Physician associates in the NHS: Balancing growth and patient safety
By Dr Richard Dune
Image by halfpoint via Envato Elements
As healthcare systems worldwide struggle with the pressures of ageing populations and increasing patient numbers, the role of Physician Associates (PAs) has expanded significantly. Originally introduced into the NHS to alleviate strain on doctors and nurses, PAs are now handling a range of medical tasks, freeing up fully qualified professionals to focus on more complex cases. However, the tragic story of Emily Chesterton serves as a stark reminder of the risks associated with task-shifting, mainly when these roles are not properly regulated and supervised.
In this blog, Dr Richard Dune highlights the importance of proper regulation and supervision to avoid such risks.
Image by fotodestock via Envato Elements
A tragic reminder
Emily Chesterton, a 30-year-old performer, tragically passed away in 2022 after being misdiagnosed by a PA. Presenting with classic symptoms of a pulmonary embolism, she was instead diagnosed with a sprain, anxiety, and long Covid. Crucially, Emily and her family believed she was under a doctor's care, but it was a PA managing her case. The coroner concluded that had she been referred to emergency care, she would likely have survived. This heartbreaking incident highlights the potential dangers of relying too heavily on PAs in scenarios requiring greater medical expertise.
The rise of physician associates in healthcare
In the UK, the number of PAs has surged from just 122 in 2015 to over 3,300 in 2023. This growth is part of a global trend known as “task-shifting,” where lower-qualified healthcare workers take on responsibilities traditionally handled by doctors. While this approach helps fill staffing gaps, especially in areas facing critical shortages of healthcare professionals, it also raises concerns about the clarity of roles and the level of supervision required.
PAs are a solution to the chronic shortage of doctors and nurses. They handle routine medical tasks such as taking patient histories, conducting physical exams, and ordering tests, allowing doctors to focus on complex cases. However, the rapid growth of PAs has led to consistency in how their role is defined and utilised across different healthcare settings.
Image by monkeybusiness via Envato Elements
Image by kenishirotie via Envato Elements
The risks and benefits of PAs
While PAs are intended to enhance healthcare efficiency, their shorter training period — typically a two-year master's degree followed by a year of supervised practice — raises concerns. Unlike doctors who undergo extensive training over several years, PAs are expected to manage various medical tasks with less preparation. This was tragically evident in Emily Chesterton’s case, where a failure to recognise a life-threatening condition underscored the risks of inadequate supervision.
In areas such as Birmingham and Solihull, with the highest number of PAs per capita, the disparity in care between wealthier and more deprived regions becomes apparent. PAs often fill gaps in under-resourced areas, but this can sometimes exacerbate inequalities in care quality, as these regions rely more on less-qualified professionals.
Patient safety and scope of practice
One of the most pressing concerns surrounding PAs is the lack of standardisation in their scope of practice. This variability can lead to dangerous situations where PAs are expected to perform beyond their expertise, often with minimal supervision. In one case, a UK doctor recounted how a PA nearly prescribed the wrong treatment for a critically ill patient — an error that could have been fatal.
These incidents highlight a growing need for more precise definitions of what PAs can and cannot do and more robust supervision to ensure patient safety.
Image by drazenphoto via Envato Elements
Image by APchannel via Envato Elements
A step in the right direction
In December 2024, the General Medical Council (GMC) will finally regulate PAs in the UK. This development is a significant step toward ensuring patient safety, as it will enforce clearer guidelines on PA responsibilities. However, the GMC has acknowledged that regulation alone will not guarantee a uniform level of expertise. Doctors and other medical professionals cannot always rely on PAs to have the same depth of knowledge as junior doctors.
Additionally, more research is still needed on the impact of PAs in real-world settings. While some studies suggest that PAs can complement doctors when adequately supervised, more data is required to assess their effectiveness in productivity, patient outcomes, and satisfaction.
Addressing patient confusion
Another vital issue is the lack of patient awareness about who is providing their care. Many patients do not fully understand the role of PAs, often assuming that a doctor is treating them. This confusion can lead to misplaced trust, where patients believe they are receiving expert care only to discover later that their condition was mismanaged.
To combat this, the NHS is working with patient advocacy groups to improve public understanding of PAs and other healthcare roles. Better communication is essential to managing expectations and ensuring patients know who is responsible for their care.
Image by monkeybusiness via Envato Elements
Image by Wavebreakmedia via Envato Elements
Looking ahead - Balancing efficiency and safety
As healthcare systems evolve, finding the right balance between efficiency and safety will be critical. The increasing reliance on PAs and other support roles is a pragmatic response to the global shortage of healthcare professionals. However, this must come at the expense of patient safety. Clear regulations, better supervision, and ongoing education are essential to ensuring that task-shifting results in safe care.
The case of Emily Chesterton is an essential reminder that while the introduction of PAs can help relieve pressure on the healthcare system, there is a human cost when these roles are not properly regulated. Her family’s campaign for greater oversight of PAs is a call to action for healthcare providers and regulators to ensure that patient safety remains the top priority.
Ensure your organisation is prepared for the future of healthcare
As the role of physician associates and other support staff continues to grow, healthcare providers must stay ahead of regulatory changes and ensure their teams are fully prepared to deliver safe, effective care. The proper training, transparent policies, and strong oversight can make all the difference in safeguarding patient outcomes and maintaining trust in your services.
With ComplyPlus™, you can streamline compliance, enhance training, and ensure that every healthcare professional in your organisation is equipped to operate within a regulated safe framework. Don’t wait for the system to catch up — take proactive steps today.
Contact us to see how ComplyPlus™ supports regulations and improves patient care.
