A coroner has issued a stark warning about the role of physician associates (PAs) in NHS hospitals after a 77-year-old woman was misdiagnosed and later died. Pauline Marking, who was experiencing severe abdominal issues, was mistakenly diagnosed with a nosebleed by a PA rather than a fully qualified doctor.
Her family believed she had been examined by a doctor in the emergency department, unaware that a PA—who has significantly less medical training—was responsible for her assessment.
Coroner Raises Alarm Over Physician Associate Training and Public Awareness
Assistant coroner for Surrey, Karen Henderson, has sent a preventing future deaths report to 12 health leaders and organizations, including UK Health Secretary Wes Streeting and NHS England. She highlighted concerns about the limited training of PAs and the general public’s lack of understanding about their role in medical settings.
The report follows Marking’s visit to East Surrey Hospital in Redhill on 16 February 2023, where she presented with blood-stained vomit and abdominal tenderness. The PA who assessed her failed to recognize the severity of her condition and sent her home the same day. Two days later, she returned to the hospital in critical condition. She underwent emergency surgery for complications related to a femoral hernia but died on 20 February 2024.
Physician Associates Acting Independently Without Oversight
The coroner emphasized that the PA effectively acted independently in diagnosing, treating, managing, and discharging Marking without proper medical supervision.
“Given their limited training and the absence of any national or local recognized hospital training for physician associates, this raises concerns that they are working outside of their capabilities,” Henderson stated.
She also warned that the title “physician associate” is misleading, causing confusion among patients and families. Marking’s son mistakenly believed his mother had been seen by a doctor, highlighting a lack of transparency in differentiating the roles of PAs and qualified medical practitioners.
Growing Concerns Over Patient Safety and Informed Consent
Henderson’s report underscores the risks posed by unclear PA responsibilities, which could devalue public trust in the medical profession. She warned that patients and families may not realize they can request a fully qualified doctor’s opinion, raising issues about informed consent and patient rights.
At Marking’s inquest last year, the coroner concluded that failures in clinical management during her initial hospital visit—and later issues with anesthesia during surgery—materially contributed to her death.
UK Government Reviewing Physician Associate Role in NHS
Following increasing concerns over patient safety, the UK government launched a review of the PA role in November 2023. The investigation aims to assess whether PAs should be allowed to diagnose illnesses and how patients should be informed that they are not doctors and have limited responsibilities.
Currently, around 3,500 PAs and 100 anaesthetic associates work in hospitals and GP practices across England. While they can take medical histories, perform physical exams, analyze test results, and assist in treatment planning, they only undergo two years of medical training, compared to the extensive education required for doctors.
With increasing reliance on PAs in the NHS, concerns are growing over the potential risks to patient safety, prompting calls for stricter regulations and clearer public awareness about their limitations.
