephalopathy due to fetal bradycardia. 15. The 2024 NHSE Learn from patient safety events (LFPSE) guidance that replaced the National Reporting and Learning System (NRLS) confirms that the recording and analysis of patient safety events that occur in healthcare support the NHS to improve learning from patient safety events to help make care safer. There is a significant risk that if reporting is graded on harm alone, clinical care that resulted in hypoxic brain damage during delivery and which was prevented by therapeutic cooling, will not adequately identify the problems that caused the harm during the delivery. 16. [REDACTED] confirmed that nationally there is inconsistency in categorisation of harm for babies who sustain a hypoxic injury due to fetal bradycardia in labour and who require cooling and clarification guidance would assist prevent further maternity deaths and ensure full and proper investigation of hypoxic injuries sustained in labour. E: Funding for MSNI [DHSC and [REDACTED], NHSE and ICB] 17. But for the HSIB investigation report into Ida’s death [REDACTED] admitted that Ida’s death due to failures by the Trust would never have come to light or resulted in an inquest. 18. The MSNI is now hosted by the CQC with funding secured for the next two years but no certainty as to ongoing funding after this date. These independent investigations by specialist skilled investigators into the most serious of events is an essential safeguard to the lives of mothers and unborn children. 19. Without an assurance that funding will continue beyond 2027 I am concerned that significant harm events to mothers and babies and deaths such as Ida’s will go unrecorded and lessons that should be learned to prevent future maternal and baby deaths will go unnoticed, and there will be a risk of future maternity deaths.
  11. Content Article
    An ECG is a test that records the electrical activity of a patient’s heart. It needs to be correctly carried out and accurately interpreted to determine the patient’s condition and potential diagnosis. This Health Services Safety Investigation Body (HSSIB) investigation was prompted by the case of a 29-year-old woman with chest pain. Her ECG was misinterpreted and she later died of a heart attack.  The investigation focused on paramedic education, training and competence in ECG practice and the task of carrying out and interpreting an ECG in the context of the patient’s clinical signs and symptoms. The investigation spoke to key stakeholders to understand the safety risks that may be present in this area. The way 12-lead ECGs are undertaken and interpreted was identified as a growing area of concern, with systemic safety risks that can have a significant impact on the outcome for patients. HSSIB identified safety learning for ambulance services to help train qualified paramedics. It has also made a safety recommendation to the Health and Care Professions Council and the College of Paramedics to improve undergraduate teaching for paramedic students, to reduce this safety risk for patients. HSSIB makes the following safety recommendation HSSIB recommends that the Health and Care Professions Council and the College of Paramedics work in collaboration with relevant stakeholders to improve the undergraduate teaching of 12-lead electrocardiograms by reviewing and updating any relevant standards, guidance, and curricula to provide clarification on: the level of education and expected level of competency and assessment required of student paramedics in relation to electrocardiograms any minimum expected standards for electrocardiogram education in higher education institutions, including the time spent on electrocardiogram learning, methods used, and subject matter expertise required of teaching staff how patient protected characteristics, health inequalities and other specific patient factors are taught in relation to electrocardiograms how effective feedback mechanisms can be developed between higher education institutions and ambulance services. This is to help improve consistency in the way paramedic students are educated about electrocardiograms. HSSIB makes the following safety observations Ambulance services can improve patient safety by including patient protected characteristics, health inequalities and other specific patient factors that can impact on the task of carrying out and interpreting a 12-lead ECG, when developing refresher training. Ambulance services and national organisations can improve patient safety by providing and supporting protected time and resources for paramedic training and continuous professional development, while understanding the potential impact on operational performance. Ambulance services can improve patient safety by providing additional support to paramedic students and paramedics through exposure to a range of clinical scenarios that help develop and maintain 12-lead ECG competency on a regular basis. Acute hospitals and ambulance services can improve patient safety by developing local mechanisms to share information about patient outcomes where paramedics have undertaken a 12-lead ECG. This can help to support learning for paramedics and provide feedback on where their practice may be improved.
