WhatDoTheyKnow and Reddit: bring them together, and amazing things can happen — as we’ve discovered from one of our users.

We’ve been talking to Yasmin Marsh, who, as part of a small collective of NHS doctors and staff named PA Project Watch group, is investigating concerns around the use of under-qualified medical staff in NHS hospitals and GP surgeries. With a combination of facts received through Freedom of Information requests, and on the ground experience from members of the r/DoctorsUK subreddit, they’ve created a change in policy in at least one NHS Trust.

What is a PA?

We asked Yasmin to explain the basics of PA Project Watch’s campaign to us, and anyone else who might not know the finer details of how the NHS functions. So first of all, what does the PA in the group’s name refer to?

“It’s ‘Physician Associate‘, a role previously known as a ‘Physician Assistant’,” she explained. 

“A PA is a member of the healthcare team who works under the supervision of a senior doctor to help care for patients. You can train to become a PA with a 24 month MSc or PgDip. 

“The role was originally designed so that PAs would always work under the supervision of senior doctors and assist the medical team in caring for patients.”

The trouble with PAs

OK, so what’s the issue with PAs? 

“Because no official rules have been set around what they can or can’t do”, says Yasmin, “they’ve been used inappropriately by NHS hospitals and GP surgeries to replace doctors.”

In these stretched times, it’s perhaps inevitable that shortages are being addressed by any means possible? Yasmin agrees:

“You can see the temptation for NHS managers and GP surgeries — if there are doctor shortages, fill the gaps with PAs instead. They’re also cheaper than doctors!”

Yasmin told us that the General Medical Council are planning to introduce regulation later this year, but meanwhile, there are potential dangers around this situation. 

“I’ve seen first-hand the problems of using PAs,” she said. “It comes back to the old saying ‘you don’t know what you don’t know’. As they’ve only done a 24 month course, they miss covering lots of important topics, and the topics they do cover are only covered in superficial depth, skimming over lots of important medical topics briefly. There’s a reason medical school is five to six years!

“So, for example, when looking at a patient’s blood tests, I’ve seen a PA miss a common critical abnormality because they simply lacked knowledge — they’d never been taught about that particular blood test abnormality or what it means. If you speak to doctors, these types of errors are happening through the use of PAs up and down the country.”

So how critical is it?

“There have been several deaths of patients due to mistakes made by PAs, which have been reported by the BBC¹, the Manchester Evening News², and in two stories from the Telegraph³.”

WhatDoTheyKnow and Reddit

So that certainly explains the groups’ concerns, and their desire to do something about it — now, how did WhatDoTheyKnow and Freedom of Information come into the picture? 

Yasmin hadn’t been fully familiar with the concept before: “I had heard of FOI requests, but I never knew they could be submitted by anybody. I thought you had to be a journalist or an investigator to submit them. However, I found WhatDoTheyKnow through Google when looking for another topic about my local council, and then discovered that anyone could send them.”

And what about the link with Reddit? Yasmin’s shared FOI responses as the group has received them, allowing for vital scrutiny of the information provided, from those working in the settings in question, who are able to compare the responses with their own experiences.

“Reddit has been central to this campaign. I’d really emphasise the role of the /r/DoctorsUK community. Without them, this would not have been possible.”

A strong example comes from the FOI request sent to Torbay Hospital.

“We received a message from a Reddit user who said this hospital was using PAs inappropriately to replace doctors, often in the paediatric department, but also covering other gaps in the hospital rota like the surgery and medicine departments.

“After this message, I sent an FOI request to the hospital, asking them how many times doctors had been replaced by PAs. They replied: 

None, physician associates are not permitted to cover doctor’s shifts.

“We then posted this on the r/DoctorsUK community asking if this was true, and for any evidence that PAs were replacing doctors. We received testimony from paediatric nursing staff and a rota, showing that PAs regularly replaced doctors in the paediatric department. This demonstrated that the hospital’s response was false. 

“We then challenged the hospital’s response by requesting an internal review, which led to them admitting that PAs did cover rota gaps in paediatrics and other departments.

“Did they deliberately try to cover up the situation? Or was this an administrative mistake? We’ll never know. Without Reddit, we would have just accepted the original response and never pushed for the internal review.”

Real-life results

And as for whether the request has had any impact? Yasmin confirms that the Trust says they’ve now stopped substituting PAs for doctors.

PA Project Watch continue in their work. “We’re now asking other hospitals to see if they have been substituting doctors for PAs, and uncovered further evidence: for example, Royal Berkshire sent us a spreadsheet of shifts where PAs had covered for doctors. This story was featured in the Daily Mail, although unfortunately without a credit.”

And perhaps as a further effect of this campaigning, doctors are now taking legal action against the General Medical Council, because while the GMC is planning to regulate PAs as Yasmin points out, “they could still technically do anything a doctor could do. 

“This is the central argument of the Anaesthetists United legal case — they want the GMC to create a clear set of limits on the tasks PAs can perform, to avoid them being used inappropriately.”

But Yasmin’s clear where the problem lies and it’s not with the PAs themselves. “They’ve been let down by their leadership at the Faculty of Physician Associates, taken advantage of by the NHS, and thrust into roles for which they are unqualified and underprepared. 

“Unfortunately, the NHS culture makes it really difficult to speak up about these issues. We’re trying to shine a light on what’s happening, and FOI gives us the power to do this — but we’re finding many Trusts are now refusing to answer requests about PAs, and we’re having to involve the ICO more and more.”

Thanks so much to Yasmin for sharing this important campaign. It’s great to see the journey from FOI novice to FOI expert! 

It’s clear that the group now has enough knowledge to request an internal review to challenge an erroneous response, and to appeal to the ICO when an authority hasn’t met their responsibilities under the FOI Act — and we’re glad that WhatDoTheyKnow has been part of that learning process, not to mention the results that have come from it.

Video summary:

---

¹ BBC: Misdiagnosis: Bereaved mum calls for physician associate role clarity

² Manchester Evening News: Gran died after ‘physician’s associate’ left treatment in place for 16 HOURS longer than allowed

³ The Telegraph: Man died from rare heart problem after being discharged from hospital
Family of film make-up artist call for inquest after treatment by physician associate

—

Image: implusq