Did you know that not all ear infections come with ear pain? I didn`t. Neither did the nurse practitioner who – despite my fever, feelings of nausea and general malaise – failed to look in my ears. Only when my symptoms worsened did a GP finally do so, diagnose the problem and prescribe antibiotics. This was a number of years ago. But the experience has endured as a salutary note to self. When I’m ill – not with something obvious, but with vague symptoms – I want to see a doctor. Not a nurse. Not a pharmacist. Not an auxiliary. Not a porter. Not one of the kind ladies from the charity coffee shop. A doctor.
Someone who has put in the hard yards at medical school, slogged through the often brutal, sleep-deprived training, and earned the right – professionally, legally, and morally – to make diagnostic decisions . Anyone else is playing a game of roulette with my health. And though I have huge respect for the vital role played by those in supportive roles in primary care, be it in GP practices or in A&E departments, the buck starts – and should stop – with the doctor.
That`s why it`s absolutely essential that NHS physician associates are banned from diagnosing patients who have not already been seen by a doctor. Their training, though clearly demanding, is limited. Doctors undergo a minimum of five to six years of medical school, followed by years of supervised practice and specialist training. In contrast, physician associates complete a two-year postgraduate course, typically without prior clinical qualifications.
That some have attempted diagnosis is surely an act of staggering arrogance which presumes their knowledge is in step with a medically qualified doctor. It`s also incredibly dangerous. There have been at least six high-profile deaths of patients who were misdiagnosed by PAs including the tragic case of 30-year-old Emily Chesterton who was misdiagnosed twice by a PA who she assumed was a GP before eventually dying of a blood clot in 2022.
That`s six too many. Six people whose lives were snuffed out because PAs presumed – undoubtedly without malice aforethought and every good intention – that they knew what to do. And because the system allowed them to. The blame is not entirely theirs. It`s likely that of the UK`s 3,500 PAs and 1,000 anaesthesia associates (AAs) a near breaking-point health service will have compelled their substitution to fill staffing gaps.
But their valuable role in the healthcare system is supposed to be supportive, not autonomous. After all, diagnostics is one of the most complex tasks in medicine, stemming from years of clinical training and supervised practice. PAs could lack experience in diagnostic nuance, and the clinical reasoning needed to safely handle undifferentiated cases. Again, to put it bluntly they are not doctors.
Exacerbating the problem is that a vulnerable patient, exhausted after hours hanging around A&E, may not realise they are not being seen by a doctor. Especially if PAs wear the same scrubs or don`t make clear their defined role. In fact, the title of the job itself should be renamed. While it may seem like a matter of semantics, the term "physician" strongly implies formal medical school training.
The UK is chronically short of doctors. Bottlenecks in training, low morale and of course an ageing population have resulted in a massive crisis for the NHS. But the solution is to invest in training more doctors. Not to supplant them with a cheaper alternative that simply cannot offer anywhere near the same level of expertise.
To be clear, PAs have an important role in our system – managing patient caseloads in GP surgeries, walk-in centres, and hospitals. Indeed modern medicine of course relies on good teamwork and communication. That`s why there`s nothing wrong with having a place in the NHS for physician associates. But there is something very wrong with pretending they are anything else.
