In recent years, many patients in NHS hospitals and GP surgeries have found themselves being seen by a new type of healthcare professional known as a physician associate (PA).
While this role is designed to support doctors and improve access to care, it has also raised some concerns about patient safety, transparency, and legal accountability.
In this blog, our medical negligence solicitors look at what a physician associate is, how their role fits into the NHS, and why patients should be aware of the potential risks when they are treated by one.
What is a Physician Associate in the NHS?
A physician associate is a healthcare professional trained to perform many of the tasks that doctors do. Following a biochemistry, health or medical science degree, they complete a two-year postgraduate course.
In comparison, doctors must complete four years at medical school followed by up to seven years post-graduate residency. There can be up to five years difference in training between PAs and doctors.
While PAs may have been through medical school, PAs are not medically qualified doctors, nor do they have the legal right to prescribe medication in the UK.
Instead, they work under the supervision of doctors and other clinicians to take medical histories, examine patients, order medical tests (except X-rays and CT scans), and contribute to treatment management plans.
Physician associates started working in the NHS in 2003. The role was introduced with the aim of increasing clinical capacity, relieving pressure on overstretched teams, and improving patient access to timely care.
It is thought that the NHS currently employs over 5,000 PAs. This could increase by 1,000 every year after the General Medical Council (GMC) recently approved 36 training courses.
However, the rapid expansion of this workforce has raised concerns within the legal and clinical communities around patient safety, legal accountability, and medical negligence. A growing number of professionals, patients, and regulators are questioning whether the current framework for PAs is fit for purpose.
Why Patients May Confuse PAs with Doctors
The increasing presence of PAs in frontline NHS settings has prompted debate over clarity, regulation, and responsibility.
The main concern centres around patient understanding of the PA role. Many individuals believe or assume they were seen by a doctor, when in fact they were treated by a physician associate. This confusion is often fuelled by things like inadequate introductions, misleading name badges or uniforms, or time-pressured consultations where roles are not clearly explained.
This ambiguity could compromise informed consent, a legal and ethical principle in medical care. Patients have the right to understand who is treating them and what qualifications they hold before agreeing to any form of care.
Failure to inform patients appropriately may amount to a breach of that right and, in certain circumstances, could give rise to legal claims based on inadequate consent or misrepresentation.
Supervision and Risk to Patient Safety
Physician associates are supposed to work under the supervision of a medically qualified doctor. However, in practice, especially in busy NHS environments like emergency or out-of-hours settings, this supervision can be inconsistent.
Concerns have emerged where PAs have:
- Conducted clinical assessments with minimal input from senior clinicians
- Contributed to diagnoses that later proved incorrect
- Managed treatment plans beyond their scope
- Missed serious illnesses
These scenarios introduce significant patient safety risks, particularly when urgent decisions are needed or when complex conditions are involved.
Real-Life Examples and Public Scrutiny
Several high-profile incidents have drawn attention to the risks associated with the current PA model.
The family of Emily Chesterton, who died in 2022 aged 30 after a blood clot was missed twice by a PA, has brought a legal challenge against the GMC. Emily’s parents, Marion and Brendon, are seeking more clarity from the GMC about the scope of the PA role in a bid to improve patient safety.
Emily was seen by a physician associate after she called her GP practice complaining of pain in her calf, which had become hard. The PA recommended she take paracetamol. At a follow-up appointment, the PA then diagnosed Emily with a calf sprain, long Covid and anxiety. The PA did not examine Emily's calves and did not make it clear that she was not a doctor. She later died from a pulmonary embolism.
Another woman, 77-year-old Pamela Marking, went to A&E in February 2024 after vomiting blood and having tenderness in her side. She was told by a PA she had a nosebleed and was sent home, but she actually had a hernia and died four days later following complications with her care.
At the inquest, the coroner called the term physician associate "misleading" and said there was a "lack of public knowledge" that they were not medically qualified.
Incidents like these have prompted Parliamentary debate and increasing scrutiny from medical professionals and advocacy groups, many of whom are calling for tighter rules, clearer job titles, and better public education about the PA role.
The British Medical Association (BMA) voiced strong opposition to the expansion of PA roles without appropriate regulatory safeguards. It accused the GMC of ‘blurring the lines’ between physician associates (PAs) and doctors, but lost its High Court case earlier this year.
The Royal College of Nursing (RCN) is also urging they be involved in any review of PAs, particularly keen to investigate the impact the role has on advanced nurse practitioners.
Last November, health secretary Wes Streeting launched an independent review of physician associates to consider how these roles are deployed across the health system in order to ensure that patients get the highest standards of care.
The Royal College of Physicians (RCP) submitted their own views to the review, proposing that the job title of a PA should be renamed to 'physician assistant'.
Who Is Responsible If Something Goes Wrong?
In December 2024, the General Medical Council (GMC) took over the regulation of physician associates.
However, at the time of writing, physician associates are not regulated in the same way as doctors. The GMC is in the process of introducing regulation for PAs, set to come into force in December 2026, but their standards will not be identical to those for fully qualified doctors.
This gap in accountability can make it harder for patients to raise complaints or take legal action if harm occurs.
In the meantime, if a concern is raised about a PA who is not yet registered, the GMC will be unable to investigate.
A major issue is the legal uncertainty surrounding the responsibility for clinical errors involving physician associates. Determining liability may be complex:
- Is the supervising doctor at fault?
- Is the employing NHS Trust responsible?
- Can a claim be brought directly against the PA?
For medical negligence solicitors like us here at Medical Solicitors, cases involving physician associates present specific challenges. We must carefully assess the nature of the PA’s involvement and extent of supervision, establish the standard of care, and whether appropriate protocols in care and consent were followed.
Without clear documentation and defined clinical boundaries, proving negligence may become increasingly difficult.
What Can Patients Do to Protect Themselves?
Here are some practical tips for patients and families:
Always ask who is treating you.
It’s your right to know whether you are seeing a doctor, a PA, a nurse practitioner, or another professional.
Ask about their training and supervision.
You can politely ask whether they are being supervised by a qualified doctor.
Request to see a doctor.
This is particularly important if you’re unsure or if your condition is complex or serious.
Check any written information.
All letters, appointment notes, and test results should clarify who provided your care.
Speak up if something doesn’t feel right.
You can raise concerns with the NHS Patient Advice and Liaison Service (PALS) or contact us for advice.
Regulatory Reform for Safe, Transparent Care
There is no doubt that physician associates can play a helpful role in supporting NHS services. However, new roles and cost-saving measures should not compromise transparency, safety, or legal responsibility.
Patient safety must remain the guiding principle in all healthcare delivery. There is a clear need for stronger regulatory frameworks and public education. Medical teams must be supported in maintaining safe supervisory structures, even in the face of workforce shortages.
Patients should never be left confused about who is treating them, especially when clinical decisions carry serious consequences. Healthcare employers should implement rigorous policies to ensure patients are explicitly informed when they are seen by non-doctor clinicians.
We all deserve clarity, safety, and informed choice, regardless of who provides care.
Medical Solicitors: Here for You
If you or a loved one has experienced harm or confusion related to care provided by a PA, it’s important to seek independent legal advice. Understanding your rights could help ensure better care for you and for others.