Welsh Government urged to limit role of Physician and Anaesthesia Associates

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

Professor Gillian Leng, president of the Royal Society of Medicine, led the review which was instigated by the UK Government’s Health Secretary Wes Streeting due to a general lack of support for the roles from the medical profession – plus high-profile deaths of patients who were misdiagnosed by PAs

The study recommended a major change to the role of PAs and anaesthesia associates after it acknowledged they have been used as substitutes for doctors, despite having significantly less training.

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 in significantly smaller.

Untriaged patients

Presenting her findings, Professor Leng, 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 said more detail was needed on which patients can be seen by PAs and national clinical protocols should be developed in this area.

She added: “Let’s be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients.”

Prof Leng also recommended PAs should be renamed “physician assistants” to position them “as a supportive, complementary member of the medical team”, while AAs should be renamed “physician assistants in anaesthesia”.

Newly qualified PAs should also work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts.

Safety concerns

The study said safety concerns in relation to PAs were “almost always about making a diagnosis and deciding the initial treatment, particularly in primary care or the emergency department, where patients first present with new symptoms.”

It added: “It is here that the risk of missing an unusual disease or condition is highest, and where the more extensive training of doctors across a breadth of specialties is important.

“Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.”

Responding to the publication of the Leng Review, Dr Iona Collins, chair of the BMA’s Welsh council, said: “Though the Leng review focused on England, the issues it covers apply to Wales and, therefore, the recommendations are pertinent to the ongoing discussions we are having with Welsh Government, NHS Employers Wales and HEIW.

“Professor Leng’s report has validated longstanding concerns raised by both the BMA and the public, such as clarifying the roles with the ‘assistant’ job titles.

“Given the seriousness of the concerns doctors and patients have raised, and the lack of an independent review commissioned for Wales, we urge the Welsh Government to immediately implement Professor Leng’s recommendations.

“Finally, the review has failed to define what these roles can and cannot do.  Supervision and career progression are lacking in detail. Patient safety requires clear scopes of practice, which the BMA has already provided. We reiterate our call on NHS Employers Wales to adopt the BMA’s safe scope of practice as a matter of urgency.”

A Welsh Government spokesperson 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.”