What's in a name?

Physician associates (PAs) working in the NHS are to be renamed to stop patients mistaking them for doctors

“That which we call a rose by any other name would smell just as sweet.” William Shakespeare, Romeo and Juliet

Physician associates (PAs) working in the NHS are to be renamed to stop patients mistaking them for doctors, The Guardian has reported.

This is based on information released from the “Leng Review” – an independent review of physician associate and anaesthesia associate roles, launched in November 2024 by the government. Professor Gillian Leng CBE, an experienced healthcare leader and patient safety champion has led the review, listening to evidence compiled by medical bodies (including DAUK) and focus groups organised by the Patients Association which found that “patients were unaware of what a PA was”.

So, what are PAs? And what exactly is in a name? Will renaming them ‘physician assistants’ or ‘doctors’ assistants’ be a step towards addressing legitimate safety concerns surrounding their scope of practice? Or will a PA by any other name continue to confuse patients about what their role actually is?

Background

Physician associates have been part of the NHS for 20 years, and they were originally known as physician assistants until 2014. Their numbers were insignificant until 2019, with growing numbers over the last five years. Expanding their numbers to more than 10,000 by 2037 is a significant feature of the NHS Long Term Workforce Plan.

The role was an export from the USA, where physician assistants had been established since the 1960s in response to a shortage of primary care doctors (GPs). As of December 2024, roughly 3,500 PAs and 100 anaesthesia associates (AAs) (their equivalents in anaesthetics) were working within the NHS in England. [For those of you still on X – there’s a timeline of PA’s in the UK here.]

To qualify for the role, most PAs complete a two-year masters degree in physician associate studies. Undergraduate PA degree programmes are now also offered by two UK institutions, comprising of a four-year integrated masters. Once qualified, PAs can then work across 20 specialty areas, with no further formal training or exams to do so. Compare this to a doctor who undergoes four to six years of undergraduate training and then once fully medically qualified, needs to spend sometimes up to 10 years+ training on the job, plus exams, to become a specialist in their field.

(Image taken from @adam_skeen on X https://x.com/adam_skeen)

The current scope of practice is undefined for PAs, with vague descriptions of them being able to ‘practice independently and make their own clinician decisions’ but ‘within the limits of their competence and scope which is decided locally by their supervising GP or consultant’ - who is ultimately responsible if things go wrong. They’re not currently permitted to request ionising radiation or prescribe medicines, although the Telegraph investigations team (with a dossier compiled by DAUK members) uncovered examples of unsafe practice outside these parameters.

As DAUK’s Dr Matt Kneale wrote in his blog, “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.”

What’s in a name?

The discussion around names was brought to the attention of Parliament following the death of 30-year-old Emily Chesterton in 2022. She visited her GP surgery with calf pain and breathlessness, and saw the same PA twice, who misdiagnosed her pulmonary embolism as a sprain and anxiety. A coroner advised she was likely to have survived if she had been referred for treatment at either appointment.

What was striking about the case, was that her mother, Marion, later told her MP that Emily thought she was speaking to a doctor, and that the title physician associate sounded ‘extremely grand, even grander than a general practitioner’.

GMC Case

The family of Emily Chesterton have joined together with Anaesthetists United to take the GMC to court to push for safe and lawful regulation of physician associates. You can read Dr Richard Marks’ post here outlining the legal arguments. The team are next in court on June 9 and any donations to their legal costs would go a long way - if you can:

Names

With all this in mind, reverting back to a title that highlights the role of a PA is welcomed - although, I would argue clinicians still need to make their job role clear to patients. At the last conference of Local Medical Committees in England, GPs raised a motion to be rebranded as ‘Consultants in Family Medicine’ - which many applaud, while others are cautious. With abundance of other ‘consultants’ within the NHS - nurse, physio, managerial…. what does consultant mean? Would this confuse patients too? Do we need to list all our qualifications under our name badges? Or wear a certain colour of scrub to identify who we are?

Ultimately, it comes down to communication. I’ve lost count of the number of referrals I’ve made to secondary care and the person taking the referral answers the phone with a grunt or a brusque hello with no introduction, and then takes immediate offence when asked who they are. This is pretty basic, and it takes seconds to incorporate your name and role into an introduction.

Changing the name is a start. We will watch the AU legal case with interest next week.