After mishaps, the medical sector is hardening its stance against physician associates being used unsupervised in emergency settings.
New rules on the supervision of physician associates (PAs) in A&E have been issued by the Royal College of Emergency Medicine (RCEM).
The professional association’s original position on the expansion of PAs within the workforce was published last year following a survey with members and it was unanimously agreed that RCEM does not support the expansion of the PA workforce in the emergency room.
In the updated rules, the requirements are now for “direct supervision by a senior clinician” and as a minimum “patients being admitted should be discussed with a more senior clinician and reviewed in person by a senior clinician if being discharged”.
Despite these strong recommendations, RCEM itself admits that it has no power to enforce them. Each NHS Trust ultimately decides how it deploys PAs, which means that some hospitals may continue allowing them to work beyond their competence.
A hardening stance
There is a sense that the sector’s stance against PAs is hardening.
“While RCEM’s new stance is a step in the right direction, it is far from sufficient. Only legal action and firm regulation will ensure that patient safety is not left to the discretion of individual hospitals,” said pressure group Anaesthetist’s United in response to the new guidance.
In February, Karen Henderson, assistant coroner for Surrey, raised concerns after an elderly lady called Pamela Marking was seen by an unsupervised PA in A&E and sent home without a medical review. The patient subsequently died.
The British Medical Association (BMA) has long raised concerns that attempts to make the regulation of PAs less restrictive could impact patient safety.
This has culminated in a court case that the BMA has brought against the GMC and which started in mid-February in London.
