The BMA has published over 600 reports from GPs and other doctors of ‘serious concerns’ about physician associates (PAs) working in the NHS.
This ‘shocking testimony’ has been submitted to the Government-commissioned Leng review, which is looking at the safety of the role, and some of its most serious reports in general practice include PAs having ignored or missed postmenopausal bleeding, raised PSA results, and deep vein thrombosis.
Doctors and medical students were able to submit concerns about the ‘blurring of lines’ between their roles and PAs via an online reporting portal between November 2023 and February 2025.
While publishing the ‘full extent of the evidence’ today, the BMA has again called on the NHS to introduce ‘urgent interim safety measures’ until the Leng review concludes in June.
The doctors’ union said the examples show PAs ‘making incorrect clinical decisions in place of doctors’, introducing themselves as doctors, and ‘dangerously prescribing medication’, which is illegal.
Doctors from across the UK submitted concerns to the BMA, and the union then compiled 23 of the ‘most serious examples’, of which five concerned PAs working general practice (see box).
Reports on PAs from doctors (anonymised)
1. A PA in GP surgery saw a woman with post menopausal bleeding and documented a normal cervical examination. She came to clinic and had a 6cm cervical cancer. Resident Doctor, Peninsula
2. Patient death as a result of a PA missing a DVT (likely patient was not examined, PA did not discussed with supervisor despite CLEAR supervision protocols in place. GP, England
3. I am a GPST3 [experienced GP registrar] working in primary care. There are PAs working at the practice. I encountered a middle aged gentleman in September 2023 who was presenting for the fourth time since Feb 2023. He was complaining of severe, unrelenting and atraumatic back pain. This is a summary of the events leading up to this telephone consultation with myself. During his first consultation about his back pain the patient had seen a PA who had documented that this patient had requested a PSA blood because a friend of his had recently been diagnosed with prostate cancer. The PA agreed to the blood test. No bone profile, fbc or myeloma screen was ordered. The PA documented that his impression was that this was muscular back pain. No analgesia [pain medication] was offered. No physiotherapy was offered The patients PSA result was over 700 in Feb 2023. The PA reviewed the result and sent the patient a text asking him to make a routine appointment to discuss it. He made no further attempts to contact the patient. A two week wait referral was not done. He failed to discuss the result with his supervisor. He failed to make the link between the patients back pain and the fact this result certainly indicates a diagnosis of advanced prostate cancer. The same patient presents again a month later. Again with severe back pain. This time he saw a different PA. This PA failed to notice the patients recent PSA. A diagnosis of trochanteric bursitis was made. No ultrasound was ordered. No analgesia was offered. No physiotherapy was offered. No questions were asked to establish just how severe this patients pain was. No information about weight loss was obtained. This patient was not discussed with a supervisor. The same patient presented for a third time. This time to the original PA who had ordered the PSA at the patient’s request. There was no discussion with the patient about the raised PSA. Once again no analgesia or physiotherapy was offered. No attempts were made to establish a history indicative of sinister, malignant pain. No questions were asked about weight loss or systemic upset. The patient was not discussed with a supervisor. By the time I spoke to the patient a repeat PSA was >2700. He gave a detailed history of progressively severe pain, including night pain to his back and right hip. He had lost 10kg of weight unintentionally. A two week wait was done and a face to face appointment offered for a full neurological examination. The following day the patient was admitted to hospital for suspected cord compression GP registrar, unspecified
4. One PA saw a patient who had recently undergone a liver resection and had swinging pyrexia, gave a course of doxy for ?LRTI, I saw a week later and sent her straight to hospital as she was septic from the liver abscess she had. GP registrar, Severn
5. When I worked on dermatology there was an influx of referrals which were completely inappropriate to the service. There were hinders of USC referral for seb Ks, a benign skin growth with no photos and a referral akin to ‘i dont know what this is but it looks bad, please see’. They were impossible to triage and clogged the service. One read ‘there are 40 melanomas [cancerous skin lesions] on this gentleman’s back and I have informed him of this.’ I reviewed this man and he had nothing that looked like anything of the sort and this was confirmed by the dermatologist. This man spent 3 weeks thinking his life was over. Resident Doctor, Wales
Source: BMA
The union has urged the Government to implement the BMA’s own scope of practice for the roles, and to conduct an ‘immediate investigation’ into PAs and AAs being placed on doctor rotas – an issue which made up a ‘large proportion’ of reported concerns.
According to the BMA, the patient safety concerns documented arose from ‘an ongoing failure to put in place a national scope of practice for these roles’.
‘Many patients have either come to harm or only avoided it by the timely intervention of a doctor after being seen by a PA who was left to act well outside their competence,’ the union said.
BMA council chair Professor Phil Banfield said this is a ‘chronicle of a health system that is seeing far too many near misses’, and the ‘one simple cause’ is that PAs and anaesthesia associates (AAs) are ‘doing things they are neither trained or legally supposed to do’.
‘These testimonies are of critical importance to Professor Leng’s impending review which must end this dangerous free-for-all,’ he added.
Professor Banfield continued: ‘PAs inserting chest drains unsupervised, prescribing dangerous levels of opioids to patients or even those outright impersonating doctors – the sheer number of these accounts is hair-raising.
‘This is an invaluable testimony from working doctors across the UK showing why we have been so insistent that we see a national scope of practice, right now.’
It is sobering to read these cases and I feel for patients involved and their families. I also feel for the clinicians involved too. I was watching ITV this morning reporting of Jess, a 27 year old who died of stage 4 cancer after being ‘ seen’ by GPs 20 times each time missing the diagnosis. ( look up Jess’s Law). There are daily mistakes made everywhere in the NHS-Martin Bromiley ( just another routine operation) calls for us to look at the human factors involved. We can all learn lessons about good communication between team members from his wife’s death and his work to improve things.
same argument- Just because airline crashes occur despite being flown by properly trained pilots does not mean that an untrained PA (Physician Associate) could fly a plane just as well. The fact that failures happen even under qualified GPs does not justify allowing unqualified individuals to take over critical roles
No doubt there has been a “Wild West” rushed element to the introduction of PAs into Primary Care (which faced an existential recruitment crisis at the time), with copious examples of poor practice, but this demonstrates a need for better regulation of PAs rather than their expulsion.
.There are many examples of excellent care where properly supervised PAs provide valuable assistance to the doctors and patients in a huge number of surgeries.
Where poor practice has been identified then appropriate actions should be taken, but let’s not have the pot calling the kettle black.
The MDO publications are crammed with some hair raising examples of dreadful GP care and cock ups, let’s not start stoning another profession in this particular glasshouse.
Playing Russian roulette with PAs. I would not even let my FY2 with better grades, 5 years of medical school and over 1 year of doctor’s experience be unsupervised. 2 years of training people with poorer grades is insufficient as it clearly shows.
I cannot conceive that anyone with medical training would miss the significance of a PSA of 700 – let alone two people missing it.
I don’t think we are doing PA’s a favour by minimising the potentially disastrous position they have been put in – they simply don’t have enough training for the role they have been parachuted into.
https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/workforce/physician-associates-and-anaesthesia-associates
Full 116 pages of submissions available through a link on this site
Really concerning reading concerning both primary and secondary care. This is not defensible
I feel sorry for patients and their families. There are 2questions here, One Should the term physician ( associates) is fair as they are are not physician but can be associates or assistant only , Second How this disguising culture can be monitored , like on referral letters or message or in introduction , vague terms like clinician are used ? Above cases are tips of Ice burgs . In Practice , patient should be given a fair choice who do they want to see?