Wes Streeting 'living in fairy world' for backing physician associates

Doctors have slammed Labour's Wes Streeting for defending 'browbeaten' physician associates (PAs) as 'valuable' and 'important' to the NHS.

In a speech earlier this week the shadow health secretary said he was 'depressed by the state of debate' around 'devalued' PAs, and urged the NHS to not 'slam the brakes' on their recruitment.

However he acknowledged that safety concerns around the group, dubbed 'cut-price doctors', needed to be 'seriously addressed'.

Speaking to MailOnline, medics reacted with fury to the comments accusing Mr Streeting of 'living in a fairy world' and claiming he was attempting to silence their concerns.

The row erupted as the Royal College of GPs (RCGP) today announced it was halting employing PAs in GP surgeries until the profession is properly regulated later this year.

Shadow health secretary, Wes Streeting, said while concerns needed to be 'seriously' addressed, he was 'depressed by the state of debate' around PAs and the NHS should not 'slam the brakes' on their recruitment

Emily Chesterton, pictured, was just 30 when she died in 2022 after a PA failed to spot a blood clot. The actress was seen twice by the same PA, who told her she had anxiety and long Covid. Her parents say that at no point during the appointment was Emily made aware the person she was seeing was not a GP

She died in November after she suffered a cardiac arrest. A coroner concluded her life could have been saved if she had been sent to A&E. The GP practice where Ms Chesterton was seen, the Vale Practice in Crouch End, has now stopped employing PAs. Her parents are now warning of the dangers patients can face amid plans to expand the use of PAs

It follows months of vocal concern by medics over the NHS's growing reliance on PA staff, which has been linked to three deaths.

PAs do not go to medical school and instead do two years of post-graduate training on top of a degree in a subject like biomedical sciences.

Mr Streeting told this website: 'I've been really depressed by the state of the debate and discussion around the future of physician associates.

'Depressed because I think physician associates do have a role to play, and that it would be wrong to throw the baby out with the bathwater and just say, because of some legitimate concerns that doctors have, that we're just going to slam the brakes on or end physician associates in the NHS.

'I've met quite a lot of PAs who are doing really valuable work with their patients and appropriate work.

'And are feeling increasingly pessimistic and browbeaten about their roles and feeling devalued by colleagues.

'And that's because I think we've ended up in that position because legitimate concerns from doctors about the substitution of doctors for physician associates and PAs sometimes being asked to work beyond their scope of practice, because of the workforce constraint — those doctors concerns haven't been listened to.

'We've ended up with a far more toxic conversation than we might otherwise have had.'

He added: 'Physician associates, working within their scope of practice, have a really important role to play, taking doctors concern seriously.

'And I think there's been a failure of leadership and not listening to doctors, and allowing this toxic culture to erupt with barely any public commentary whatsoever from the leaders of this system.

Norman Jopling, 79 from North London, suffered a serious brain bleed after a PA mistakenly told him that his painful headaches were nothing to worry about. His wife Maureen, right, accused the NHS of 'trying to cut corners' by allowing PAs to carry out 'complicated tasks they're not qualified to perform'

'I've been genuinely shocked by it, and shocked by the extent to which any number of organizations, political or not, could have gotten a grip on this and could have shown leadership, and instead have run for the hills.

'And that doesn't bode so well for the future of the NHS, if that's the culture we have.'

Tropical disease medic Dr Eilidh Garrett, however, warned Mr Streeting's position 'suppresses the genuine concerns of doctors who are worried about patient safety'.

She added: 'It's a massive red flag that he isn't even Health Secretary yet and is already feeding into this culture.

'Streeting's position on PAs shows that he has a lack of knowledge of the medical world.

'If he had this knowledge, he would know that PAs should not be used to diagnose or treat patients, which is how they are being used by the NHS right now.

'He is living in a fairy world if he thinks that someone with less training than a doctor can take on the same tasks.'

Heather Ryan, a Formby-based GP, and member of the Royal College of General Practitioners (RCGP) council also said: 'Personal attacks are not nice and doctors need to be civil to PAs.

'However I don't think it is constructive to silence debate by invoking this idea that we need to “be kind”.

'We need to be free to openly discuss this serious issue.'

Meanwhile, Dr Helen Salisbury, a GP and medical education expert at the University of Oxford, told MailOnline: 'Doctors have no axes to grind with individual PAs, but we are legitimately upset about the NHS structures in place, which mean that PAs can autonomously manage patients without proper supervision from a doctor.

'Our concerns are all about patient safety. I feel sorry for the PAs being put in these dangerous situations, but it’s a mess and it needs sorting out.

'He [Wes Streeting] needs to get to grips with this topic, because while there has been some toxicity, its an issue which needs serious attention.'

The NHS employs more than 3,000 PAs in England and plans to increase this to 10,000 by 2036.

Labour has already promised to deliver the long-term workforce plan if it triumphs at the next General Election.

First introduced in 2003, a PA role currently allows them to take medical histories, perform physical examinations, analyse test results and make diagnoses.

But they should always work under supervision.

So just how qualified are physician associates? 

