As a clinical negligence solicitor, I’m increasingly concerned by recent developments in the NHS’s use of physician associates (PAs), soon to be renamed “physician assistants” and the implications for patient safety and legal accountability.

Six deaths linked to PAs: The Gillian Leng Review

Earlier this month, a government-commissioned review led by Professor Gillian Leng CBE laid bare a sobering finding: six patient deaths have been linked to misdiagnoses by PAs filling in for doctors in overstretched NHS settings. These are the only ones that have been proven and there may be more to come.

The cases involved tragic outcomes such as that of Emily Chesterton (30), who was misdiagnosed twice by a PA in a North London GP with chest pain and breathlessness, later found to be pulmonary embolism.

I’m currently working on a tragic case of Nathan Blackburn (40). He was a father of two, and he died following a number of contacts with a PA who failed to refer for a suspected pulmonary embolism. He then attended A&E who also sadly missed the signs. The coroner noted it to be a fully avoidable death - startlingly similar to the facts in the Emily Chesterman case.

There was also the tragic case of Pamela Marking (77), wrongly diagnosed with a nosebleed despite severe abdominal pain; she was discharged, and died only days later.

These events highlighted a dangerous blurred role with patients, families, and staff all too often mistaking PAs for fully qualified doctors.

Transparency, scope and supervision: key failings

The Leng report recommends 18 important changes, several of which are noted to be urgent steps:

• Rename to “Physician Assistant” and require distinctive ID/uniform to prevent confusion.

• Banned from seeing un-triaged patients or those on their first attendance and initial diagnoses must be made by a doctor.

• Enforce two years post-qualification in hospital before entering GP or mental health roles.

• Mandate named doctor supervision and national scope-of-practice protocols.

Whilst the government has accepted all 18 recommendations, worry remains about the fragmented roll-out and the slow pace of implementation in individual trusts.

Legal implications

From a legal standpoint, several issues concern me:

• Misrepresentation and consent: If patients are unknowingly assessed by PAs instead of doctors, have they given informed consent to treatment?

• Liability gaps: NHS indemnity covers them under the Clinical Negligence Scheme for GPs (CNSGP), but the fault usually lies with their supervisor, putting further pressure on GPs.

• Supervisory failure: The review concluded that lack of oversight can lead to “catastrophic” outcomes. As a solicitor, I see this as a potential breach of supervisory duty by employing trusts and supervising doctors.

I’m also hearing anecdotal evidence of GPs unable to get full time roles but if we’re relying on unqualified and under supervised PAs this seems like a false economy, if it's true.

Picking up the pieces

Coroners are increasingly left to highlight the errors and a Surrey coroner issued warnings after Pamela Marking’s death noted a PA acted “outside their capabilities” and that the term itself misled the public.

Expansion is a clear risk

The NHS is poised for expansion of PA roles, from around 3,500 now to a projected 10,000 by 2035. Without rigorous implementation of the Leng review, we risk systemic erosion of patient safety and a flood of new negligence claims. We should be utilising trained staff, training more staff and then treating them in a way where they want to stay in the NHS.

It is vital that:

• Patients receive care from appropriately qualified and clearly identified clinicians.

• Healthcare providers are transparent about role boundaries.

• Victims of negligence are empowered to seek justice and compensation.

I believe the heightened scrutiny on physician associates marks a critical juncture. With six avoidable deaths directly tied to their use, urgent reforms are in motion and need to be implemented without delay, or the loss of more lives - and subsequent claims - may follow.