A family have been left distraught after their daughter tragically passed away following a misdiagnosis by a "substitute doctor."
Emily Chesterton, a 30-year-old woman who died after a misdiagnosed blood clot, died in November 2022 after suffering a pulmonary embolism.
In the weeks leading up to her death, she visited her GP surgery in north London twice. Both times, she was seen not by a doctor, but by a physician associate.
Her condition was misdiagnosed as anxiety, and she was prescribed propranolol. What Emily didn’t know - and what her parents only discovered later - was that she had never seen a doctor at all.
“If she come out and said I've seen someone called the physician's associate I'm sure we would have insisted that, you know, let's go back and insist that you see a doctor. She never knew,” her father Brendan Chesterton told Sky News.
In response to mounting concerns and several high-profile cases like Emily’s, Health Secretary Wes Streeting commissioned a review led by Professor Gillian Leng, president of the Royal Society of Medicine.
The findings call for a major shift in how PAs are used in the NHS.
Prof Leng's report recommends that PAs should not be allowed to diagnose patients who haven't already been seen by a doctor.
She emphasized: “Crucially I'm recommending that PAs should not see undifferentiated or untriaged patients.”
She added: “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.”
The review also proposed that newly qualified PAs should work in hospitals for at least two years before moving into GP surgeries or mental health settings.
And, in a push for transparency, Prof Leng called for standardized uniforms and a new job title - rebranding PAs as “physician assistants” and AAs as “physician assistants in anaesthesia.”
While the review didn’t recommend scrapping the roles entirely, it stated there is no justification for continuing with the status quo.
“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 said.
Emily's mother, Marion Chesterton, said she welcomed some aspects of the report and believes her daughter would still be alive if these measures had already been in place.
“I think so, yes, which is so important, which is why we're so pleased that this review has been made,” she said.
But for the Chestertons, the review doesn't go far enough. Marion added, “We feel it's a missed opportunity. It could have gone all the way there and cleared things up totally.
"Our daughter died. She was prescribed a drug that she should not have been prescribed. And it had absolutely catastrophic circumstances. She died for goodness sake.”
The British Medical Association shares the Chestertons’ concerns. Dr. Emma Runswick, the BMA’s deputy chair, said: “It is definitely a problem that the roles of doctors and now physician assistants has been blurred and it's positive that their name is going to change, that there will be a uniform.
“But whilst they continue to be deployed in a way that mimics doctors at the behest of any local employer decision, we have to have ongoing concerns about their safety.”
Meanwhile, the trade union UMAPs, which represents both PAs and AAs, has fired back at the changes, warning that they could create more problems than they solve.
“By trying to placate them, at a time when they're striking - and they want their strikes to bite the hardest by taking us out of the workforce - we're now putting patients at risk,” said Steve Nash, general secretary of UMAPs.
“I think the biggest patient safety risk, out there right now, is the BMA.”
Despite the controversy, the government is standing behind the review's recommendations. Health Secretary Wes Streeting confirmed all proposed changes will be adopted.