PAs and anaesthesia associates (AAs) are healthcare professionals who have been practising in the NHS since 2002 and 2004, respectively.

They require two years of postgraduate study but no formal medical training, unlike doctors who typically complete five years of medical school followed by a two-year hospital placement.

They are intended to increase capacity and improve patients' access to care by taking on some routine tasks – easing pressure on doctors.

PAs can work autonomously but must always be under the supervision of a fully-trained and experienced doctor.

The adoption of PAs has spread globally and, as of 2022, at least 16 countries have been in various stages of expanding their use of PA-like medical workers.

PAs are not allowed to prescribe drugs or refer patients for procedures.

However, several high-profile cases of harm occurring to patients following consultation by PAs have recently hit headlines, including three deaths.

In 2022, actress Emily Chesterton, 30, died of a blood clot after a PA dismissed her symptoms as anxiety and gave her pills instead of directing her to A&E.

She wrongly believed she had been seen by a GP at her surgery in North London but had twice been seen by an associate.

The GP practice where Ms Chesterton was seen, the Vale Practice in Crouch End, has since stopped employing PAs.

Her parents are now warning of the dangers patients can face amid plans to expand their roles.

And Norman Jopling, 79 from North London, suffered a serious brain bleed after a PA mistakenly told him that his painful headaches were nothing to worry about.

His wife Maureen later accused the NHS of 'trying to cut corners' by allowing PAs to carry out 'complicated tasks they're not qualified to perform'.

In the past year there have also been reports of PAs requesting prescriptions, discharging patients from hospital without a sign-off from a doctor and even taking part in brain surgery.

In February, Liberal Democrat peer Baroness Brinton told a House of Lords debate that doctors had reported '70 instances of avoidable patient harm and near misses caused by PAs', including 'fatalities, missed diagnoses causing terminal diseases, sepsis and heart attacks'.

Discussing the role of PAs Mr Streeting later added: 'I think it is important that we address seriously the concerns that doctors are raising, that we make sure that physician associates are deployed appropriately.

'And that they work within their scope of practice that they are complementing the role of doctors not replacing them or substituting them inappropriately. That's important for patient safety.

'I also think it's important for a much better workplace culture. And I don't think that they're mutually exclusive things.'

Demonstrators, including doctors, gathered outside Parliament in protest against handing over responsibilities to Physician Associates on February 26, 2024. Pictured, Dr Robert Laurenson (third left), Co-Chair of the Junior Doctors Committee, taking part in the protest

Doctor and campaigner Jatinder Hayre told MailOnline: 'Personally, I do not see or foresee any role for physician associates within our NHS. It marks a dilution of standards within medicine — with the ultimate losers being our patients.

'This is a national scandal in the process and only in retrospect in a few years' time will we be able to look back and assess the damage that has already been done.'

Meanwhile, Helen Fernandes, consultant neurosurgeon and chair of the Doctors Association, told MailOnline the situation was 'akin to the post office scandal' by allowing 'the public to think they're being seen by a doctor when they're not'.

She added: 'Although thankfully people aren't being charged with criminal offenses and being jailed.

'I feel that they [PAs] have been mis-sold a degree, which is not really a master's qualification. They've been mis-sold a career.

'It is a crying shame for both the NHS, patients and for the PAs themselves, that the initial design of their role has morphed into something that's become this unimaginable monster of inappropriate use of people who are well motivated, and want to help in the care of patients but that are not qualified or trained to do so and never will be.'

The RCGP's decision today to halt PA recruitment followed 'concerning findings' from its recent consultation, the college said.

Its survey of over 5,000 GPs found more than 80 per cent believe the use of PAs in general practices has a negative impact on patient safety.

The 'disturbing' results also showed half respondents reported 'being aware of specific examples of patient safety being compromised by the work of PAs', including instances of misdiagnosis and inappropriate prescribing.

Professor Kamila Hawthorne, Chair of the RCGP, said: 'The fundamental issue here is that of patient safety and maintaining the high standards of general practice.

'We understand the picture emerging from these results is disturbing, and will be of concern to many, including patients, GPs and PAs themselves.'

Earlier this year, doctors union the British Medical Association (BMA) also called for PAs to be barred from diagnosing patients.

It said PAs must be seen as 'an assistant role to doctors' helping with simple practical procedures, administrative tasks, and working with patients in a supportive and specified role.

They should also never perform complex or life-threatening procedures or be put on doctors' rotas.

Professor Philip Banfield, BMA council chair, today told MailOnline: 'Patients need to know when they are being seen by a doctor and when they are not, and what tasks require the training, experience and expertise of a doctor.

'Despite these assistant roles having existed in the NHS for the last 20 years, the recent emphasis on their rapid expansion makes the need for patients and clinicians to have crystal clear understanding of the skills, qualifications and the limitations of those providing care.

He added: 'Amid a disappointing lack of clarity, engagement and leadership in this area from the Government, NHS England, the GMC and many of the Medical Royal Colleges, we, as the doctors trade union and professional association have been forced lead from the front, producing guidance for safe practice and supervision ourselves.'

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