Concerns Over Physician Associate Deployment After Patient’s Death in NHS

The husband of a woman who passed away following a surgical drain being inadvertently left in her abdomen for 21 hours has criticized the growing reliance on physician associates (PAs) within the National Health Service. An inquest into the death of Susan Pollitt at Royal Oldham Hospital in July 2023 determined that her demise resulted from an “unnecessary medical procedure contributed to by neglect.” Roy Pollitt was unaware that his 77-year-old spouse was being cared for by a physician associate – a role requiring only two years of medical training – and he asserts, “she would have lived if the NHS had not used cheap labour.” The coroner investigating Mrs Pollitt’s passing underscored the absence of a nationwide structure governing the training, oversight, and evaluation of competency for PAs. Physician associates were first integrated into the NHS 21 years prior, with the initial aim of assisting doctors by providing fundamental care. In the last two years, the count of these associates has surged to 3,000, representing more than a twofold increase. Beyond their two years of medical training, PAs typically need an undergraduate degree in a field related to health or life sciences. The NHS Long Term Plan projects a workforce of 12,000 physician and anaesthetic associates by the year 2036. Health Secretary Wes Streeting acknowledged “legitimate concerns” regarding the function of PAs even prior to their expanded deployment. Apprehensions have been voiced that certain PAs have operated outside their initial scope of duties. BBC News has obtained information indicating that during the month Mrs Pollitt died, the NHS trust responsible for Royal Oldham utilized PAs to staff almost 20% of doctor shifts within its elderly care division. Multiple organizations, among them the British Medical Association (BMA), have articulated worries concerning the indistinct professional boundaries between doctors and associates throughout NHS trusts and primary care settings. Anaesthetists United, an organization established by concerned medical practitioners and consultants, has initiated legal proceedings against the General Medical Council (GMC), contending that it has failed to adequately delineate the roles and responsibilities of associates. Richard Marks, a consultant anaesthetist and one of the group’s founders, stated that patients were “being put at risk” as a result, a situation he described as something that “strikes to the heart of you” as a doctor. Furthermore, BBC News has discovered that PAs have overstepped their designated authority in multiple NHS trusts, specifically by: Commencing in December, associates will come under the regulatory oversight of the GMC, alongside doctors. Nevertheless, considerable apprehension persists among certain members of the medical profession. Susan Pollitt initially presented at Royal Oldham Hospital with a broken arm, sustained after a fall at her residence in Failsworth, Greater Manchester. The great-grandmother, who was first attended to in a corridor, also received a diagnosis of an acute kidney injury. Owing to a shortage of gastroenterology beds, she was transferred to a respiratory ward. Her daughter, Kate Pollitt, observed that staffing levels appeared “very low,” and further stated that on the evening her mother passed away, “it took nearly four hours to find a doctor in the whole of the hospital.” During Mrs Pollitt’s inquest, numerous deficiencies in her care were revealed. The PA not only left an abdominal drain – a device for extracting surplus fluid from her body – in place for 15 hours beyond the allowed duration, but also instructed colleagues to clamp it, thereby elevating the potential for infection. It also came to light that, in the preceding year, a liver nurse had endorsed the associate’s proficiency in operating the equipment solely because she presumed he was a doctor. Kate Pollitt commented: “He thought he was doing right… but he was in a situation where he wasn’t supported.” She added: “There was too much confusion and not enough supervision.” The Northern Care Alliance (NCA) NHS Foundation Trust, the entity managing the Royal Oldham, concluded that Mrs Pollitt would likely have lived if the drain had been extracted sooner. Dr Rafik Bedair, the trust’s chief medical officer, stated: “We’re saddened Mrs Pollitt didn’t receive the standard of care that she should have done and we remain deeply sorry to her family for this.” He further expressed that the trust had a duty to the family to “learn from what went wrong and make things safer for patients in the future.” The NCA provides services to over a million individuals across Salford, Oldham, Rochdale, and Bury, in addition to offering specialized care to patients from Greater Manchester and surrounding areas. Subsequent to Mrs Pollitt’s inquest, North Manchester Coroner Joanne Kearsley issued a Prevention of Future Deaths notice, citing her apprehensions regarding PAs. The GMC concurred that patient safety was jeopardized in the absence of adequate safeguards. Charlie Massey, its chief executive and registrar, commented that the forthcoming regulatory adjustments next month would represent “a vital step towards strengthening both patient safety and public trust in these professions.” He also emphasized that employers bear the responsibility for clearly delineating roles, and that, akin to “all regulated professionals, [associates] will be expected to work within their competence.” However, consultant anaesthetist Dr Marks cautioned that the absence of a national scope of practice – complete with explicit limitations and benchmarks – would continue to endanger patients. He noted that insufficient supervision for PAs had been a “key feature” in recent prominent cases, such as the death of a 30-year-old woman from Salford. He asserted: “In each one of them, had a doctor been more closely involved and seen what was going on, they would have made changes to that patient’s care.” Dr Marks further expressed: “What we’re most concerned about is that you’ve got a big increase in numbers of PAs who don’t have the depth of understanding because of their background, and who are going to be let loose on the public without adequate supervision.” Mr Marks also voiced apprehension regarding the disparity in training duration, with doctors undergoing seven years compared to PAs’ two years. He remarked, “What you don’t know, you don’t know,” suggesting that PAs “not having the skills or experience” to accurately diagnose patients presenting with diverse levels of complexity. The Academy of Royal Colleges has similarly advocated for an independent examination into the deployment of associates, citing an “increasingly acrimonious and destructive debate.”