Union loses High Court bid for temporary block on medical associate changes

A medical union has lost a High Court bid to temporarily block NHS England (NHSE) from implementing recommended changes to the roles of physician associates (PAs) and anaesthesia associates (AAs).

The union, United Medical Associate Professionals (UMAPs), had asked for an injunction to stop the NHS from changing the name of PAs and AAs, known together as medical associates, to medical “assistants”, and implementing a number of other suggestions, as recommended by the Government-ordered Leng Review.

The review, chaired by the president of the Royal Society of Medicine, Professor Gillian Leng, found that PAs have been used as substitutes for doctors despite having significantly less training.

‘Catastrophic’ misdiagnoses

One of its 18 recommendations was that PAs be banned from seeing patients whom a medic has not reviewed to prevent the risk of “catastrophic” misdiagnoses.

UMAPs announced in July that it was taking legal action against the Government and NHSE over the decision to accept the review’s recommendations.

Patrick Green KC, for the union, said on Friday that a temporary injunction should be granted to “maintain the status quo” before the full challenge is heard.

Mr Green also told the court that the recommendations affect the titles, employment, scope of practice and careers of PAs and AAs.

NHSE opposed the injunction bid and is also opposing the wider legal challenge.

In written submissions, Oliver Jackson, for the organisation, said it would be “far-fetched to suppose that preserving the current situation in aspic would lead to a betterment of the position for PAs and AAs”.

He added: “The actual status quo is that there is considerable uncertainty and a variety of different approaches being adopted by different stakeholders in the healthcare system.

“Making the order now sought will not ‘remove’ that uncertainty, or contrary to what the claimants seem to suppose, return the situation to as it was before the Leng Review had been published.”

Dismissing the application, Mr Justice Dove said he was “unconvinced” that there was a “justification” for a temporary injunction.

More than 3,500 PAs and 100 AAs are working in the NHS, and there have been previous calls for an expansion in their number.

But their roles were reviewed following high-profile deaths of patients who were misdiagnosed by PAs, with six patient deaths linked to PAs recorded by coroners in England.

They include 30-year-old Emily Chesterton, who died from a pulmonary embolism after being misdiagnosed by a PA on two occasions and told she had anxiety.

In her report, Prof Leng concluded there were “no convincing reasons to abolish the roles of AA or PA” but there is also no case “for continuing with the roles unchanged”.

She said more detail was needed on which patients can be seen by PAs, and national clinical protocols will now be developed in this area.

The Welsh Government is being urged to implement the findings of the review into the use of Physician Associates (PAs) and Anaesthesia Associates (AAs) in England.

PAs have been working in Wales since 2015 and now there are approximately 220 working across primary and secondary care. There are no official statistics for the number of practising anaesthesia associates, but it is thought to be significantly smaller.

In response to the BMA’s Welsh council calling for the recommendations of the Leng review to to introduced in Wales, The Welsh Government said: ”We welcome the publication of the Leng review, which sets out recommendations for England, and will respond in due course.

“We note the review’s emphasis on the importance of accepting the recommendations across all four nations to ensure consistency and clarity for staff and patients. We will work with the UK governments in the coming weeks to consider this further.”