  12. News Article
    By the entrance to Furness General Hospital in Barrow-in-Furness sits a sculpture of a moon with 11 stars. It is a memorial to the mother and babies who died unnecessarily due to poor care at the hospital between 2004 and 2013. When the memorial was unveiled in 2019, Aaron Cummins who is chief executive at University Hospitals of Morecambe Bay NHS Trust, which runs the hospital, said: "We will never forget what happened. We owe it to those who died to continually improve in everything that we do." Barely a month later, Sarah Robinson stepped into a birthing pool at the Royal Lancaster Infirmary, a hospital run by the same NHS trust. She was about to give birth to her second child. Within an hour, Ida Lock was born; within a week, she was dead. The inquest into Ida Lock's death, which concluded last week, exposed over five weeks why maternity services across England have long struggled to improve - and this one case holds a mirror to issues that appear to be prevalent across a number of trusts. 'That investigation, carried out by Dr Bill Kirkup and published in March 2015, found there had been a dysfunctional culture at Furness General, substandard clinical skills, poor risk assessments and a grossly deficient response to adverse incidents with a repeated failure to properly investigate cases and learn lessons. Morecambe Bay became a byword for poor maternity care and the trust promised to enact all 18 recommendations from the Kirkup review. And yet that never happened. Ida Lock's inquest began last month, more than five years after she died - the delay was down to several reasons, including its particular complexity. What emerged was just how profoundly many of those lessons had not been learned. Particularly egregious, says Ms Robinson, was a suggestion from a midwife – shortly after the birth - that Ida's poor condition was linked to her smoking, something Sarah had never done in her life. As the coroner found on Friday, Ida's death was wholly avoidable, caused by a failure to recognise that she was in distress prior to her birth, and then a botched resuscitation attempt after she was born. By the time she was transferred to a higher dependency unit, at the Royal Preston hospital, she had suffered a brain injury from which she could not recover. Having failed to deliver their daughter safely, Ida's parents would have expected that the trust would properly and openly investigate her death. Instead, they pursued an investigation that Carey Galbraith, the midwife who completed it, would later describe as "not worth the paper it was written on". They didn't take responsibility for their failings despite having an independent report from the Healthcare Safety Investigation Branch (HSIB). Clearly, the Morecambe Bay report was not, as was hoped, a line in the sand for maternity services across England, or a rallying cry for widespread improvements. As the inquest has shown, it did not even lead to sustained improvement at Morecambe Bay. Read full story Source: BBC News, 24 March 2025 Further reading: Ida Lock: Baby girl died from brain injury because midwives failed to provide basic care, coroner rules
  13. News Article
    A 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)
  14. Content Article
    On 16 February 2024, Pamela Anne Marking – who was unable to give a complete history due to cognitive issues – was admitted to the Emergency Department at East Surrey Hospital from her home address after unknowingly vomiting blood-stained fluid, with right sided and suprapubic abdominal tenderness. She was diagnosed as having had an epistaxis (nosebleed) by a Physician Associate  and discharged home later that afternoon without a medical review or direct medical supervision of the Physician Associate who had a lack of understanding of the significance of abdominal pain and vomiting and had undertaken an incomplete abdominal examination which would have been likely to have found a right femoral hernia. Mrs Marking re-presented to the Emergency Department two days later with grossly dilated small bowel obstruction due to an incarcerated right femoral hernia containing ischaemic bowel requiring emergency surgery later that evening. Despite maximal support Mrs Marking died at East Surrey hospital on 20th February 2024. The clinical management Mrs Marking had on her first admission and thereafter during the Rapid Sequence Induction materially contributed to her death. The medical cause of death given was: 1a Respiratory failure and Sepsis   1b Aspiration of feculent gastric contents at induction of anaesthesia 1c. Strangulated femoral hernia. Coroner's concerns 1. The term ‘Physician Associate’ is misleading to the public. Mrs Marking’s son was under the mistaken belief that the Physician Associate was a doctor by this title in circumstances where no steps were taken by the Emergency Department or the Physician Associate to explain or clearly differentiate their role from that of medically qualified practitioners. 