The report suggests a major change to the role of PAs after acknowledging they have been used as substitutes for doctors, despite having significantly less training.
They are postgraduates who have taken a two-year course to qualify. PAs are overseen by a dedicated medical supervisor, but they can work autonomously with appropriate support in GP surgeries and hospitals.
However, a bitter row with medics over their responsibilities – plus high-profile deaths of patients who were misdiagnosed by PAs – led Health Secretary Wes Streeting to order a review.
Presenting her findings, Professor Gillian Leng, president of the Royal Society of Medicine, said: “Crucially, I’m recommending that PAs should not see undifferentiated or untriaged patients.
She said more detail was needed on which patients can be seen by PAs, and national clinical protocols should be developed in this area.
The report outlines 18 recommendations. Here, The i Paper takes a look at some of the most important.
The report said that while research suggests patients are satisfied after seeing a PA, concerns were raised in three key areas.
Anaesthesia associates should be renamed as “physician assistants in anaesthesia” or PAA.
Identifying the role
As part of her review, Prof Leng listened to the views of patients and the public.“Of particular importance was hearing from the families of those who died,” she said. “Relatives feel strongly that confusion between the PA role and that of the doctor was an important contributory factor in their relatives’ deaths.
Newly qualified PAs should also work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts.
It added: “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 specialities is important. Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.”
“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.
Named doctor should supervise every PA
Many doctors also told the review that they were concerned about the time required to supervise PAs and AAs and the lack of training for supervisors about the role of PAs.
The survey also found “marked differences in which tasks were considered appropriate in primary and secondary care, with PAs significantly more likely than doctors to believe that certain activities were appropriate for them to carry out”.
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Professor Leng concluded there were “no convincing reasons to abolish the roles of AA or PA” but there is also no case “for continuing with the roles unchanged”, adding: “The mistakes of the past must not be repeated.”
A named doctor should take overall responsibility for each PA, while clothing, lanyards, badges and staff information should be standardised to “distinguish physician assistants from doctors”.
Dr Hilary Williams, incoming RCP clinical vice president, welcomed the report and said: “Now is the time for clear timelines, funding and engagement with doctors and patients on the implementation of these important recommendations.”
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