Physician Associates – the solution or just another problem for healthcare providers?

What is a Physician Associate? 

Physician Associates (PAs) were first introduced in 2003 to alleviate the shortage of NHS doctors and improve access to care. The PAs role is to support doctors diagnosing and managing patients, often in GP surgeries or hospitals.  PAs undergo two years of postgraduate training.  The role usually requires a bioscience-related undergraduate degree to get onto one of the training programmes, although registered healthcare professionals such as nurses or midwives can also apply.  This is markedly different from the qualifications and experience of a doctor, who typically undergoes around 10 years of training before formally qualifying.

Currently, around 3,500 PAs and Anaesthesia Associates (AAs) are working in the NHS in England, with plans to increase that number to address workforce shortages. However, following a series of recent high profile patient safety incidents and diagnostic errors, there have been calls to immediately pause the expansion of PAs and AAs roles. 

Case Examples of Clinical Failures

Emily Chesterton - 2022 

Emily Chesterton, who was 30 years old at the time of her death, was seen twice by the same PA she believed was a GP. Emily was misdiagnosed as suffering from anxiety and a sprain and later sadly died from a pulmonary embolism. The Coroner found that Emily should have been immediately referred to a hospital emergency unit, where she would have likely been treated for a pulmonary embolism and survived.  The poor-quality care had contributed to the death and highlighted the critical need for enhanced training, and oversight for PAs to prevent misdiagnoses and ensure patient safety.

Susan Pollitt - 2023

Susan Pollitt, aged 77,  had a drain inserted in her abdomen by a PA, which remained in place for 15 hours longer than recommended and she subsequently died. The Coroner found evidence of neglect, and issued a Prevention of Future Deaths (PFD) report raising concerns about the scope of PAs practice,  the clinical limitations of PAs knowledge, the lack of patient awareness and informed consent, and the need for clearer oversight and defined escalation for procedures.  

Pamela Marking - 2024

Pamela Marking attended the Emergency Department in East Surrey Hospital after vomiting blood and suffering from tenderness on her side. She was seen by a PA who misdiagnosed her condition as being a minor nosebleed and discharged her without proper medical review. Two days later, she returned to the hospital in a critical condition due to an incarcerated femoral hernia, which required emergency surgery.  Despite intensive care, she passed away shortly after.

In 2025, the Coroner released a PFD report concerning the “misleading” title of PAs and the lack of national guidelines to regulate their practice. The Coroner highlighted significant concerns around the risks associated with PAs practising without adequate supervision and public awareness of their limitations, emphasising the need for better oversight to prevent future incidents to ensure patient safety is not compromised. Specific concerns included: 

• The term ‘Physician Associate’ is misleading to the public, as it does not clearly indicate that they are not a medically qualified doctor. 
• Patient consent must be informed,  and if patients are dissatisfied with explanations, they have the right to seek a second opinion. 
• There is a lack of guidance and supervision of PAs. 
• There are regulatory gaps putting patient safety at risk.

The Risk to Patient Safety 

The implications of these reported cases are significant and far-reaching. Although the General Medical Council (GMC) began regulating PAs in December, mandatory regulation and legal enforcement won't take effect until December 2026. This move faces legal challenges from the British Medical Association (BMA) and Anaesthetists United. The latter's case, expected to be heard in May, includes the parents of Emily Chesterton as claimants and focuses on the failure to establish a scope of practice. 

The boundaries between doctors and PAs has become increasing blurred with the use of the term ‘medical professional’ collectively describing doctors, PAs and AAs. Without a distinct training framework, the setting of clear boundaries, and the scope of practice, the risk to patient safety remains.

Government Review and Response

In response to these concerns in November 2024 Wes Streeting, the Secretary of State for Health and Social Care, announced an independent review led by Professor Gillian Leng which aims to address the concerns raised and assess the contributions of PAs (and AAs) within multidisciplinary healthcare teams, focusing on: 

• Safety and Efficacy
• Scope of Practice 
• Supervision and Regulation

The government’s subsequent Call for Evidence in March 2025 sought views from healthcare professionals to understand the day-to-day practice of AAs and PAs, and the development of these roles. 

British Medical Council report 

In April 2025 the BMA published a report highlighting widespread serious concerns from over 600 doctors and medical students who had witnessed serious issues around patient safety, supervision, and the inappropriate substitution of doctors to retrospectively sign off prescriptions or imaging requests.

This testimony, collected via an online reporting portal between November 2023 and February 2025, has been submitted to the ongoing Leng Review. It highlights a clear disconnect between the intended and actual practices of PAs, indicating that the NHS has failed to ensure patient safety. The BMA is calling for a pause on PA/AA recruitment and for clearer national guidance on their scope of practice and supervision. 

The conclusions from this review are expected to inform the government’s workforce plan scheduled for publication in summer 2025.  It may also lead to changes in regulatory requirements and operational protocols which will require adjustments to polices to protect patient safety. 

What does this mean for those working in healthcare? 

For healthcare providers, these cases serve as a crucial reminder that when deploying PAs, it is essential to take measures to minimise the risk of future incidents and ensure patient safety. This requires:

• Supervision and escalation pathways – ensuring all staff know when and how to escalate concerns to senior clinicians.
• Clear patient communication – providing clarity as to who is providing care and their capabilities. NICE Guidelines advise that all healthcare professionals should introduce themselves, so patients understand who is treating them, manage expectations, and build trust. 
• Informed consent and transparency – with PAs explicitly informing patients when care is be handled by a PA rather than a doctor, especially during complex procedures. 
• Training and governance – reinforcing safe practice guidelines for PAs and other non-medical clinical. Designated supervisors to individuals PAs. 
• Recording all incidents/near misses – to facilitate reflection and learning. 

For those involved in supporting providers and professionals when things go wrong these cases are an important reminder that with new solutions for healthcare delivery come new risks and addressing these as soon as possible can reduce complaints, claims, and adverse publicity. 

Author: Rebecca Gilbert