## Review Suggests Rebranding Physician Associates for Clarity in Healthcare
In a recent independent review, it has been proposed that Physician Associates (PAs) and Anaesthesia Associates (AAs)—roles that assist doctors in various healthcare settings such as GP surgeries and hospitals—should be re-designated as “assistants.” This recommendation aims to alleviate confusion among patients regarding the qualifications and roles of these healthcare professionals. The review further advocates for the adoption of standardized clothing and badges in order to clearly distinguish PAs and AAs from doctors, emphasizing that they should not be involved in diagnosing patients. Such changes come in response to ongoing debates surrounding the complexities of their responsibilities.
The initiative to assess the utility and clarity of PAs and AAs was instigated by Health Secretary Wes Streeting last year, amid rising concerns about the roles these professionals play within the healthcare system. The British Medical Association (BMA) has expressed the opinion that while the review addresses some key issues, it could delve deeper into the structural and operational realities of these roles.
The author of the review, Professor Gillian Leng, engaged with a diverse range of stakeholders, including doctors, patients, and the general public, in an effort to gather evidence on the effectiveness and safety of PAs and AAs. She noted that when these roles were first introduced to the NHS in 2000, the overarching vision for their integration was largely absent. Consequently, there was no national framework to clearly define how these professionals fit into existing healthcare teams, which has led to widespread uncertainty regarding their purpose and authority.
In her findings, Prof. Leng observed that in situations where there was limited capacity in local medical services, gaps were frequently filled by PAs. However, this was often done without proper consideration of their limited training, or ensuring that their supervisors possessed a comprehensive understanding of the necessary oversight and support they required. The review underscored that the introduction of PAs must come with a clear set of protocols and guidelines.
Critically, the review also examined distressing cases where the lack of clarity in these roles resulted in tragedy. In one instance, a young woman named Emily Chesterton experienced calf pain, which was misdiagnosed by a PA as a sprained muscle, only for it to later be determined as a blood clot. Tragically, she passed away at the young age of 30 after being seen multiple times by this healthcare professional. Similarly, Susan Pollitt, aged 77, had her treatment compromised by a PA at a hospital, ultimately leading to her death due to an infection arising from inadequate care.
These incidents have resonated profoundly with families, such as that of Susan Pollitt, who seek to understand the roles of those involved in their loved ones’ care and advocate for more visible identifiers, such as distinct uniforms and badges, to clarify the personnel involved in patient care. This sentiment was echoed by Kate Pollitt, Susan’s daughter, who remarked on the stress families experience during hospital visits, which can inhibit their ability to comprehend who is responsible for their relatives’ care.
Despite these negative experiences, the review indicated that many patients have expressed satisfaction after consultations with PAs, citing effective communication and attentive care. The recommendations emerging from this review include the renaming of physician associates to “physician assistants” to better reflect their supporting roles, prohibiting them from independently seeing new patients or making diagnoses, requiring a minimum of two years of hospital experience before working in general practice or mental health settings, necessitating them to be supervised by a senior doctor, and differentiating them through uniforms and identification badges.
Similarly, Anaesthesia Associates should potentially be rebranded as “physician assistants in anaesthesia” (PAAs). Further recommendations include ensuring patients receive clear information regarding the PA’s role and the establishment of a dedicated faculty responsible for PA representation and training standards.
The evolution of PAs and AAs since their introduction into the NHS has brought about many changes. Originally designed to alleviate the burdens placed on doctors, these roles have expanded, raising questions of safety and overlap with traditional medical duties. Current estimates state that there are over 3,000 PAs and AAs within England, with projections to increase their numbers to 12,000 by 2036.
While initial training consists of a rigorous two-year postgraduate course for PAs and AAs, concerns have arisen regarding their integration into healthcare teams, especially in the context of new tasks and responsibilities that may stretch beyond their intended capabilities. Regulated by the General Medical Council since December 2024, the BMA insists that clearer demarcations are essential for ensuring that patients know the qualifications of individuals providing their care.
In conclusion, while the proposed name change to “physician assistants” has been recognized as a step in the right direction by various stakeholders, including Dr. Emma Runswick from the BMA, further actions are deemed necessary to ensure that the distinctions between medical personnel and their duties are clearly defined, thereby enhancing patient safety and care
