A legal dispute is currently unfolding at the Royal Courts of Justice concerning the responsibilities of physician associates (PAs) within the NHS framework.

The case has been initiated against the General Medical Council (GMC) by retired educators Marion and Brendan Chesterton, following the tragic passing of their daughter, Emily, in 2022, due to a blood clot that was overlooked during two consultations with a PA.

Together with Anaesthetics United, the Chestertons are seeking clearer guidelines from the GMC regarding the PA role to enhance patient safety amidst rising concerns over the deployment of PAs and anaesthesia associates (AAs) in medical environments.

In December, the GMC assumed regulatory authority over physician associates and anaesthesia associates.

On the eve of Wednesday’s hearing, Mrs. Chesterton expressed her desire for others to avoid the pain their family has experienced. She urged the GMC to eliminate any ambiguity surrounding the PA role, emphasizing that “we all deserve better.”

Physician associates and anaesthesia associates began their practices in the NHS in 2003, and it is estimated that there are currently over 5,000 individuals in these positions.

To qualify, PAs and AAs typically complete a partially funded two-year master’s program, often requiring a background in biosciences, though this is not always mandatory.

Their responsibilities include taking patient histories, performing physical assessments, and formulating treatment strategies. However, they do not possess the authority to prescribe medications or order scans that involve ionizing radiation, such as X-rays or CT scans. They operate within a multidisciplinary team under the supervision of a designated senior physician.

When the government designated the GMC to regulate PAs and AAs last year, CEO Charlie Massey noted that this move would ensure these professionals “receive the appropriate education and training, meet our standards, and can be held accountable if serious issues arise.”

Emily Chesterton, aged 30, died after a blood clot was misdiagnosed in two visits to a PA whom she believed to be a general practitioner. She had reached out to her GP clinic in Crouch End, north London, due to pain and hardness in her calf. The PA suggested she take paracetamol.

As her symptoms worsened, Mrs. Chesterton recounted that her daughter experienced “difficulty walking” and was “lightheaded and breathless.” During the follow-up appointment, the PA diagnosed Emily with a calf sprain, long Covid, and anxiety, without adequately examining her calves or clarifying her status as a non-medical doctor.

Emily ultimately suffered from a blood clot in her left leg, which led to her death from a pulmonary embolism. The coroner determined that she “should have been immediately referred to a hospital emergency unit,” implying that prompt intervention could have saved her life.

Mrs. Chesterton shared with the BBC that losing a child is profoundly painful, stating, “It is not how life is meant to unfold.” She expressed hope that the High Court case would prevent similar tragedies in the future.

Legislation governing the regulation of PAs and AAs stipulates that GMC registration will not be mandatory until December 2026. After that date, practicing as either role in the UK without registration will be considered illegal.

A GMC representative commented that regulation will assist in assuring patients, peers, and employers of the safety of PAs and AAs and that they can be held accountable in the event of serious concerns.

To gain GMC registration, physician associates and anaesthesia associates must demonstrate the requisite knowledge, skills, and experience to provide safe patient care, and show there are no open concerns regarding their professional fitness.

Presently, there are 2,479 physician associates and 109 anaesthesia associates registered with the GMC.

In January, the health and social care secretary initiated an independent review of the PA and AA professions “to formulate recommendations for the future.” The review intends to evaluate “the safety of these roles and their impact on multidisciplinary healthcare teams.”

The United Medical Associate Professionals (UMAPs), a trade union established in 2023 to advocate for PAs and AAs, released a statement recognizing the resilience of the Chesterton family. While they may not fully align with all views expressed regarding the case, they respect the family’s determination during a time of significant personal loss.

The statement emphasized that PAs are “highly trained healthcare professionals,” many of whom have substantial prior experience in nursing, pharmacy, or clinical sciences. It further warned that the current legal review initiated by Anaesthetists United poses risks, as it seeks to impose excessively restrictive practice conditions on a single profession, potentially leading to rigid regulations across all clinical roles.

Mrs. Chesterton noted that she was unaware of what a physician associate was when she found out her daughter had been diagnosed by one. “Losing a child is incredibly devastating, but discovering that your child’s demise was avoidable is utterly heartbreaking,” she remarked.

Brendan, Emily’s father, pointed out that protocol violations occurred when she was evaluated by a PA twice for the same ailment and that prescribing should not have taken place.

The Vale Practice, where Emily received care, expressed deep sorrow over her passing, stating that they now only book appointments with registered GPs, nurses, and pharmacists following a comprehensive review of their procedures.

The Chestertons told the BBC that the regulatory changes implemented by the GMC have not clarified the PA role, despite being assured of clearer supervision guidelines.

The GMC responded that it is not their role to provide guidance on the skill development of individual PAs and AAs over time, as this is determined by employers based on clinical contexts and workforce demands.

“We anticipate that employers will remain cognizant of and adhere to the guidance on scope of practice issued by royal colleges and other professional bodies when making deployment decisions.”

A spokesperson from the Department of Health and Social Care expressed condolences regarding the tragic event, affirming that the health secretary has initiated an independent review to establish the facts and ensure that qualified individuals are placed in roles to provide appropriate care.

For Mrs. Chesterton and her husband, their desire is straightforward.

“We want the GMC to accept their responsibility,” she conveyed to BBC London. “They were appointed by Parliament to regulate, and they should fulfill that obligation instead of delegating it to employers.”

She asserted the need for a well-defined framework for the PA role and oversight to ensure patient safety, advocating for a future where there are no more tragic cases like Emily’s.