Lack of Evidence Raises Concerns Over Safety of Replacing NHS Doctors with Physician Associates

In a compelling discussion surrounding the efficacy of new healthcare roles within the United Kingdom’s National Health Service (NHS), a recent study published in The BMJ sheds critical light on the contributions of physician associates and anaesthetic associates. Despite the increasing integration of these positions into the healthcare system, extensive research questions their actual value and effectiveness in real-world settings. Scholars Professors Trisha Greenhalgh and Martin McKee argue that the evidence supporting the deployment of these roles is not only lacking but is also overshadowed by growing concerns regarding patient safety and care quality.

The salient research, focused primarily on UK healthcare, highlights a systematic review that analyzed literature over the last few years. It draws attention to a comprehensive search of three major electronic databases—PubMed, CINAHL, and Cochrane Library—spanning studies involving physician associates and anaesthetic associates published between 2015 and January 2025. Out of numerous studies identified, a meager number met the stringent criteria necessary to ensure their relevance and reliability, thereby raising serious questions about the breadth and depth of research available.

Out of the 52 papers that were identified as eligible for inclusion, a staggering 48 focused on physician associates while only four centered around anaesthetic associates. Among these, only 29 studies (all from England) passed the critical filters of trustworthiness, generalizability, and direct relevance to contemporary UK healthcare policy. The review unmistakably discovered that the total sample size of physician associates scrutinized was alarmingly small, especially within the context of primary care, where a more expansive understanding of their roles would be necessary.

A striking finding is the lack of direct assessment correlating with the clinical competencies of anaesthetic associates, as no studies explicitly documented their performance or contributions. The review did manage to uncover that, in a rare instance, one study involving four physician associates featured assessments performed by a supervising doctor. This limited interaction signifies an alarming gap in evaluation mechanisms for these emerging healthcare professionals, leaving both their skill proficiency and the subsequent impact on patient safety largely unmonitored and unreported.

The scant evidence that does compile around physician associates suggests potential advantages, especially in ward-based teams and emergency departments when they operate under well-defined roles and supervision in lower-risk clinical environments. However, these findings remain preliminary given the small sample sizes and the restricted settings explored throughout various studies. Thus, the conversation pivots toward whether such roles can truly elevate the quality of care or merely perpetuate an illusion of enhanced healthcare delivery.

Compounding the concerns raised by the research is the distinct struggle physician associates face within primary care settings. The review noted that the autonomy required in primary care, combined with a diverse mix of case complexities, aggravates the challenges these associates encounter. Decisions in primary care are often marked by uncertainty, institutional support inadequacies, and complicated arrangements for supervision. This creates an environment rife with potential pitfalls, fundamentally questioning the viability of employing physician associates to tackle complex clinical cases.

Moreover, patient feedback regarding physician associates largely reflects positive or neutral experiences, yet a stark contrast emerges when evaluating opinions from the healthcare staff. Among staff, there exists palpable anxiety regarding the competency of physician associates and anaesthetic associates, particularly concerning their ability to engage with patients presenting undifferentiated or clinically intricate conditions. In addition, concerns surrounding their capacity to order necessary imaging scans or prescribe medications further exacerbate skepticism regarding these occupations.

The study highlights that while some positives can be gleaned, the absence of robust evidence points toward a concerning trend. Some findings indicate that physician associates can aptly support healthcare teams under the right circumstances. However, their actual contributions do not present a strong enough case for widespread adoption without extensive strategies aimed at refining the roles to ensure safety and effectiveness. Caution remains advised, as the existing research does not suffice to demonstrate that the introduction of these roles translates into substantive enhancements in patient care.

These researchers emphasize that the urgent need for additional research cannot be overstated. New inquiries must expand to encompass broader data that includes staff perceptions, safety incidents, and comprehensive evaluations of the roles and responsibilities associated with physician associates and anaesthetic associates. Furthermore, this research should feed into an overarching framework that delineates national scopes of practice for such roles, thus informing future policies.

As the UK government engages in an independent review to assess the integration and safety of these new roles within NHS frameworks, the depth of existing research serves as a poignant reminder of the complexities accompanying healthcare workforce expansion. The researchers acknowledge the limitations inherent in focusing predominantly on UK evidence while not accounting for parallel roles present in other nations. Nonetheless, they assert that the rigorous analysis of the most pertinent UK studies is vital in guiding future policy discussions.

In parallel, Professor Kieran Walshe from the University of Manchester critiques the overarching landscape that has led to this conundrum regarding physician associates and anaesthetic associates. He asserts that insufficient investment in workforce-related research, coupled with ambiguous plans for workforce expansion, ultimately sets the stage for disarray. Walshe’s insights urge for a reevaluation of how healthcare workforce reforms are approached moving forward, emphasizing the need for systemic enhancements geared toward both patient safety and staff wellbeing.

The implications of these findings extend beyond the individual roles of physician associates and anaesthetic associates; they resonate with the larger discussion of how the healthcare industry adapts to the evolving needs of society. As the framework for healthcare delivery continues to develop, understanding the ramifications of employing such roles is critical. Learning from the current review and associated discussions presents an opportunity to recalibrate workforce strategies in alignment with the pioneering aspirations of efficient and effective healthcare.

While the conversation surrounding physician associates and anaesthetic associates evolves, it undeniably ushers in broader queries regarding the future of integrated healthcare models. How can providers strike the balance between innovative role expansions and ensuring the utmost quality of patient care? What measures need to be enacted to transform the perceived risks associated with the introduction of these roles into tangible benefits for both staff and patients alike? Response to these evolving questions may be pivotal for the future of healthcare within the UK and beyond.

Subject of Research: People
Article Title: Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research to inform Leng review
News Publication Date: 7-Mar-2025
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Keywords: Public health

Tags: anaesthetic associate contributionsanaesthetic associates effectivenessevidence-based healthcare roleshealthcare quality assessmenthealthcare roles in UKhealthcare workforce challengesintegration of physician associatesNHS physician associatespatient safety concerns NHSphysician associate research studiessystematic review of healthcare rolesUK healthcare policy implications