Physician associates – dubbed ‘cut-price doctors’ – illegally ordered more than 1,000 hospital scans at NHS hospitals without being medically qualified to do so – as doctors slammed the ‘direct threat to patient safety’.
Un-regulated physician associates (PAs) working for the Leeds Teaching Hospitals NHS Trust (LTHT) – which runs seven hospitals including Leeds General Infirmary and Leeds Children’s Hospital – ordered 1,168 tests which expose patients to ionising radiation.
These scans, which include X-rays and CTs, are only legally allowed to be ordered by healthcare professionals, including doctors who have passed five years of medical school and advanced clinical practitioners, who have received extra training.
Medical ionising radiation is used widely in hospitals and dental practices to help diagnose and treat conditions, but exposure to these rays carries risks such as increased chances of cancer.
This comes amid repeated calls by doctors and the BMA to halt the expansion of the roles after mistakes by PAs led to patient deaths or suffering serious injury. Emily Chesterton, 30, died in 2022 after a blood clot was written off as anxiety by a PA and long Covid and Norman Jopling, 79, suffered a brain bleed after a PA said his headaches were nothing to worry about.
Dr Tom Sharp, who works for LTHT, hit out against the ‘direct threat to patient safety’ caused by PAs, who have two years of postgraduate study, ‘acting as doctors’ and illegally ordering tests despite no formal medical training.
Physician associates – dubbed ‘cut-price doctors’ – illegally ordered more than 1,000 hospital scans at a NHS hospitals in Leeds without being medically qualified to do so – as doctors slammed the ‘direct threat to patient safety’ (Leeds General Infirmary pictured)
Emily Chesterton (pictured) was just 30 when she died last year after a PA failed to spot a blood clot and misdiagnosed her with anxiety and long Covid
Norman Jopling (left), 79 from North London, suffered a serious brain bleed after a PA mistakenly told him that his painful headaches were nothing to worry about. His wife Maureen (right) accused the NHS of ‘trying to cut corners’ by allowing PAs to carry out ‘complicated tasks they’re not qualified to perform’
Actress Emily Chesterton, 30, died of a blood clot in 2022 after a PA dismissed her symptoms as anxiety and gave her pills instead of directing her to A&E. She believed she had been seen by a GP at her surgery in North London but had actually been seen twice by an associate.
And Norman Jopling, 79 from North London, suffered a serious brain bleed after a PA mistakenly told him that his painful headaches were nothing to worry about. His wife Maureen, accused the NHS of ‘trying to cut corners’ by allowing PAs to carry out ‘complicated tasks they’re not qualified to perform’.
The Government plans to recruit 10,000 PAs in the next 15 years, and legislation is are going through parliament for them to be regulated by the GMC, angering doctors.
Dr Sharp, a doctor at LTHT and chair of the Yorkshire regional junior doctors committee told MailOnline: ‘This is a very concerning situation. PAs are neither qualified nor legally permitted to request ionising radiation such as x-rays and the Trust needs to answer questions immediately on how this could have happened so many times.
Dr Tom Sharp (pictured), who works for LTHT, hit out against the ‘direct threat to patient safety’ caused by PAs
‘PAs acting as doctors where they are not qualified to do so – and employing trusts not having robust systems in place to prevent this – are a direct threat to patient safety. Patients must be confident that they are receiving medical care from those with the appropriate training and legal entitlement to provide it. The two year PA qualification is nowhere near the standard doctors receive, and incidents like this will only serve to further undermine patient confidence in the healthcare system.
‘The creeping expansion of use of PAs that we’ve seen at this Trust must end – as it must across the NHS.’
The trust has blamed the issue on the ‘system error’ which it says has now been fixed. It said it review the test orders and ‘no incidents of patient harm’ were reported in relation.
This comes as a BMA survey of nearly 19,000 doctors today revealed that more than half of them think that PAs and anaesthesia associates (AAs) are increasing their workloads, with only around one fifth saying it had decreased.
