We write on behalf of United Medical Associate Professionals to correct untrue, biased, and damaging information reported in your 27/01/24 article titled ‘Physician associates accused of illegally prescribing drugs and missing diagnoses’ (1). We request an immediate retraction and apology on the front page where this article was first posted.
As you are aware, Physician Associates (PAs) are qualified professionals trained in the medical model and can assess, diagnose, formulate management plans, and perform treatments within their scope of practice (2). PAs have been working in the UK for 20 years and have been successfully established in similar positions in countries around the world including the United States, New Zealand, and Canada, where they complement the care provided by doctors. In a modern clinical environment, this diverse range of experiences and skills has worked well as part of balanced NHS care teams. Research has found PAs to be safe and effective (3,4,5).
Whilst your report is stated as having been written by your investigations team, it is clear there has been minimal investigation into the motivations of the sources you have referenced. Disappointingly, this has led to the publication of biased and potentially damaging information. Your article refers to a survey conducted by the Doctors Association UK, in which there were 600 participants. You may not be aware, that the Doctors Association has been involved in the aggressive pursuit of medical associate professionals (MAPs) through social media, the press, and the attempted organisation of a potential large-scale data breach – of which they now claim has been successful (6,7). The survey findings you report claim that ‘more than 70 instances of patient harm and near misses’ have been reported by doctors.
Other than the clear research bias (admitted by the survey co-creator themselves, 8), the validity of this research must be questioned when considering the following;
- The accounts are not verified. Contact details were optional, the vast majority remained anonymous. These testimonials have therefore not been confirmed as true.
- The respondents are not verified. The survey was publicly accessible and therefore respondents did not have to be a healthcare professional. Confusingly, medical students were encouraged to participate, those who have not worked with a PA, or in fact, even as a doctor.
- There were 600 respondents to DAUKs survey- an organisation with a specific agenda against MAPs. Followers of DAUK have a clear bias against MAPs and therefore are motivated to falsify accounts.
- Participants were not limited to a singular submission- again showing failure to validate participants and increases risk for falsified accounts.
- The timeframe of these 70 events has been omitted. Are these events over the last 20 years, and as the NHS runs a “just culture” applying no blame, it is difficult to gauge the extent of the role of the PA in some cases, and the role of their supervising consultant or GP.
- Omission of proportion of ‘near misses’ and ‘actual harm’. Assuming this data was differentiated, there could in fact, only be 1 actual harm out of 70. has been no comparable data to give scale and proportion to this accusation. For context, there are 1.4 million adverse events in the NHS per year.
The co-chair of DAUK, as you have referenced, has admitted that some reports had been falsified (9). DAUK state that many reports were general negative comments, such as ‘I don’t like PAs’, with no suggestion of unprofessional, inappropriate, or unsafe behaviour suggesting the report is biased and misleading. A further proportion attempted to report positive feedback, despite the survey post title being ‘we are collating concerns about Physician Associate roles’ (10). There have been several unethical and biased surveys distributed over the past year, which would fail any scrutiny by a research ethics panel, and most have only been distributed on social media platforms, thus limiting the exposures to a broad consensus of views.
When examining the data presented, after making an overwhelming assumption that this data is true, and ignoring all bias, the results claim that 1.75% of the estimated 4000 PAs in the country have caused a near miss or harm. Therefore 98.25% of PAs have not acted in any way that has caused concern for doctors. If this data is true, it represents an extremely small proportion of PAs. You have failed to examine this data and communicate the implications.
These apparent patient safety incidents have been collected and not reported appropriately through local and national statutory procedures, they are instead being drip-fed into the press as part of a harassment campaign, showing an egregious error of judgment by those involved. They should reflect on their motivations for doing so and report all patient safety incidents immediately through the correct channels inclusive of referral to the FPA or police if they think there has been a serious compromise on patient safety or criminality. Anything other than this denies patients and employees their right to understand the incident and the ability to address any concerns.
