PHYSICIAN associates (PAs) should not see patients until they have been reviewed by a medic, a government-ordered report has found, but the British Medical Association (BMA) warned today that the review fell short of fully protecting patients.

The review into the safety and effectiveness of physician associates (PAs) and anaesthesia associates (AAs) concluded the roles should be renamed “assistants” and that they should not see or treat undifferentiated patients to avoid the risk of “catastrophic” misdiagnoses.

Unlike doctors, who study medicine for five years and undertake two years of placements, medical associates qualify by taking a two-year master’s degree course. 

More than 3,500 PAs and 100 AAs are working in the NHS. The previous Tory government set out plans to train 12,000 more.

But safety concerns, particularly arising from patient deaths following misdiagnosis by a PA, prompted a review.

Professor Gillian Leng, president of the Royal Society of Medicine, who carried out the review, said: “Crucially, I’m recommending that PAs should not see undifferentiated or untriaged patients.

“If [patients] are triaged, they [PAs] should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs.”

She recommended that PAs should be renamed “physician assistants” and that AAs should in future be called “physician assistants in anaesthesia.”

The report suggests that new PAs work in hospitals for two years before they are allowed to practise in GP surgeries or mental health trusts.

Professional standards for doctors and associates should also be “presented separately to reinforce and clarify the differences in roles from those of doctors”, it says.

But the BMA pointed out that the review did not recommend a nationally agreed scope of practice for associates. 

BMA council chairman Dr Tom Dolphin said that an opportunity had been missed “to end the postcode lottery of what PAs can and can’t do,” leaving patients “at the mercy of local decisions by employers who can still choose where and how assistants can work.”

He added: “Despite correctly recommending that assistants shouldn’t be the first person seeing patients coming straight through the doors in GP practices or in A&E, the report then contradicts itself by saying that PAs can act as a first point of contact in primary care for minor and common conditions.”

Unison head of health Helga Pile said: “By working closely with doctors and other healthcare professionals, these roles can make a real difference to the improvement of services and reduction of waiting lists.

“Clearer identification of physician associates and anaesthesia associates will give patients a greater understanding of who’s delivering their care and what they can expect.”