The General Medical Council (GMC) is soon expected to publish guidelines on how it will regulate PAs, who currently they cannot be held responsible for their mistakes. Doctors have hit out against the regulator for dismissing concerns over PAs.
The practice of PAs ordering radiological tests in Leeds was uncovered through a Freedom of Information request by paramedic lecturer Chris Pritchard, 33, from Nottingham Trent University and junior doctor Eilidh Garrett, 27, who works at Southport Hospital, in Merseyside.
The FOI, which was originally denied incorrectly on cost grounds, revealed that one incident of a PA illegally ordering a scan triggered an internal audit which identified the 1168 incidents of PA referrals.
Dr Eilidh Garrett, 27, said many doctors get in touch with her to say that PAs have ordered tests they are not allowed to at their hospitals
Dr Garrett said since posting about the findings online, she has had many doctors get in touch with her to say that PAs have ordered tests they are not allowed to at their hospitals.
‘I think it’s likely to be happening in a lot of hospitals across the country,’ she told MailOnline.
She said questions needed to be answered, adding: ‘What’s happened in system to allow this, why have these individuals and the hospital broken the law so flagrantly?’
Dr Garrett said the findings should ‘prompt a review of all hospitals to see if scans are being requested by appropriately qualified staff’. ‘Where else is this happening?’ she asked.
The trust’s risk management committee in December said an investigation into the illegal ordering of these tests was being undertaken and said the actions have now been reported the to the Care Quality Commission (CQC).
Minutes from the meeting said the committee noted: ‘Actions that had been taken to mitigate the risks of Physicians Associates ordering ionising radiation diagnostic tests, which was known to be outside the scope of practice.’
Regulator the Healthcare and Professions Council advise: ‘As a health and care professional, you must keep within your scope of practice at all times to ensure you are practising safely, lawfully and effectively.’
Dr Garrett said the findings should ‘prompt a review of all hospitals to see if scans are being requested by appropriately qualified staff’. ‘Where else is this happening?’ she asked.
The extract concluded: ‘An investigation was being undertaken to identify the contributory factors that led to this emerging risk and the actions that have subsequently being [sic] taken, notification had also been submitted to the CQC in line with the IR(ME)R regulations.’
Medical ionising radiation is used widely for procedures such as X-rays to help diagnose and treat conditions, but exposure to these rays carries risks such as increased chances of cancer
The FOI also revealed that 44 out of 47 PAs at the trust had access to the ICE computer system, which is used to book radiological tests and view results.
Dr Garrett said the findings should ‘prompt a review of all hospitals to see if scans are being requested by appropriately qualified staff’.
‘Where else is this happening?’ she asked.
The trust also did not log any of these incidents or the ongoing risk in its risk register, the FOI revealed. The trust said in its response: ‘There are no risk register entries related to PA’s requesting ionising radiation diagnostic tests.
‘The ability for PAs to request ionising radiation diagnostic tests has been removed on ICE following identification of the incident described, this risk has therefore been mitigated.’
Commenting on the plans to regulate PAs under the GMC and increase their use within the NHS, Prof Phil Banfield, BMA chair of council said: ‘The House of Lords will soon have a chance to oppose damaging legislation that aids that blurring of lines by regulating PAs under the GMC, the doctors’ regulator rather than the more appropriate Health and Care Professions Council.
‘The Government and NHSE should be instead ensuring that PAs return to their original purpose of supporting, not replacing doctors, so that doctors can get on with utilising the diagnostic and treatment skills they have spent so long at medical school gaining their expertise in.
‘Their scope should be strictly defined and, to ensure patients are not confused, the title returned to the more accurate ‘physician assistant’ – then they can play their valuable role in supporting the delivery of NHS care safely.’
Dr Magnus Harrison, Chief Medical Officer at Leeds Teaching Hospitals, told MailOnline: ‘We were made aware of a system error which allowed some Physician Associate (PA) colleagues to refer patients for x-rays and scans. This error has since been fixed.
‘We have reviewed these referrals and no incidents of patient harm have been reported.’