Hospitals are flouting NHS rules by allowing staff with as little as two years’ training to treat expectant mothers and stroke victims in place of doctors, The Mail on Sunday can reveal.
In a move described as a ‘huge potential threat to patient safety’, a number of NHS hospitals are routinely using physician associates (PAs) to cover doctors’ shifts.
A PA is an NHS worker with no medical degree who is meant only to assist doctors and nurses. They are not qualified to diagnose patients, prescribe drugs or order scans, and are meant to be supervised by a doctor.
But an investigation carried out by this newspaper has uncovered dozens of cases where hospitals have used PAs to cover for a lack of doctors in departments including gynaecology and A&E.
This is against NHS guidance.
In 2022, Emily Chesterton, 30, died after a PA failed to spot a blood clot. The actress was seen twice by a PA, who told her she had anxiety and long Covid
In one of the most worrying cases, PAs have covered for doctors at the Blackpool Victoria Hospital stroke ward 14 times since the beginning of the year. According to a Freedom of Information request, the hospital has also allowed PAs to cover doctors’ shifts in A&E.
The same stroke ward was hit with scandal last year when a nurse and a junior colleague were convicted of unlawfully sedating patients.
A murder probe is also ongoing after a patient bled to death on the ward from internal injuries after being assaulted by an unknown member of staff. Six years on, police have not been able to identify the suspect.
There is no suggestion that any of these crimes were committed by PAs or occurred during shifts where these non-medics were present.
In response to our findings, the family of a woman who died due to mistakes made by a PA at a GP practice has urged the NHS to stop using underqualified medics to make up for doctor shortages.
In 2022, Emily Chesterton, 30, died after a PA failed to spot a blood clot. The actress was seen twice by a PA, who told her she had anxiety and long Covid.
Her parents say that at no point during the appointment was Emily made aware the person she was seeing was not a GP. A coroner concluded that Emily should have been immediately referred to a hospital emergency unit.
The North London GP practice where she was seen has since decided to stop employing PAs.
‘It’s terrifying to think that people are being treated in hospital by people who they believe are doctors, but are actually just PAs,’ said Emily’s mother Marion Chesterton, 65, a retired teacher from Salford.
‘We lost our daughter as a result of mistakes made by a PA who was not qualified to diagnose her. The fact hospitals still allow PAs to work in this manner shows that lessons have not been learned.’
Emily’s parents say that at no point during the appointment was Emily made aware the person she was seeing was not a GP
Emily pictured with her mother Marion and sister Jasmine, left
The NHS plans to recruit some 10,000 PAs by 2038 to relieve the strain of the doctor shortage.
Last night NHS England criticised the trusts named in our investigation. ‘There should never be any circumstances where physician associates are replacing doctors,’ said a spokesman. ‘We are following this up with all trusts concerned. The NHS has always been clear that PAs are not a substitute for doctors.’
Doctors’ union the British Medical Association (BMA) urged new Health Secretary Wes Streeting to take action. ‘These reports confirm that PAs have been used in place of doctors on medical rotas at trusts across the country,’ said BMA Council chairman Professor Phil Banfield.
‘This practice represents a huge potential threat to patient safety and is a cause for national alarm. PAs do not have the rigorous medical training or the qualifications to take on a doctor’s responsibility for patient care, at these trusts or anywhere else.’
He added: ‘While PAs may have a useful role assisting the wider medical team, NHS England themselves have communicated repeatedly to hospital trusts that PAs should not be used as replacements for doctors on any rota. It’s inexcusable for these trusts to use PAs in this way.
‘After no action from the previous Government, it’s essential the new Health Secretary takes this on and stops this practice in its tracks.’
Demonstrators gather outside Parliament in protest against handing over responsibilities to physician associates who have limited medical training and are not doctors
The protesters argue that using physician associates in place of doctors can potentially endanger patients and can lead to loss of life
The Mail on Sunday first raised the alarm about PAs last year and has been running a campaign to Rein In The Physician Associates. We believe there should be strict limitations on what tasks PAs can and can’t do.
Following growing concerns, in March, NHS England issued new guidance stating ‘PAs should not be used as replacements for doctors on a rota’.
But last month we revealed that Royal Berkshire Hospital had used PAs to cover doctors’ shifts in emergency wards more than 70 times over the past six months – including 21 times since March.
On several occasions the hospital also asked trainee PAs – yet to even complete their two years’ training – to fill in for doctors.
Following these revelations we sent Freedom of Information requests to every hospital trust in the country, asking them to reveal every time they had used PAs to cover doctors’ shifts since December 2023.
More than 100 NHS trusts responded. The vast majority were not using PAs in this manner, and several provided strongly worded responses distancing themselves from the practice.
Maidstone and Tunbridge Wells NHS Trust said that it would ‘not ask a PA to cover vacant slots on any medical rota’.
Mid Cheshire Hospitals NHS Foundation Trust said it does not use PAs to fill rota gaps left by doctors as ‘they cannot prescribe or request X-rays’.
However, not all trusts shared this attitude. Between December 2023 and May 2024, Northampton General Hospital NHS Trust asked PAs to cover doctors’ shifts 25 times, typically in its emergency department. The trust, which employs eight PAs, admitted they were given the shifts because ‘no doctor cover was available’.
London North West University Healthcare NHS Trust said its 37 PAs had filled in for doctors 76 times during the same time period, but did not elaborate on which wards these shifts took place.
Barts Health NHS Trust in east London has placed PAs on its junior doctors rota in A&E 20 times over the past six months. Four of these cases occurred after the NHS directed trusts to end the practice. A spokesman said: ‘Physician associates play an important role in caring for patients in our hospitals, and we employ 16 alongside our 2,500-strong medical workforce.
‘Their clearly defined roles are in line with their training, experience and qualifications and they always work under the supervision of senior doctors.’
The Shrewsbury and Telford Hospital NHS Trust said PAs were approached ‘to fill in a doctor gap on the rota’ and ‘cover some aspects of the on-call team rather than leave a gap empty’.
The trust, which said leaving an unfilled vacancy would ‘adversely affect patient care’, said it would take too much time to ‘establish the number of shifts covered by physician associates’.
And the Rotherham NHS Foundation Trust listed five occasions where doctors’ shifts were covered by PAs, all of which were on its gynaecology ward.
A spokesman said: ‘PAs perform a range of tasks within their scope of practice, always ensuring patient safety. All care involving PAs is overseen by qualified gynaecologists to maintain the highest standards of medical care.’
Dr Helen Fernandes, chairman of the Doctors’ Association, which represents NHS clinicians, said: ‘PAs shouldn’t be covering for doctors in any area.’
A Department of Health and Social Care spokesman said: ‘Physician associates have an important role to play but should always work with doctors, not replace them.
‘As we fix the NHS, we will end the workforce crisis and deliver the NHS long-term plan, so patients are always cared for by the right, qualified healthcare professional.’
Every hospital mentioned was approached for comment.
The NHS has a shortage of nearly 9,000 doctors, according to the British Medical Association.