Image by MargJohnsonVA via Envato Elements
A tragic reminder
Image by fotodestock via Envato Elements
Emily Chesterton, a 30-year-old performer, tragically passed away in 2022 after being misdiagnosed by a PA. Presenting with classic symptoms of a pulmonary embolism, she was instead diagnosed with a sprain, anxiety, and long Covid. Crucially, Emily and her family believed she was under a doctor's care, but it was a PA managing her case. The coroner concluded that had she been referred to emergency care, she would likely have survived. This heartbreaking incident highlights the potential dangers of relying too heavily on PAs in scenarios requiring greater medical expertise.
The rise of physician associates in healthcare
Image by monkeybusiness via Envato Elements
In the UK, the number of PAs has surged from just 122 in 2015 to over 3,300 in 2023. This growth is part of a global trend known as “task-shifting,” where lower-qualified healthcare workers take on responsibilities traditionally handled by doctors. While this approach helps fill staffing gaps, especially in areas facing critical shortages of healthcare professionals, it also raises concerns about the clarity of roles and the level of supervision required.
PAs are a solution to the chronic shortage of doctors and nurses. They handle routine medical tasks such as taking patient histories, conducting physical exams, and ordering tests, allowing doctors to focus on complex cases. However, the rapid growth of PAs has led to consistency in how their role is defined and utilised across different healthcare settings.
The risks and benefits of PAs
Image by kenishirotie via Envato Elements
While PAs are intended to enhance healthcare efficiency, their shorter training period — typically a two-year master's degree followed by a year of supervised practice — raises concerns. Unlike doctors who undergo extensive training over several years, PAs are expected to manage various medical tasks with less preparation. This was tragically evident in Emily Chesterton’s case, where a failure to recognise a life-threatening condition underscored the risks of inadequate supervision.
In areas such as Birmingham and Solihull, with the highest number of PAs per capita, the disparity in care between wealthier and more deprived regions becomes apparent. PAs often fill gaps in under-resourced areas, but this can sometimes exacerbate inequalities in care quality, as these regions rely more on less-qualified professionals.
Patient safety and scope of practice
Image by drazenphoto via Envato Elements
One of the most pressing concerns surrounding PAs is the lack of standardisation in their scope of practice. This variability can lead to dangerous situations where PAs are expected to perform beyond their expertise, often with minimal supervision. In one case, a UK doctor recounted how a PA nearly prescribed the wrong treatment for a critically ill patient — an error that could have been fatal.
These incidents highlight a growing need for more precise definitions of what PAs can and cannot do and more robust supervision to ensure patient safety.
A step in the right direction
Image by APchannel via Envato Elements
In December 2024, the General Medical Council (GMC) will finally regulate PAs in the UK. This development is a significant step toward ensuring patient safety, as it will enforce clearer guidelines on PA responsibilities. However, the GMC has acknowledged that regulation alone will not guarantee a uniform level of expertise. Doctors and other medical professionals cannot always rely on PAs to have the same depth of knowledge as junior doctors.
Additionally, more research is still needed on the impact of PAs in real-world settings. While some studies suggest that PAs can complement doctors when adequately supervised, more data is required to assess their effectiveness in productivity, patient outcomes, and satisfaction.
Addressing patient confusion
Image by monkeybusiness via Envato Elements
Another vital issue is the lack of patient awareness about who is providing their care. Many patients do not fully understand the role of PAs, often assuming that a doctor is treating them. This confusion can lead to misplaced trust, where patients believe they are receiving expert care only to discover later that their condition was mismanaged.
To combat this, the NHS is working with patient advocacy groups to improve public understanding of PAs and other healthcare roles. Better communication is essential to managing expectations and ensuring patients know who is responsible for their care.
Looking ahead - Balancing efficiency and safety
Image by Wavebreakmedia via Envato Elements
As healthcare systems evolve, finding the right balance between efficiency and safety will be critical. The increasing reliance on PAs and other support roles is a pragmatic response to the global shortage of healthcare professionals. However, this must come at the expense of patient safety. Clear regulations, better supervision, and ongoing education are essential to ensuring that task-shifting results in safe care.
The case of Emily Chesterton is an essential reminder that while the introduction of PAs can help relieve pressure on the healthcare system, there is a human cost when these roles are not properly regulated. Her family’s campaign for greater oversight of PAs is a call to action for healthcare providers and regulators to ensure that patient safety remains the top priority.
Ensure your organisation is prepared for the future of healthcare
Image by MargJohnsonVA via Envato Elements
As the role of physician associates and other support staff continues to grow, healthcare providers must stay ahead of regulatory changes and ensure their teams are fully prepared to deliver safe, effective care. The proper training, transparent policies, and strong oversight can make all the difference in safeguarding patient outcomes and maintaining trust in your services.
With ComplyPlus™, you can streamline compliance, enhance training, and ensure that every healthcare professional in your organisation is equipped to operate within a regulated safe framework. Don’t wait for the system to catch up — take proactive steps today.
Contact us to see how ComplyPlus™ supports regulations and improves patient care.
About the author
Dr Richard Dune
With over 20 years of experience, Richard blends a rich background in NHS, the private sector, academia, and research settings. His forte lies in clinical R&D, advancing healthcare tech, workforce development and governance. His leadership ensures regulatory compliance and innovation align seamlessly.
About the author
Dr Richard Dune
With over 20 years of experience, Richard blends a rich background in NHS, the private sector, academia, and research settings. His forte lies in clinical R&D, advancing healthcare tech, workforce development and governance. His leadership ensures regulatory compliance and innovation align seamlessly.
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