2. Lack of public understanding of the role of Physician Associate. Witnesses from the Trust gave evidence that a Physician Associate was clinically equivalent to a Tier 2 resident doctor without evidence to support this belief. This blurring of roles without public knowledge and understanding of the role of a Physician Associate has the potential to devalue and undermine public confidence in the medical profession whilst allowing Physician Associates to potentially undertake roles outside of their competency thereby compromising patient safety. 3. The right of patients and family to seek a second opinion. The lack of public knowledge that a Physician Associate is not medically qualified has the potential to hinder requests by patients and their relatives who would wish to seek an opinion from a medical practitioner. It also raises issues of informed consent and protection of patient rights if the public are not aware or have not been properly informed that they are being treated by a Physician Associate rather than a medically qualified doctor. 4. Lack of national and local guidelines and regulation of the scope of practice for a Physician Associate. A diagnosis of epistaxis was made by the Physician Associate without appreciating the relevance of the vomiting and lower abdominal discomfort and in the absence of understanding the need to undertake palpation of the groins in an abdominal examination in a patient who was unable to give a proper clinical history because of short term memory loss. No evidence was presented that the management of Mrs Marking was subject to a reflective practice review. 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. 5. Lack of guidelines for direct supervision and consideration of an appropriate level of autonomy for Physician Associates. Whilst there were discussions with the ‘supervising’ consultant the Physician Associate was effectively acting independently in the diagnosis, treatment, management and discharge of Mrs Marking without independent oversight by a medical practitioner. This gives rise to a concern that inadequate supervision or excessive delegation of undifferentiated patients in the Emergency Department to Physician Associates compromises patient safety. 6. Lack of ‘Updated’ National Guidelines for Rapid Sequence Induction (RSI) of Anaesthesia for emergency surgery. Mrs Marking required a rapid sequence induction to protect her airway from aspiration of bowel contents as a consequence of small bowel obstruction. The consultant anaesthetist gave evidence that the ‘traditional’ use of consecutive syringes of induction agent and muscle relaxant was obsolete, and it was common practice locally and nationally to routinely undertake a RSI with Total Intravenous Anaesthesia, in the absence of updated local or national guidelines to support this practice. 7. Lack of ‘Updated’ National Guidelines to support the use of TIVA for RSI. Other than empirically increasing the rate of infusion of TIVA agents (Propofol and Remifentanil) no evidence was forthcoming as to the target range required to ensure and confirm an adequate depth of anaesthesia for patients or the length of time required prior to and following the administration of a muscle relaxant (Rocuronium) to facilitate intubation. This is despite TIVA being known to provide a slower onset of anaesthesia and approximately 50% of all anaesthetic related deaths are due to aspiration (NAP 4). 8. Lack of ‘Updated’ Guidelines for use of Cricoid pressure and other measures to protect the airway in a RSI anaesthetic. Evidence was heard that as cricoid pressure was ineffective it was not routinely applied for a RSI intubation. After aspiration on Induction, the only suction device was attached to the nasogastric tube giving rise to a possible delay in timely suctioning of the feculent aspirate which was in excess of two litres after intubation was achieved.
