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Physician associates should be banned from giving diagnoses to "improve patient safety", the British Medical Association said after a woman died from a blood clot that went undetected.

In new guidance published on Thursday, the union said medical associate professions (MAPs) must not be responsible for first assessing or diagnosing patients, and must be closely supervised when tending to those who have already seen a doctor.

The British Medical Association (BMA) added that MAPs, a category that includes physician associates (PAs) and anaesthesia associates (AAs), should also refrain from telling patients "I am one of the medical team", without stating their actual job title.

MAPs were introduced by the NHS in 2003 to support doctors, but have been criticised for high-profile mistakes.

In 2022, actress Emily Chesterton died from a blood clot after being misdiagnosed twice. She believed she had been seen by a GP, but instead was assessed on both occasions by a PA.

Professor Phil Banfield, BMA chair of council, said the union hopes the document will "improve patient safety", saying an outline for the role of what MAPs "can do safely" is "paramount".

"With the government's clear intent to expand the numbers of MAPs in the medical workforce, but without the clarity on the scope of their skills and responsibilities, it is even more important that patients must know who is treating them and the skills and abilities that clinician has," he said.

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'We need regulation'

Speaking to Sky News' Ashish Joshi, Marion Chesterton said that new regulation on PAs is "absolutely" needed after her daughter Emily's death.

The 30-year-old was seen by a PA at a north London surgery in October two years ago, saying she felt pain in her calf.

She was diagnosed with a sprained ankle, but returned to the surgery days later with new symptoms - a swollen and hot leg, and shortness of breath.

The PA prescribed her propranolol medication for anxiety. Ms Chesterton was later rushed to hospital after collapsing the same evening, and died from a pulmonary embolism.

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Emily's mother said to Sky that the doctor in charge of the surgery told her "that had Emily seen her she would have sent her immediately to A&E for emergency treatment".

She said the doctor had added, "the PA should not have prescribed, they're not allowed to prescribe and yet she did, and the prescription got through, that's why we need regulation".

Brendan Chesterton also said that "as we're reading [the BMA guidelines], we're saying 'that's what happened to Emily'".

"All the things that they're saying shouldn't happen, happened."

Prof Banfield also warned that MAPs "are working in roles that increasingly cross the line into situations more appropriately requiring the expertise of a doctor".

He added the BMA's guide sets out what it "considers a safe scope of practice that will keep patients protected and allow the NHS to effectively employ MAPs to assist medical teams - which was their original purpose".

The union recommended in its guidance that MAPs should work using a traffic light system, where green indicates a task they can do alone, amber means they need supervision and red indicates a task they should not do.

The Royal College of Physicians' Faculty of Physician Associates estimated in 2021 there were around 3,000 qualified PAs working in the UK and 300 AAs in the NHS.

PAs role expansion 'approved'

In a poll of 18,100 UK doctors, the BMA also found that 55% said they experienced a higher workload since PAs and AAs were introduced. Only 21% said their workload had eased.

A Department of Health and Social Care spokesperson said in response: "Physician associates have worked in the NHS for over two decades.

"They have been found to be safe, positively contributing to medical and surgical teams, and patient experience, while supporting the clinical teams' workload - which is why we expanded the role of PAs in the NHS's Long-Term Workforce Plan.

"The legislation regulating both PAs and anaesthesia associates has now been approved by parliament and will be in place by the end of 2024.

"It will set standards of practice, ensuring that PAs meet the standards that we expect of all regulated professionals, with the General Medical Council operating strict fitness-to-practice procedures and setting education and training expectations."