In your report, you wrote ‘The data suggest that at over half of England’s hospital trusts, doctors are being replaced by PAs on the rota, despite associates only completing a two-year postgraduate course and having no legal right to prescribe’. You state that doctors are being replaced by PAs, this is untrue. We would be fascinated to know how you came to this conclusion when there were 8858 NHS medical vacancies in September 2023, as per the BMA (11). Additionally, you have insinuated that PAs are not suitably qualified. The average PA will undergo a minimum of a 3-year undergraduate followed by a 2-year intensive postgraduate course, a total of 5 years of training. Your statement on PA training could therefore be considered unjustifiably damaging to all PAs, as they have at least 150% more training than you are giving them credit for.
You have reported that the ‘findings’ in your article have been shared with Baroness Foster, who plans to discuss the results in the House of Lords regarding MAP regulation by the GMC, in a further attempt to oppose this long planned and reasonable approach to regulation of PAs proposed by the Department of Health and Social Care. This is in contradiction to the concerns expressed in your article on professional standards.
This is a poor example of investigative journalism with no attempt to seek opinions from PAs or their senior supervising doctors. You have reported unilaterally on a self-professed bias survey, conveying messages of widespread PA criminality to the public, with, at the time, no evidence to support these claims. It stains the good name of the Sunday Telegraph. We ask that you retract this article and post a formal apology or correction. We also ask that you immediately confess these grievous errors in your investigation to the Baroness to avoid causing her damage when she misquotes your previous findings in the House of Lords.
Yours faithfully,
UMAPs
United Medical Associate Professionals
Some of these references may be deleted from social media/online forums at the time of your reading. We have screenshots of all original posts that we can present if needed.
- Investigations team; Claire Newell; Katherine Rushton; Sophie Barnes; Janet Eastham (2024) Physician Associates accused of illegally prescribing drugs and missing diagnoses, The Telegraph. Available at: https://www.telegraph.co.uk/news/2024/01/27/nhs-doctors-allege-patient-harm-near-misses-pa-training/ (Accessed: 28 January 2024).
- Physician associate title and introduction guidance for PAs, supervisors, employers and organisations: https://www.fparcp.co.uk/file/media/652d35a68d9a6_FPA_Physician_Associate_Titles_and_Introductions_Guidance_FINAL_5_10_23.pdf
- Drennan, V.M. et al. (2019) ‘The role of Physician Associates in secondary care: The pa-SCER mixed-methods study’, Health Services and Delivery Research, 7(19), pp. 1–158. doi:10.3310/hsdr07190.
- Halter, M. et al. (2017) ‘Patients’ experiences of consultations with physician associates in Primary Care in England: A qualitative study’, Health Expectations, 20(5), pp. 1011–1019. doi:10.1111/hex.12542.
- NHS choices. Available at: https://www.hee.nhs.uk/our-work/medical-associate-professions/impact-case-studies/physician-associate-role-secondary-care-impact-case-study (Accessed: 24 December 2023).
- Doctors’ Association UK (2024) We urgently need copies of rotas nationally which show further examples of PAS or AAS taking the place of a doctor. we can discuss why and how these with be used, but we can assure discretion and confidentiality of submitting doctors. please get in touch by DM or contact@dauk.org, Twitter. Available at: https://twitter.com/TheDA_UK/status/1750600561378914405 (Accessed: 28 January 2024).
- Doctors’ Association UK (2024a) Thank you for those sharing rotas showing maps replacing doctors. we will be in touch with those submitting once the Data Protection Impact Assessment is finalised., Twitter. Available at: https://twitter.com/TheDA_UK/status/1751389826195079224 (Accessed: 28 January 2024).
- (No date a) Quick map update : R/doctorsuk – reddit. Available at: https://www.reddit.com/r/doctorsUK/comments/17z1i4x/quick_map_update/ (Accessed: 28 January 2024).
- (No date a) Doctorsuk – Reddit. Available at: https://www.reddit.com/r/doctorsUK/comments/17z1i4x/comment/k9x043q/?context=3 (Accessed: 29 January 2024).
- (No date a) R/doctorsuk on reddit: We are collating concerns about physician … Available at: https://www.reddit.com/r/doctorsUK/comments/17e2iz4/we_are_collating_concerns_about_physician/ (Accessed: 28 January 2024).
- (No date a) NHS delivery and workforce – advice and support – BMA. Available at: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce (Accessed: 28 January 2024).
