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Calls for change after ‘poor care’ from physician associate contributed to patient’s death

by Anna Colivicchi
12 July 2023

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The role of physician associates (PAs) in general practice was discussed in Parliament last week after an incident of ‘poor quality’ care contributed to the death of a patient.

The GP practice in North London involved has also now made the decision to stop employing physician associates.

Labour MP for Worsley and Eccles South, Barbara Keeley, raised the issue in Parliament following the death of Emily Chesterton – the daughter of her constituents, Marion and Brendan – who died in November 2022 after suffering a pulmonary embolism.

She had made an appointment at the Vale Practice in Crouch End after feeling unwell for a few weeks and reported calf pain and feeling breathless, and saw a PA at the practice.

PAs are part of ARRS and can perform diagnostic and therapeutic procedures and develop treatment management plans, under the supervision of doctors.

Speaking in the House of Commons, Ms Keeley said: ‘Emily believed that this appointment was to see a GP, but the person she was booked to see at the practice was a physician associate.

‘After a short appointment, the physician associate diagnosed Emily with a sprain and possible long Covid. She was told to rest and take paracetamol.

‘At no point during the appointment at the GP surgery was Emily made aware that the person who had diagnosed her was not a doctor.’

Ms Keeley told the House of Commons that Ms Chesterton made another appointment at the practice a week later, as her leg was swollen and hot and she struggled to walk a few steps without becoming out of breath, and saw the same PA.

She said: ‘It appears that this was a short appointment and that Emily’s legs were not examined. The physician associate suggested that Emily’s breathlessness was due to anxiety and long Covid and prescribed propranolol for the anxiety.

‘In messages Emily sent on this day, she described seeing “the doctor” and it appears that she was never told that the person she was consulting for medical assistance was not a fully qualified GP.

‘In its serious incident report, the Vale Practice states that patients should not see a physician associate twice for the same condition, and guidelines make it clear that physician associates cannot currently prescribe, with any prescriptions needing to be signed off by a supervising GP.

‘It appears that the oversight of prescribing medication was missing and that this system failed in Emily’s case.’

Ms Chesterton’s health deteriorated on the same evening and she took a propranolol tablet as advised by the PA.

Later her family called an ambulance but she suffered a cardiac arrest on the way to the hospital.

Ms Keeley said: ‘The coroner concluded that the poor quality of care given to Emily Chesterton by the physician associate at Vale Practice contributed to her death. That concerns me deeply, and it should concern the Minister, too.

‘The Government must now move quickly to regulate physician associates and learn from the events that led to the sad and tragic death of Emily Chesterton.’

The coroner concluded that Ms Chesterton ‘should have been immediately referred to a hospital emergency unit’ and that ‘if she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived’.

Ms Keeley also added that the practice made ‘a collective decision to terminate the contract of the particular physician associate’ and that ‘a decision was made not to employ physician associates going forward’.

Health minister Will Quince said: ‘Improved patient safety and care lay at the heart of the NHS long-term workforce plan, which, backed by significant Government investment, shows our determination to support and grow the healthcare workforce.

‘As set out in the plan, roles such as physician associate play an important role in NHS provision, but critically, healthcare teams remain supervised and led by clinical experts.

‘We would strongly recommend that employers only consider recruiting PAs who are on the voluntary register.

‘It enables supervisors and employers to check whether a physician associate is qualified and safe to work in the United Kingdom.’

A spokesperson for the practice told our sister publication Pulse: ‘First of all, the practice would like to extend their heartfelt condolences to Emily’s family, for the tragic loss of their loved one.

‘The practice team have spent considerable time reflecting on this case and implementing changes to try to ensure that nothing of this nature happens again.

‘Since this tragic incident happened, the practice ended the employment of a physician associate.  We cannot comment further due to our duty of patient confidentiality.’

The Doctors’ Association UK (DAUK) said it was ‘deeply unsettled’ to hear about the death following a missed diagnosis by a PA and called for reform and regulation of non-doctor roles.

Co-chair of DAUK, Dr Matt Kneale, said there was a ‘crucial need for greater public understanding of non-doctor roles, ensuring patients are well-informed about where their treatment is coming from’.

In a statement, DAUK called on the Government to ‘take necessary steps to reinforce the unequivocal understanding of non-doctor roles amongst patients, and mandate the disclosure of professional titles and qualifications in all consultations’. 

It also wants to see the name changed to ‘physician assistant’ to make it clearer to patients that PAs are not doctors. 

The DHSC has now closed the long-awaited consultation on new legislation to bring and PAs into regulation and expanding their role.

A version of this story first appeared on our sister publication Pulse.