surgery
Doctors’ Association survey finds ‘deeply disturbing’ misuse of govt’s non-doctor roles
Danger to patients and conflicts of interest as government continues to push for expanded use of ‘associate’ roles – with help from the Royal College of Physicians
A survey by the Doctors’ Association UK (DAUK) has revealed ‘deeply disturbing’ ‘scope creep’ in which – as warned by the British Medical Association (BMA) and others – ‘physician associates’ (PAs), who are not qualified as physicians, are being used and acting as doctors.
A statement by the group warns that PA are not only overstepping the boundaries in which they are meant to operate, but also being used by NHS trusts and health companies to fill positions that require fully-qualified doctors:
PAs are overstepping boundaries, putting patient safety at risk, and impacting doctors’ training. This is shocking in itself, but made far worse by recent events at the Royal College of Physicians… Doctors at Torbay report PAs being used as “middle grades” – clear scope creep.
According to a doctor recruitment agency:
Doctors in speciality training programmes are known as Middle Grade doctors. Junior Middle Grade doctors are trainees who have completed their foundation training and are now in the early years of their speciality training. They are: ST1/ST2: ST stands for Specialty Training.
According to survey responses from doctors at Torbay and South Devon NHS Trust, as well as being used as ‘middle grade’ doctors and putting patients at risk by acting outside their competencies, PAs:
- work without adequate supervision
- consent inappropriately
- participate in unsafe clinical activity
- treated severe infective colitis with antibiotics and steroids simultaneously
According to NHS Scotland, steroids “shouldn’t be used if you have an ongoing widespread infection. This is because they could make it more severe.”
The DAUK also linked the survey results to this week’s fiasco at the Royal College of Physicians (RCP), where attendees of an extraordinary general meeting (EGM) regarding concerns about PAs linked the behaviour of the RCP’s panel, which was accused of ‘contempt’, shutting down discussion and even filibustering, to the RCP’s financial conflict of interest in the millions of pounds it reportedly makes from administering PA examinations.
The RCP is hiding their full survey data from FRCP and Council until after the EGM vote. This lack of transparency is unacceptable…
The RCP Registrar, who sets RCP professional standards, works at this Trust. (Important note: there is no indication she was involved in this case [of steroid/antibiotic administration].)
Doctors at Torbay report PAs being used as “middle grades” – clear scope creep. Yet the Registrar, whose job is to “create consensus” & uphold standards, has been involved in withholding critical data that potentially sways the EGM vote. This is not leadership.
The Registrar’s own job description emphasises “accountability for clinical and professional affairs” and “…setting and maintaining professional standards.” How can the Registrar fulfil these duties, ensuring patient safety and upholding standards, when those very standards are being violated in their own Trust? This is an untenable conflict of interest.
In our view, the Registrar has failed in their core responsibility for transparency and integrity of RCP decision-making. We call for their resignation to restore trust in the RCP. The RCP’s position on PAs is currently compromised.
The statement concludes with a call on all voting members of the RCP to vote to support all the motions tabled at the EGM calling for a rethink on the issue of PAs:
Lastly, we are asking that Fellows vote in favour of all five motions as presented, to ensure that a safe revaluation of the PA role can be conducted to ensure patient safety and to ensure continued viable training of the medical profession moving forward.
The use of PAs, which is considered by nine out of ten doctors to be dangerous to patients and confuses many patients, who do not realise that they have not been seen and treated by a fully-qualified medic, is being pushed by the government as a way of ‘downskilling’ the NHS, reducing costs and allowing increased profits for private providers, under the guise of the so-called ‘NHS Workforce Plan’ as part of the ‘Integrated Care Systems’ (ICS) project.
ICS, formerly called ‘Accountable Care Organisations’ (ACOs) after the US system it copied, were renamed after awareness began to spread that ACOs were a system for withholding care from patients and that care providers were incentivised to cut care because they receive a share of the ‘savings’. The system remained the same, but the rebranding disguised the reality.
The government used a ‘statutory instrument’ (SI) to pass these changes, avoiding proper parliamentary scrutiny, but both the Tories and Keir Starmer’s Labour support these and other measures to cheapen the NHS for private involvement and only independent MP Claudia Webbe spoke against them during the brief SI debate. Green peer Natalie Bennett’s motion in the House of Lords to attempt to kill the instrument was defeated by the Tories with the help of Labour peers.
At least two people have already died avoidably because of misdiagnosis by PAs. Emily Chesterton, 30, who didn’t realise she wasn’t seeing a doctor, was treated for a calf strain when she had a deep vein thrombosis that led to a lethal embolism. Ben Peters, 25, was sent home from A&E with a ‘panic attack’ that was really a serious heart condition. A doctor’s Twitter/X thread includes details of others said to have died because of issues around PAs.
