A Government-commissioned report has warned that physician associates (PAs) should no longer assess patients without prior medical triage, in an effort to prevent potentially “catastrophic” misdiagnoses within the NHS.
The findings come amid growing concerns over the expanding role of PAs, who receive significantly less training than doctors but are increasingly being used as their substitutes across the healthcare system.
Critical Role Review Sparks Urgent Recommendations
The report, led by Professor Gillian Leng, president of the Royal Society of Medicine, proposes major reforms to the current structure of PA responsibilities. The push for change follows a series of serious safety concerns and the deaths of six patients, where PAs were directly involved in misdiagnoses.
“Crucially I’m recommending that PAs should not see undifferentiated or untriaged patients. If (patients) are triaged, they (PAs) should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs,” Professor Leng said.
Currently, more than 3,500 PAs and 100 anaesthesia associates (AAs) are active in the NHS. Despite previous plans to expand these roles, mounting pressure from the medical profession and high-profile failures have prompted a rethink.
The report highlights that the greatest safety concerns are rooted in initial patient assessments—often the stage where conditions are first identified.
It noted: “It is here that the risk of missing an unusual disease or condition is highest, and where the more extensive training of doctors across a breadth of specialties is important. Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.”
One of the most tragic cases was that of 30-year-old Emily Chesterton, who died of a pulmonary embolism after being misdiagnosed twice by a PA, and wrongly told she was suffering from anxiety.
Lack of Evidence, Need for Clearer Guidelines
Prof Leng stressed that current evidence supporting the safe use of PAs as doctor substitutes in primary care is weak.
“The evidence is poor,” she said, adding there is “no compelling evidence” from published studies that PAs are safe to act in place of doctors in general practice.
She urged the creation of national protocols to determine which patients can be seen by PAs and recommended that newly qualified associates should serve a minimum two-year hospital placement before transitioning to GP surgeries or mental health settings.
In a further move to clarify their role and reduce patient confusion, Prof Leng advised that PAs be renamed “physician assistants”, and AAs become “physician assistants in anaesthesia”.
The report criticised some NHS trusts for plugging rota gaps with PAs without properly addressing their limited clinical training.
It stated: “This seems to have been done without taking into account the more limited training of the PAs and how the roles would interact, other than with the caveat that they would be supervised by doctors.”
This lack of planning, the report suggests, has bred resentment among junior doctors and inadvertently put patients at risk.
While the report stops short of calling for the scrapping of PA and AA roles, it firmly states that continuing with the current setup is not viable.
“Let’s be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients,” Prof Leng added.
The review’s findings also tie into broader discussions around the future of NHS workforce planning. Efforts to modernise care models must now strike a balance between addressing staff shortages and ensuring patient safety.
This aligns with the broader health service strategy currently being mapped out. For more on the NHS’s direction of travel over the next decade, including its workforce priorities and care model shifts, explore the recent breakdown of the 10-year NHS health plan.
The British Medical Association (BMA) responded strongly to the report. Dr Tom Dolphin, chair of the BMA council, said it: “laid bare the catastrophic failures in NHS leadership that have put patients at serious risk of harm. but warned the report’s recommendations still “do not adequately protect patients”.
As NHS staffing pressures persist, the review signals a pressing need to redefine non-doctor roles, prioritising patient safety and ensuring clarity across the healthcare system.
