Study Finds No Evidence that the Use of Physician Associates is Safe or Improves Care
According to a University of Oxford study, there is a lack of evidence supporting the use of physician associates (PAs) or anaesthetic associates (AAs) in the NHS, raising concerns about the safety and effectiveness of these roles.
The study, published in the British Medical Journal (BMJ), highlighted the limited research on PAs and the absence of any studies on AAs, despite thousands of individuals working in these positions. Only one study assessed the clinical competency of PAs, involving just four associates, with no research on the safety of PAs.
The report authors stated that there is no evidence to suggest that PAs add value in primary care, or that AAs add value in anaesthetics. In fact, some evidence indicated the opposite.
Researchers found that PAs and AAs, who have health or life science degrees and undergo two years of postgraduate training, struggle in certain settings and have raised concerns among medical staff about their ability to manage complex cases or prescribe medication.
Issue of Safety
Authors of the study emphasized that the lack of evidence on the safety of PAs and AAs should not be interpreted as proof of their safety. They cautioned against assuming that the absence of safety incidents in limited research studies means there are no safety concerns.
Cost and Efficiency Implications
Despite being deployed to address staffing shortages and improve patient care, there is no evidence to suggest that using PAs or AAs improves efficiency or saves money. In fact, the need for supervision by senior doctors may make this model more costly than employing doctors directly.
A general view of staff on a NHS hospital ward at Ealing Hospital in London, on Jan. 18, 2023. Jeff Moore/PA Wire
McKee, a co-author of the study, highlighted the need for rigorous research evidence to support the expansion of PAs and AAs. He warned against substituting doctors with individuals whose training may not align with the responsibilities they are given, stressing the importance of evidence-based strategies.
Regulation and Future Recommendations
A review led by Professor Gillian Leng is underway to assess the effectiveness and safety of medical associate roles, with the findings expected to be published in the spring. The Department for Health and Social Care has emphasized the importance of ensuring patient safety and professional accountability through the regulation of PAs and AAs by the General Medical Council.
Overall, the study raises concerns about the deployment of PAs and AAs in the NHS, particularly in light of misdiagnoses by medical associates in recent cases that have resulted in tragic outcomes.