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Royal College of GPs deletes article exposing lack of supervision of ‘PA’ not-doctors
RCGP has been equivocal about government’s changes to use of ‘associates’ without medical training to treat patients
The Royal College of GPs has deleted an article that detailed the extent of the lack of supervision by fully-qualified doctors over the actions and decisions of the ‘physician associate’ (PA) roles – who have only two years’ training – whose use the government is expanding.
The use of PAs, which is considered by ninety percent of doctors to be dangerous to patients and confuses many patients, who do not realise that they have not been seen and treated by a fully-qualified medic, is being pushed by the government as a way of ‘downskilling’ the NHS, reducing costs and allowing increased profits for private providers, under the guise of the so-called ‘NHS Workforce Plan’ as part of the ‘Integrated Care Systems’ (ICS) project.
ICS, formerly called ‘Accountable Care Organisations’ (ACOs) after the US system it copied, were renamed after awareness began to spread that ACOs were a system for withholding care from patients and that care providers were incentivised to cut care because they receive a share of the ‘savings’. The system remained the same, but the rebranding disguised the reality.
Now, as Pulse magazine has revealed, the RCGP has deleted a case study that revealed a shocking lack and laxity in the supervision of a PA:
According to the now-deleted case study, held a ‘minimum’ of 27 10-minute appointments each day and asked the on-call doctor to review patients for an ‘urgent opinion’ only ‘once every two to three months’…
…After screenshots circulated on social media, the RCGP removed the case study at the PA’s request…
…The case study previously said: ‘[The PA] has three, ten-minute appointment slots in a row, and at the end of those slots has a ten-minute break for administration and including having prescriptions signed by a GP.’
It said supervision is ‘shared’ between GPs working at the practice, and that for ‘non-urgent concerns’ there is a ‘ten minute debrief with an on-call doctor’ which takes place every two to three weeks.
Matt Kneale, co-chair of the Doctors’ Association UK which along with the British Medical Association is opposing the changes, said:
Much of the concern from doctors in recent months has built up from a lack of transparency from Royal Colleges about where they stand on physician associates.
While we are grateful that the RCGP has removed what can, at best, be described as unprofessional practice, we maintain that the College needs to sit down with wider stakeholders on the concerns around PA roles and scope more generally.
The RCGP has voiced ‘concerns’ about the new system, but has not formally opposed it, despite the outrage of doctors and the increasing examples of companies hiring PAs instead of doctors and even making doctors redundant to switch to PAs.
The government’s expansion and renaming of these roles, along with backdoor to regulate them via the General Medical Council (GMC), which regulates doctors – is part of what experts call ‘scope creep’: physician’s assistants and anaesthetist’s assistants, as they were originally called, are valuable roles in carefully limited settings, but NHS England, the government body appointed to run (and run down) the NHS has been using them way beyond their original scope, for example even to perform some types of brain surgery and expecting them to ‘learn on the job’.
The government used a ‘statutory instrument’ to pass these changes, avoiding proper parliamentary scrutiny, but both the Tories and Keir Starmer’s Labour support these and other measures to cheapen the NHS for private involvement and only independent MP Claudia Webbe spoke against them during the brief debate. Green peer Natalie Bennett has tabled a motion in the House of Lords in an attempt to kill the instrument, but without support from the notional ‘opposition’, it is unlikely to succeed.
During the Statutory Instrument debate, Tory former Health Secretary Therese Coffey gushed about the potential for using three associates to anaesthetise patients during operations, with just a single consultant anaesthetist monitoring remotely as an ‘efficiency’.
At least two people have already died avoidably because of misdiagnosis by PAs. Emily Chesterton, 30, who didn’t realise she wasn’t seeing a doctor, was treated for a calf strain when she had a deep vein thrombosis that led to a lethal embolism. Ben Peters, 25, was sent home from A&E with a ‘panic attack’ that was really a serious heart condition.
SKWAWKBOX needs your help. The site is provided free of charge but depends on the support of its readers to be viable. If you’d like to help it keep revealing the news as it is and not what the Establishment wants you to hear – and can afford to without hardship – please click here to arrange a one-off or modest monthly donation via PayPal or here to set up a monthly donation via GoCardless (SKWAWKBOX will contact you to confirm the GoCardless amount). Thanks for your solidarity so SKWAWKBOX can keep doing its job.
If you wish to republish this post for non-commercial use, you are welcome to do so – see here for more.