  15. News Article
    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
  16. News Article
    The NHS in England should slow or scrap altogether the recruitment of physician associates (PAs) and ban them from seeing patients one-to-one, medical groups are urging ministers. The Royal College of Physicians (RCP), which represents hospital doctors, has called for a rethink of government plans to increase the number of PAs from 3,000 to 10,000 by the mid-2030s. They should also not be allowed to run clinics on their own, without a senior doctor present, because left unsupervised they could pose a risk to patients’ safety, the RCP added. “We’re calling on NHS England to slow down the expansion of the PA role [and] review its projections for growth in the PA workforce,” said an RCP spokesperson. While the college is not proposing exactly how many more PAs the NHS should train and hire in coming years, it “believes their growth should be carefully managed” and NHS England needs to take “a more measured approach” to recruiting and using them. Its move comes weeks after Wes Streeting ordered an independent investigation into the role and competence of PAs, after a series of cases in which patients they treated came to harm. They include Emily Chesterton who died after her blood clot was misdiagnosed by a PA as a calf strain. The health secretary said the review, by Prof Gillian Leng, was needed because “there are legitimate concerns over transparency for patients, scope [of PAs’ role] and the substituting of [them for] doctors. These concerns have been ignored for too long.” Read full story Source: The Guardian, 17 December 2024
  17. News Article
    Nearly 1,000 women were diverted to other NHS trusts or units while in labour within a six-month period this year, HSJ can reveal. The information was obtained via a Freedom of Information request, but only 68 of approximately 120 trusts with maternity units provided responses – so the true figure is likely to be significantly higher. In 528 of the 925 incidents recorded between January to June this year, patients were diverted to a different NHS trust from their chosen place of birth to either have their baby or to receive further care while they were in suspected or confirmed labour. Of those, 402 were due to staffing, capacity issues in neonatal units, and high acuity of illness in women with a lack of diverse skill mix to support them. The remaining diverts were for clinical reasons such as premature labour. A further 397 incidents involved diversions being made to other hospitals within the same NHS trust, bringing the overall total to 925. HSJ’s research shines a light on a problem which is widely known but has not been properly quantified for several years. Read full story (paywalled) Source: HSJ, 17 December 2024
  18. News Article
    Health Secretary Wes Streeting said there are “legitimate concerns” over the role of physician associates (PAs) amid worries they are being used to replace fully-qualified doctors. He said he wanted to look into the issues around the roles before a planned expansion in the number of medical associates. Mr Streeting acknowledged there were concerns around the tasks PAs were doing and transparency, with patients not necessarily realising they were not being treated by a doctor. There has been an ongoing debate within the NHS about the use of such roles, with the Academy of Medical Royal Colleges calling for a review into PAs and anaesthesia associates (AAs) to “clarify claims around their safety and usefulness in patient-facing roles”. Mr Streeting told BBC Breakfast: “I am taking these concerns seriously and I’ve spent a lot of time listening to clinicians, listening to physician associates as well, by the way. “I think they do have a role to play and can add value, not least in freeing up doctors’ time to do the things that only doctors can do. “But I think there are legitimate concerns about the extent of doctor substitution and replacing doctors with PAs, there are issues around transparency. “As patients, we should know who we’re seeing, who’s in front of us and why, and we’ve got to take those issues seriously.” Mr Streeting said he would be saying more about the associate roles “in the coming weeks”, hinting an expansion in the number of the roles could be paused while work is carried out to address concerns. Read full story Source: Medscape, 13 November 2024 Read our interview this week with Asif Qasim, Consultant Cardiologist and Founder of MedShr, about the role of physician associates in the NHS and the patient safety issues.
  19. News Article
    A man whose wife died after a drain was mistakenly left in her abdomen for 21 hours has condemned the increased use of physician associates (PAs) within the NHS Susan Pollitt's inquest concluded her death at Royal Oldham Hospital in July 2023 had been caused by an "unnecessary medical procedure contributed to by neglect". Roy Pollitt did not know his 77-year-old wife was being treated by a PA - who are only required to have two years' medical training - and believes "she would have lived if the NHS had not used cheap labour". The coroner who examined Mrs Pollitt's death highlighted the lack of a national framework covering PAs' training, supervision and competency assessment. Associates were introduced in the NHS 21 years ago with the expectation they would support doctors by delivering basic care. Over the past two years the number of associates has more than doubled to 3,000. According to the NHS Long Term Plan, there will be 12,000 physician and anaesthetic associates by 2036. Health Secretary Wes Streeting said there were "legitimate concerns" about the role of PAs before the expansion. Fears have been expressed that some have been acting beyond their original remit. Read full story Source: BBC News, 13 November 2024 Read our interview this week with Asif Qasim, Consultant Cardiologist and Founder of MedShr, about the role of physician associates in the NHS and the patient safety issues.
