British Medical Association (BMA) members have hit back in defence of their profession with scores of horror stories submitted to the Reporting Portal Submissions – Physician Associates and Anaesthesia Associates, which was published last week.
Physician Associates (PAs) and Anaesthesia Associates (AAs), are not fully trained and qualified doctors or medical practitioners, but are being increasingly used in the NHS.
In his introduction to the report, BMA Chair of Council, Professor Phil Banfield, said: ‘In November 2023 the BMA established a reporting portal for doctors and medical students to share concerns regarding the deployment of physician and anaesthesia associates in both primary and secondary care.
‘When submitting a concern, the BMA was clear that incidents should additionally be reported through formal mechanisms.
‘This report includes all submissions received by February 2025 that concern patient safety.
‘In addition, we have submitted a wider report to the Independent Review of Physician Associates and Anaesthesia Associates, chaired by Professor Gillian Leng (the “Leng Review”), which includes submissions relating to the impact these roles have on the training and education of medical students and doctors.
‘We have submitted this report to relevant regulators across England, Wales, Scotland and Northern Ireland, as well as those responsible for the delivery of healthcare services across all four nations.
‘We expect the Leng Review to take the themes reported here seriously when making its final recommendations. This report presents unequivocal evidence of doctor substitution, doctors being coerced or pressured into signing prescriptions or ionising radiation requests for patients of whom they have no knowledge, examples of doctors losing out on basic skills training and multiple situations where neither the public nor other healthcare staff know the role or competencies of physician and anaesthesia associates.
‘Of greater concern are the many examples where harm has come to patients or has thankfully been narrowly avoided only by subsequent intervention from a doctor.
‘Doctors consistently tell us that formal patient safety reporting mechanisms are complex and insufficient.
‘Many doctors continue to be afraid of raising safety concerns in the workplace for fear of reprisal.
‘This represents a problem across the health service which must be tackled by government, healthcare providers and healthcare regulators.
‘The BMA will work with all relevant organisations to change this dangerous culture, but it will require substantial efforts on behalf of all parties.
‘Rather than ignoring problems, safety concerns must be responded to with openness and a genuine curiosity to learn from and correct errors.
‘The current situation is unfair on staff, including physician and anaesthesia associates, but most importantly unfair for patients and their families.
‘Healthcare system leaders must take responsibility for patient safety, take note of this large body of evidence and act now to ensure that unsafe practice is not happening in their own organisations.
‘Doctors are instructed by their regulator to act promptly when patient safety or dignity is, or may be, seriously compromised.
‘It is high time that the leaders of regulators and providers are held to the same standard.’
What follows is a small selection of the masses of submissions to the BMA Reporting Portal Submissions – Physician Associates and Anaesthesia Associates.
‘PA (Physician Associate) reviewed a young patient with chest pain in ED (Emergency Department) and was discussing the case with me as the registrar. I did not understand really what their role was as a PA and no safety information given by the department. They told me a vague history and that the examination was entirely normal.
‘After inadequate responses and the feeling the PA did not know what they were doing, I reviewed the patient in-person. They were a young man with sudden onset left sided chest pain which was pleuritic. I put my stethoscope on the left side of his chest and there was NO air entry whatsoever. Not even subtle. Looking at the chest x-ray there was a radiological tension pneumothorax.
‘The patient was immediately moved to Resus where I took over his care and a chest drain was promptly inserted. He had been sitting in a far away part of the department in a chair.’ Resident Doctor, North Thames.
‘A respiratory PA at my hospital recently inserted a chest drain in a patient unsupervised. This patient was a haematology patient who had platelet levels of 8. Normal platelet levels are 150. Therefore, this patient was at extremely high risk of having uncontrolled bleeds.
Chest drains are an invasive procedure which involves cutting through all the layers of the skin to enter the pleural cavity. The chest drain, as expected, caused the patient to have a significant bleed and deteriorate over night.
‘The PA told no doctors from either the respiratory team nor the haematology team that they were inserting the chest drain. Luckily the night doctors transfused the patient and gave medication to control the bleeding. However, this could have easily resulted in a catastrophic outcome.
‘This would not have happened if the PA acted within their capabilities. This would not have happened if the patient was seen by a real doctor. This would not have happened if the NHS had enough doctors.’ Resident Doctor, East of England.
‘A physician associate refers to themselves as doctor/junior doctor to other staff and to patients, resulting in confusion within the workforce.
This same PA assessed a patient independently on a ward round. This patient had had an iatrogenic opioid overdose due to her poor renal and hepatic function. Her oxycodone and buprenorphine patch were stopped by the on call doctor who was alerted of this.
‘During the PA’s ward round, they restarted the buprenorphine patch and Oxycodone, asked their colleague to prescribe it, without any documentation of discussion with the consultant. This resulted in another opioid overdose in this patient.’ Resident Doctor, East of England.
‘Physician associate on xxx. Patient spiking temps with CRp >400. CXR looked like effusion so I asked resp to see for chest drain empyema. The PA said “I can do chest drains”. I said “are you signed off for pleural USS?” He said “I can do ultrasound and chest drains”. I said “I’ll call respiratory”.
The PA got the ultrasound and said “there’s loads of fluid, come on let me tap it” I said “no we will wait for respiratory as you are not pleural ultrasound trained” he was very insistent but I stood my ground.
‘Respiratory came and scanned the patient. The lung was collapsed and the PA was scanning the spleen, he was very close to sticking a needle into the patient’s spleen.’ Resident Doctor, North W.
‘I’m a final year medical student who had to shadow the surgical F1 on call for a twilight shift. I turned up and instead there was a PA who was doing the job. It was quite frankly dangerous how this PA was not able to prescribe anything for anyone, even the sickest of patients had a delay in getting prompt treatment, she was woefully out of her depth and worst of all, her handover list for the night F1 was nearly three pages long!! Absolutely disgusting how this PA managed to be on this rota.’ Medical Student, Wales.
‘Dodging discharge summaries piled up in the wards to be done and most of the time doing their own ward rounds.’ Resident Doctor, West Midlands.
‘General surgery PA – (upper GI firm) carries out ward rounds alone for acutely ill patients, has carried out shifts on the SHO on call rota in the past and has carried out consultant clinics unsupervised by a consultant. Resident Doctor, West Midlands.
‘I am a 4th year medical student, but work as an HCA (Health Care Assistant) on the weekends at XXX Hospital. They have two PAs on the ED rota. I have been alarmed to see that they can hold the SEPSIS bleep and the RESUS bleep. In both occasions they have told nurses to get drugs without a Dr present which without the ability to prescribe is a loophole.
‘Additionally, they introduce themselves as a member of the medical team meaning that patients think they have seen a Dr, a few times they have done things that I know is incorrect such as D-dimer on a pregnant lady and no pre-reduction X-ray on a finger dislocation which, when pointed out, they say “oh I didn’t know”.
‘I find the manner in which PAs are used in the EDs as alarming.’ Medical Student, West Midlands.