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| Coroner warns about NHS physician associates after misdiagnosis and death of woman | Coroner warns about NHS physician associates after misdiagnosis and death of woman |
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| Pamela Marking, suffering severe stomach issues, diagnosed in hospital with nosebleed and sent home by PA | Pamela Marking, suffering severe stomach issues, diagnosed in hospital with nosebleed and sent home by PA |
| A coroner has issued a warning about the role of physician associates in NHS hospitals after a woman with severe abdominal problems was wrongly diagnosed as having a nosebleed and died four days later. | |
| The family of Pamela Marking, 77, were under the mistaken impression she had been seen by a doctor when she was examined in an emergency department, rather than a physician associate (PA) with far less training. | The family of Pamela Marking, 77, were under the mistaken impression she had been seen by a doctor when she was examined in an emergency department, rather than a physician associate (PA) with far less training. |
| Surrey assistant coroner Karen Henderson has written to 12 health leaders or bodies including the UK health secretary, Wes Streeting, and NHS England expressing concerns about the “limited training” PAs have and the lack of public understanding about their roles. | Surrey assistant coroner Karen Henderson has written to 12 health leaders or bodies including the UK health secretary, Wes Streeting, and NHS England expressing concerns about the “limited training” PAs have and the lack of public understanding about their roles. |
| In a preventing future deaths report, Henderson said Marking was taken to East Surrey hospital in Redhill on 16 February last year after she vomited blood-stained fluid and had a tender abdomen. | In a preventing future deaths report, Henderson said Marking was taken to East Surrey hospital in Redhill on 16 February last year after she vomited blood-stained fluid and had a tender abdomen. |
| The coroner said the PA who saw her had “a lack of understanding of the significance of abdominal pain” and sent her home the same day. Marking deteriorated, returning to the hospital two days later. She underwent surgery for complications arising from a femoral hernia but died on 20 February 2024. | The coroner said the PA who saw her had “a lack of understanding of the significance of abdominal pain” and sent her home the same day. Marking deteriorated, returning to the hospital two days later. She underwent surgery for complications arising from a femoral hernia but died on 20 February 2024. |
| Henderson said the PA had effectively acted independently in the diagnosis, treatment, management and discharge of Marking without independent oversight by a medical practitioner. | Henderson said the PA had effectively acted independently in the diagnosis, treatment, management and discharge of Marking without independent oversight by a medical practitioner. |
| The coroner said: “Given their limited training and in the absence of any national or local recognised hospital training for physician associates once appointed, this gives rise to a concern they are working outside of their capabilities.” | The coroner said: “Given their limited training and in the absence of any national or local recognised hospital training for physician associates once appointed, this gives rise to a concern they are working outside of their capabilities.” |
| The coroner said the term physician associate was misleading to the public. “Mrs Marking’s son was under the mistaken belief that the physician associate was a doctor [and] no steps were taken by the emergency department or the physician associate to explain or clearly differentiate their role from that of medically qualified practitioners.” | The coroner said the term physician associate was misleading to the public. “Mrs Marking’s son was under the mistaken belief that the physician associate was a doctor [and] no steps were taken by the emergency department or the physician associate to explain or clearly differentiate their role from that of medically qualified practitioners.” |
| Henderson added that the lack of public knowledge about PAs “has the potential to hinder requests by patients and their relatives who would wish to seek an opinion from a medical practitioner”. | Henderson added that the lack of public knowledge about PAs “has the potential to hinder requests by patients and their relatives who would wish to seek an opinion from a medical practitioner”. |
| She continued: “It also raises issues of informed consent and protection of patient rights.” | She continued: “It also raises issues of informed consent and protection of patient rights.” |
| She said a lack of clarity over the role of PAs had “the potential to devalue and undermine public confidence in the medical profession”. | She said a lack of clarity over the role of PAs had “the potential to devalue and undermine public confidence in the medical profession”. |
| At the end of Marking’s inquest last year, Henderson concluded the clinical management she had on her first visit to hospital – and later the issues with anaesthesia when she was operated on – “materially contributed to her death”. | At the end of Marking’s inquest last year, Henderson concluded the clinical management she had on her first visit to hospital – and later the issues with anaesthesia when she was operated on – “materially contributed to her death”. |
| In November, the UK government ordered a review of the role of PAs in the NHS, amid growing alarm in the medical profession about patient safety. | In November, the UK government ordered a review of the role of PAs in the NHS, amid growing alarm in the medical profession about patient safety. |
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| It will examine the safety of their roles and how patients should be made aware that, despite their titles and ability to diagnose illness, they are not doctors and can only perform certain tasks. | It will examine the safety of their roles and how patients should be made aware that, despite their titles and ability to diagnose illness, they are not doctors and can only perform certain tasks. |
| About 3,500 PAs and about 100 equivalents who work in anaesthesia – called anaesthetic associates – are working in hospitals and GP surgeries in England. | About 3,500 PAs and about 100 equivalents who work in anaesthesia – called anaesthetic associates – are working in hospitals and GP surgeries in England. |
| PAs can take a patient’s medical history, conduct physical examinations, analyse test results, diagnose illnesses and help draw up the plan for managing a person’s condition. They do two years of medical training, far less than a doctor. | PAs can take a patient’s medical history, conduct physical examinations, analyse test results, diagnose illnesses and help draw up the plan for managing a person’s condition. They do two years of medical training, far less than a doctor. |
| Philip Banfield, the chair of the BMA council said: “Mrs Marking needed care from a doctor, because they are specifically trained in more depth and more widely to consider a diagnosis that may not be obvious at first sight. | |
| “As the coroner says, the continued blurring of the lines between PAs and doctors is compromising patient safety. A government review is ongoing but this tragic case already shows it must result in nationally agreed safe scopes of practice for these assistant roles.” | “As the coroner says, the continued blurring of the lines between PAs and doctors is compromising patient safety. A government review is ongoing but this tragic case already shows it must result in nationally agreed safe scopes of practice for these assistant roles.” |
| This article was amended on 27 February 2025. An earlier version misnamed Pamela Marking as “Pauline” Marking. | This article was amended on 27 February 2025. An earlier version misnamed Pamela Marking as “Pauline” Marking. |