Concerns have emerged over the increasing use of physician associates (PAs) in the National Health Service (NHS) following the tragic death of Susan Pollitt, a 77-year-old patient at Royal Oldham Hospital.
Susan was initially admitted with a broken arm and diagnosed with an acute kidney injury. Her husband Roy Pollitt believes she would have survived if not for the involvement of a PA with only two years of medical training. The inquest into her death concluded that an “unnecessary medical procedure” contributed to her demise.
The case highlights growing concerns about PAs, who were originally introduced to support doctors but have seen their numbers more than double to 3,000 in the past two years. The NHS plans to increase this to 12,000 by 2036. However, multiple organizations have raised alarms about PAs potentially working beyond their original scope, including:
– Covering doctor shifts
– Prescribing medicines
– Ordering X-rays without supervision
In Susan’s specific case, a PA left an abdominal drain in her body for 21 hours – 15 hours longer than permitted – and instructed colleagues to clamp it, increasing infection risks. Notably, a liver nurse had previously approved the PA’s competence, assuming he was a doctor.
The Northern Care Alliance NHS Foundation Trust acknowledged the substandard care, with Chief Medical Officer Dr. Rafik Bedair expressing deep sorrow and commitment to learning from the incident.
Consultant anaesthetist Richard Marks has been vocal about the risks, emphasizing that PAs receive only two years of training compared to doctors’ seven years. He warns that PAs lack the depth of understanding to handle complex medical situations without adequate supervision.
The coroner issued a Prevention of Future Deaths notice, and the General Medical Council (GMC) agrees that patient safety is at risk without effective safeguards. From December, PAs will be regulated by the GMC, with the organization’s chief executive Charlie Massey stressing that employers must clearly define roles and ensure professionals work within their competence.
The Academy of Royal Colleges has called for an independent review due to the increasingly contentious debate surrounding medical associates.
The Department of Health and Social Care emphasized that patient safety is their priority and they are working to ensure PAs support, not replace, doctors. NHS England has promised updated guidance on the appropriate deployment of medical associates.
Susan’s family, while devastated, does not blame the individual PA and instead seeks systemic change. Her daughter Kate Pollitt expressed a desire to reduce the chances of similar incidents occurring in the future.
The case has sparked a broader conversation about medical training, supervision, and the expanding role of physician associates in the healthcare system, with many calling for clearer guidelines and more robust oversight.
