‘Our daughter would still be alive if she had seen GP and not an associate’

Brendan Chesterton, 64, a retired maths and ICT teacher, and his wife Marion, 65, a retired languages teacher, are backing new guidance from the British Medical Association (BMA) calling for limits on the role of NHS physician associates (PAs).

Physician associates are graduates – usually with a health or life sciences degree – who have undertaken two years of postgraduate training.

According to NHS Careers, they work under the supervision of a doctor and can diagnose people, take medical histories, perform physical examinations, see patients with long-term conditions, analyse test results and develop management plans.

Most physician associates work in general practice, acute medicine and emergency medicine.

In England, the NHS and the Government have said they will increase the physician associate workforce to 10,000 from around 3,300 at present.

Speaking at the launch of the new BMA guide – Safe Scope of Practice for Medical Associate Professionals – Mr and Mrs Chesterton said their daughter Emily would “100%” still be alive if the guidance had been in place before her death.

The 30-year-old died on November 8 2022 from a pulmonary embolism after being misdiagnosed on two occasions when she visited her local GP practice in Crouch End, north London.

She had been under the impression that she was seeing a GP when she had been seeing a physician associate after being triaged by a practice receptionist.

The physician associate failed on both occasions to spot her leg pain and breathlessness was a blood clot which ultimately travelled to her lungs.

She was instead prescribed medication for anxiety.

Ms Chesterton had taken her partner to the second appointment as she felt she needed his support and was struggling to walk.

However, he was told by the associate that he was not allowed to be with her at the appointment.

A coroner later ruled that Ms Chesterton “should have been immediately referred to a hospital emergency unit” where she would likely have been treated for pulmonary embolism and would have survived.

Mr Chesterton said: “We were very naturally very pleased with this (BMA framework) because it spoke to us directly, to our experience, and what has happened in our lives.”

Regarding his daughter being prescribed medication for anxiety instead of being diagnosed with a pulmonary embolism, he said: “She was deeply worried about her own state of health and so it was something that went part and parcel with the physical aspects.

“And so the PA chose to basically ignore that and say ‘take some paracetamol’ and then prescribed propranolol (for anxiety).”

Mrs Chesterton told reporters that many people have no idea what a PA does, or that they are not doctors.

She said her daughter was assessed “at a distance” and the physician associate had not made clear what her role was.

She added: “We did not find out that Emily had seen the PA on two consecutive occasions – and not a GP – until the week before her inquest on March 21 2023.

“We believe that the present title of physician associate is confusing, inaccurate and sounds rather grand – indeed grander and superior in qualification and status to a general practitioner, and should be changed to doctor’s assistant.”

Regarding the prescription for anxiety medication, she said it had been signed off by a GP.

“Emily had never taken the medicine before,” she said. “At the inquest, the doctor concerned said she had hundreds of prescriptions to sign off on a Monday afternoon and unfortunately this one slipped through the net.

“Later that day, Emily took a tablet and immediately said she felt weird.

“An ambulance was called, but Emily’s heart stopped in the ambulance on the way to the hospital.

“We had followed in a car. On arrival at the hospital, we were informed that they had to administer an antidote to the propranolol and sadly there was nothing the doctors could do.

“She died in the early hours of November 8, just three weeks after celebrating her 30th birthday in Manchester with us.

“She was subsequently diagnosed with a pulmonary embolism, which had started in her left calf.”

Mr and Mrs Chesterton, who have another daughter, Jasmine, 35, and two grandchildren, said they liked the “easy to follow traffic light system” in the new BMA framework.