  20. Content Article
    There’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.
  21. Content Article
    Following on from the care failures highlighted in the 2021 report, 'No one's listening', the Sickle Cell Society have published a new report taking a deeper look at sickle cell nursing care. The findings show the need for vastly more resources, training and support in this critical area of care. The report highlights that not only is no-one listening, but that lives are still being put at risk.
  22. Content Article
    Recently, 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.
  23. Content Article
    The aim of this investigation and report is to help improve the inpatient care of adults with a known learning disability in acute hospital settings. It focuses on people referred urgently for hospital admission from a community setting, such as a person’s home or residential home. In undertaking this investigation, the Health Services Safety Investigations Body (HSSIB) looked to explore the factors affecting: The sharing of information about people with a learning disability and their reasonable adjustment needs following admission to an acute hospital. How ward-base staff are supported to delivery person-centred care to people with a learning disability. Reference event The investigation used as a reference event a patient safety incident involving a 79-year-old man who was recorded on his GP’s learning disability register as having a mild learning disability. After being admitted to hospital due to his worsening health. Throughout the patient’s stay, up to his death following a cardiac arrest, his individual needs were not always identified and reasonable adjustments to meet his care needs were not always made. Findings The health and care system is not always designed to effectively care for people with a learning disability. People with a learning disability who are admitted to an acute hospital are often cared for by staff without specialist training, skills and experience in working with people with a learning disability. These staff often have limited support and are unable to take the time they would like to meet the person’s needs. There is no standard model or national guidance for an acute learning disability liaison service (that is, teams that are specifically trained in caring for people with a learning disability). Consequently, there is variation in how these services are funded, their availability, the size of teams and what they are expected to do. The quality of learning disability services is currently monitored via the learning disability improvement standards annual benchmarking survey which is funded until the end of 2023/24. Decisions on future years have yet to be made. Staff in acute hospitals may lack confidence and support in assessing the mental capacity of people with a learning disability, in line with the Mental Capacity Act (2005). There is no national shared system with a single point of access for storing and managing information about the needs of people with a learning disability and the reasonable adjustments required for each individual. Current mechanisms for sharing information about a person – such as ‘care passports’ (a document that gives staff helpful information about the person’s health and social needs, including their preferred method of communication, likes and dislikes) and alert flags (a way to highlight key information to staff) on the electronic patient record – can be unreliable. Instead, information is often gathered from friends and family. Evidence exists that people with a learning disability experience health inequities. Long-held societal beliefs about the abilities of people with a learning disability may influence the provision of and decisions made around their care. Safety recommendations As a result of this investigation, HSSIB recommended that NHS England should: Develops and issues learning disability liaison nursing service best practice and workforce guidance to all acute hospitals. This is to help local decision making about specialist learning disability provision and enable appropriate support for people with a learning disability and the staff who care for them. Ensure that the national learning disability improvement standards annual benchmarking survey for the care of people with a learning disability is continued for acute hospitals in order to help assure that local population needs are met. Commission the development and dissemination of guidance on the practical assessment of the mental capacity of people with a learning disability in acute hospitals. This is to ensure that appropriate decisions are made about the person’s care. With support from key stakeholders including the Professional Record Standards Body, work collaboratively to develop and publish a set of guidelines on information to be included in a health and care passport (which could be paper based, digital, or both) for people with a learning disability with consideration of the reasonable adjustments that people may need. This is to ensure the most current and accurate information about reasonable adjustments to the person’s care is accessible when and wherever it is needed. Safety observations HSSIB made four safety observations as a result of this investigation: Health and care providers can improve patient safety by ensuring that local configuration of electronic patient record systems consider the accessibility and usability of the digital record reasonable adjustments flag in patient records. Health and care curricula can improve patient safety by aligning with the national code of practice on statutory learning disability and autism training, when finalised. Health and care providers can improve patient safety by advocating for all people with a learning disability to have an up-to-date care passport.
  24. Content Article
    Physician 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.
  25. Content Article
    Physician 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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