From Discovery to Accountability

How a Quiet Workforce Reform Became a National Scandal

Photo by Colin Lloyd on Unsplash

Across the NHS, something is breaking. Lines that once defined who does what, and why, are now dangerously blurred. A workforce reform sold as support has become a source of confusion, risk and, in some cases, tragedy. The expansion of Physician Associates (PAs) and Anaesthesia Associates (AAs)—collectively MAPs—has sparked a crisis not just in staffing, but in trust.

The General Medical Council (GMC) has taken on the regulation of these roles without setting national scope limits, and with a decision to hold PAs to the same professional standards as doctors. The result? A system where the boundaries of responsibility are unclear, where legal protections are muddied, and where patients are often unaware they’re being treated by someone who is not a doctor.

This isn’t theoretical. The consequences are already here.

PAs are now diagnosing, prescribing and leading care in settings they were never intended to staff alone. The BMA, Royal Colleges, and grassroots organisations like DAUK and Anaesthetists United have warned repeatedly: these roles were meant to assist, not replace, doctors. But in practice, support has turned into substitution—with neither the training nor legal framework to make that safe.

Nowhere is this failure more disturbing than in child safeguarding.

In 2024, it emerged that a PA had carried out Child Sexual Abuse (CSA) medical examinations at Alder Hey Children’s Hospital. This wasn’t an error or misunderstanding but a violation of national standards. These assessments require specialist paediatric knowledge, forensic expertise and the authority to provide court-ready evidence. No one without that training should ever be tasked with such responsibility.

Let’s be clear: a child already failed by one adult must not be failed by a system designed to protect them. Anything less is a second betrayal.

The National Network of Designated Healthcare Professionals (NNDHP), the Faculty of Forensic & Legal Medicine, and the Royal College of Paediatrics and Child Health have all now confirmed this: such examinations must be carried out only by appropriately trained clinicians. And yet, this still happened. Which raises the question—where was the accountability?

This scandal is just one symptom of a deeper, wider breach.

Emily Chesterton died after seeing a PA—twice—believing she’d seen a GP. Her symptoms were misdiagnosed as anxiety. She had a pulmonary embolism. A coroner later confirmed she wasn’t told the clinician wasn’t a doctor.

Pamela Marking died after a PA described life-threatening calcium levels as “normal.”

Christopher Tucker died from sepsis following a cystoscopy performed by a PA, with no antibiotics given, abnormal bloods ignored, and no consultant sign-off. His case was never referred to a coroner. The hospital’s own internal investigation? Co-authored by the PA involved in his care—despite NHS England guidance clearly forbidding this.

We believe these aren’t rare cases. They are the warning lights of a system in trouble—one that has moved too fast, without transparency and with dangerously thin protections.

At the heart of it is the GMC.

In December 2024, the GMC formally began regulating PAs and AAs. But instead of carving out clear legal and clinical boundaries, they imposed the same “Good Medical Practice” rules designed for doctors—despite the difference in training being not a matter of years, but of decades.

This regulatory approach assumes equivalence where there is none. It’s not just unwise. It’s unsafe.

That’s why DAUK supports the legal challenges now before the High Court. These are not fringe actions—they are necessary examinations of whether the GMC is acting within its legal mandate and in the public interest. The BMA’s challenge ultimately fell short. The Anaesthetists United case presses forward on the bigger question: who gets to decide scope of practice—and for whose benefit?

Because patients deserve the truth. They deserve clarity. They have a right to know whether the person treating them is a doctor, and what that actually means for their care. In too many cases, that basic clarity has been lost—or deliberately obscured.

Much of what the public now knows about the risks posed by this workforce model has been unearthed by frontline doctors: individuals working anonymously, risking reputational damage, labelled disruptive or unprofessional for simply sounding the alarm. But it begs the question—if speaking out is punished, what do we say about those who stayed silent?

This is bigger than individuals. It’s about systems that failed to ask questions. NHS trusts that blurred lines to plug rota gaps. A regulator who has looked the other way. Policymakers who chased savings without understanding the cost.

For years now, this has been a story of exposure—freedom of information requests, whistleblowing, patient testimony and mounting professional dissent.

Now it is to become a story of accountability.

Because the legal challenges are only the beginning. The families who lost loved ones are not going away. Nor are the clinicians speaking up. And neither are we.

The question now is whether the NHS is willing to reckon with what’s been done in its name—or whether more harm, more spin and more silence lie ahead.