Physician Associates (PAs) are healthcare workers trained to provide support to doctors, but they are not trained to the same level as a doctor.
However, in 2022 the Royal College College of Physicians held a census into their role of PAs in the UK’s healthcare system (654cfde59a060_FPA_Census_Report_2022_final_for_web.pdf) and found they are taking on a wide range of clinical tasks, including many that are traditionally performed by doctors.
These tasks span specialties from emergency medicine to surgery and include managing both chronic and acute conditions, physical examinations, and patient education.
Despite taking on more complex roles, the fact that Physician Associates are not fully qualified doctors raises significant legal concerns, particularly in regard to patient consent and transparency. Would you know to ask if the person treating you is a fully-trained doctor, or would you assume that you’ll be dealing with a doctor or nurse in a hospital or GP surgery?
What are the Patient Safety Principles governing PAs?
According to the High-Level Principles Concerning Pas Consensus_statement_High_level_principles_concerning_PAs_040324.pdf statement issued by the Academy of Medical Royal Colleges, maintaining patient safety while integrating PAs into clinical teams requires adherence to strict protocols. These principles, supported by 23 medical royal colleges, emphasize several key areas that should guide the safe use of PAs:
1. Role Definition and Clear Communication: PAs should only be employed where there is a clear, defined need within the healthcare team. Critically, the distinction that PAs are not substitutes for doctors must be communicated clearly to both you as a patient, and team members. Failure to inform you that you are being treated by a PA, rather than a fully qualified doctor, can raise legal issues around informed consent and your patient rights.
2. Supervision and Governance: PAs must be supervised by a named senior doctor at all times, especially after they have qualified, and must not be left to work beyond their capabilities. This supervision is crucial for your safety and ensures that the PA’s actions are within the scope of their training. Inadequate supervision or excessive delegation to PAs without proper oversight could increase the chance of treatment going wrong, especially in complex cases.
3. Transparency and Training: PAs’ capabilities should be clearly defined and developed over time, but their progression should be well documented and communicated to both the PA and the supervising medical team. The need for transparency as to the tasks they are doing is particularly important, as this helps protect your safety and ensures that you are aware of the qualifications of the people treating you.
4. Limitation in High-Risk Settings: PAs may not be suitable to work in certain high-risk specialties. Specialties should assess whether a PA’s scope of practice can safely meet the specific demands of that area, and their inclusion in such settings should be carefully considered. In complex or high-risk procedures, such as surgeries, using a PA without proper safeguards could endanger your safety.
What do GPs think about the use of Physician Associates in General Practice?
Interestingly, the British Medical Association’s General Practitioners Committee for the UK (GPC UK) recently voted in favour of stopping the use of PAs in general practice, with a motion wanting to phase out existing PA roles. This stance might suggest that they are also concerned that the care provided by PAs in such settings might not always meet the expected standards of competence. It’s understandable that GPs might be concerned that patients may not get the same level of treatment from PAs who are doing the same tasks, but haven’t received the same level of training as them. (GPs vote in favour of phasing out physician associate role in general practice – BMA media centre – BMA)
What are the legal implications of being treated by a Physician Associate?
From a legal perspective, this increasing reliance on PAs—coupled with their expanding roles in performing complex procedures—raises significant issues regarding informed consent and transparency. You must be explicitly informed when your care is being handled by a PA rather than a doctor, especially when complex medical procedures are involved. Failure to do so could expose healthcare providers to legal challenges, particularly if your treatment goes wrong as a result from a PA’s actions in circumstances where you thought you were being treated by a fully qualified doctor.
The GPC UK’s vote to phase out PA roles in general practice may also signal that concerns about the standard of care PAs provide are valid, particularly when they are in unsupervised or less structured environments. This adds weight to the argument for tighter regulation and stricter guidelines on when and how PAs should be used in medical settings.
Conclusion:
To safeguard your safety as a patient, a legal framework must enforce the principles outlined by the Academy of Medical Royal Colleges regarding role clarity, supervision, and transparency of PAs in healthcare settings. Ensuring that you and other patients are fully aware of who is providing their care is critical, as is ensuring that PAs operate within a tightly regulated scope of practice. As the role of PAs continues to grow, it is essential that their integration into medical teams does not come at the expense of patient safety, informed consent, or the quality of care provided.
If you believe that you’ve received substandard treatment from a Physician Associate, contact us today for a free initial chat about your claim.