UK Study Warns of Safety Risks as NHS Expands Use of Physician Associates

A new British Medical Journal study raises serious concerns about the National Health Service's (NHS) expansion of physician associates (PAs) and anaesthetic associates (AAs) roles without sufficient safety evidence.

Professor Trisha Greenhalgh of Oxford University, the study's lead author, warns that allowing PAs to take on doctor responsibilities 'costs lives' due to inadequate research on safety outcomes [1]. The NHS currently plans to increase its PA and AA workforce beyond the present 3,500 practitioners.

The research reveals critical gaps in safety data, with no comprehensive studies examining incident rates. The limited existing research only covered PAs treating low-risk patients under close supervision [2].

Recent coroner reports have highlighted fatal consequences. In one case at East Surrey Hospital, a PA misdiagnosed a 77-year-old patient's hernia as a nosebleed, leading to the patient's death. Another case involved a 30-year-old who died from pulmonary embolism after two PA misdiagnoses [1].

The Royal College of Physicians issued guidance in December 2024 stating PAs should 'never function as a senior decision maker' or prescribe medications [3]. The Royal College of GPs separately concluded there was 'no role for PAs in general practice' [1].

Professor Martin McKee from the London School of Hygiene and Tropical Medicine called the expansion a 'red flag,' noting that workforce shortages cannot be addressed by 'replacing doctors with people whose training maps poorly to the duties expected of them' [4].

In response, the Department of Health and Social Care confirmed an ongoing independent review of PA and AA roles, with new General Medical Council regulation implemented in December 2024 [5].