The parents of a woman who died after her blood clot was misdiagnosed by someone who she thought was a doctor have called a government-ordered review “a missed opportunity”.
Marion and Brendan Chesterton have welcomed many of the recommendations in Professor Gillian Leng’s review of the role that physician associates (PAs) perform in the NHS, but say “they don’t go far enough”.
Emily, 30, died in November 2022 after suffering a pulmonary embolism. She went to see her GP at a north London surgery twice in the weeks before her death – and on both occasions was seen by a physician associate who missed the blood clot and instead prescribed propranolol for anxiety.
Image: Marion and Brendan Chesterton
The actress from Salford had told her worried parents that she had been seen by a doctor, but she had not.
Her father Brendan told Sky News: “If she come out and said I’ve seen someone called the physician’s associate I’m sure we would have insisted that, you know, let’s go back and insist that you see a doctor. She never knew.”
Now, a government-ordered review led by Prof Leng, president of the Royal Society of Medicine, has recommended NHS physician associates should be banned from diagnosing patients who have not already had contact with a doctor for their illness.
The report suggests a major change to the role of PAs after it acknowledged they have been used as substitutes for doctors, despite having significantly less training.
Image: Emily Chesterton. Pic: Family handout
More than 3,500 PAs and 100 anaesthesia associates (AAs) are working in the NHS and there have been previous calls for an expansion in their number.
But a general lack of support for the roles from the medical profession – plus high-profile deaths of patients who were misdiagnosed by PAs – led Health Secretary Wes Streeting to order a review.
Presenting her findings, Prof Leng said: “Crucially I’m recommending that PAs should not see undifferentiated or untriaged patients.
“If (patients) are triaged, they (PAs) should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs.”
She said more detail was needed on which patients can be seen by PAs and national clinical protocols should be developed in this area.
She added: “Let’s be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients.”
Prof Leng also recommended PAs should be renamed “physician assistants” to position them “as a supportive, complementary member of the medical team” – and have standardised uniforms to distinguish them from doctors – while AAs should be renamed “physician assistants in anaesthesia”.
Newly qualified PAs should also work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts.
The report said that while research suggests patients are satisfied after seeing a PA, some did not know they were not seeing a doctor.
Prof Leng concluded there were “no convincing reasons to abolish the roles of AA or PA”, but there is also no case “for continuing with the roles unchanged”.
She recommended that both PAs and AAs should have the opportunity for ongoing training and development, with potential to prescribe medicines in the future, and they should also have the opportunity to become an “advanced” PA or AA.
Six patient deaths linked to contact with PAs have been recorded by coroners in England.
Emily’s mother Marion said some of the review’s findings were significant and her daughter would still be alive if the recommendations had been in place when she fell ill.
Image: Marion Chesterton
She said: “I think so, yes, which is so important, which is why we’re so pleased that this review has been made.”
But Mrs Chesterton added that more could have done, including stopping all PAs from prescribing drugs.
“We feel it’s a missed opportunity. It could have gone all the way there and cleared things up totally. Our daughter died. She was prescribed a drug that she should not have been prescribed. And it had absolutely catastrophic circumstances. She died for goodness sake.”
The Chestertons’ concerns are shared by the British Medical Association (BMA).
Image: Dr Emma Runswick, the BMA’s deputy chair
Dr Emma Runswick, BMA’s deputy chair, said: “It is definitely a problem that the roles of doctors and now physician assistants has been blurred and it’s positive that their name is going to change, that there will be a uniform.
“But whilst they continue to be deployed in a way that mimics doctors at the behest of any local employer decision, we have to have ongoing concerns about their safety.”
But UMAPs, the trade union which represents both PAs and AAs, has warned the changes will undermine their qualifications and their role, lengthen waiting lists and worsen the impact of any strike action.
Image: Steve Nash, who represents PAs and AAs
“By trying to placate them, at a time when they’re striking – and they want their strikes to bite the hardest by taking us out of the workforce – we’re now putting patients at risk,” said Steve Nash, general secretary of UMAPs.
“I think the biggest patient safety risk, out there right now, is the BMA,” he added.
Health Secretary Wes Streeting, who ordered this review, is expected to implement all the recommendations of the report.
You know bad economic news is looming when a Chancellor of the Exchequer tries to get their retaliation in first.
Treasury guidance on Tuesday afternoon that Rachel Reeves has prioritised easing the cost of living had to be seen in the light of inflation figures, published this morning, and widely expected to rise above 4% for the first time since the aftermath of the energy crisis.
In that context the fact consumer price inflation in September remained level at 3.8% counts as qualified good news for the Treasury, if not consumers.
The figure remains almost double the Bank of England target of 2%, the rate when Labour took office, but economists at the Bank and beyond do expect this month to mark the peak of this inflationary cycle.
That’s largely because the impact of higher energy prices last year will drop out of calculations next month.
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5:27
Inflation sticks at 3.8%
The small surprise to the upside has also improved the chances of an interest rate cut before the end of the year, with markets almost fully pricing expectations of a reduction to 3.75% by December, though rate-setters may hold off at their next meeting early next month.
September’s figure also sets the uplift in benefits from next April so this figure may improve the internal Treasury forecast, but at more than double the rate a year ago it will still add billions to the bill due in the new year.
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10:13
Minister ‘not happy with inflation’
For consumers there was good news and bad, and no comfort at all from the knowledge that they face the highest price increases in Europe.
Fuel prices rose but there was welcome relief from the rate of food inflation, which fell to 4.5% from 5.1% in August, still well above the headline rate and an unavoidable cost increase for every household.
The chancellor will convene a meeting of cabinet ministers on Thursday to discuss ways to ease the cost of living and has signalled that cutting energy bills is a priority.
The easiest lever for her to pull is to cut the VAT rate on gas and electricity from 5% to zero, which would reduce average bills by around £80 but cost £2.5bn.
More fundamental reform of energy prices, which remain the second-highest in Europe for domestic bill payers and the highest for industrial users, may be required to bring down inflation fast and stimulate growth.
Schools need to be “brave enough” to talk about knives, Sky News has been told, as the killer of Sheffield teenager Harvey Willgoose is sentenced today.
His killer, who was also 15 and cannot be identified for legal reasons, had brought a 13cm hunting knife into school.
Image: Harvey Willgoose. Pic: Sophie Willgoose
Following Harvey’s murder, his parents Caroline and Mark Willgoose told Sky News they wanted to see knife arches in “all secondary schools and colleges”.
“It’s 100% a conversation, I think, that we need to be empowered and brave enough to have,” says Katie Crook, associate vice principal of Penistone Grammar School.
The school, which teaches 2,000 pupils, is just a few miles away from where Harvey was killed.
After being contacted by the Willgoose family, it has decided to install a knife arch.
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The arch – essentially a walk-through metal detector – has been described as a “reassuring tool” and “real success” by school leaders.
“We’re really lucky here that we don’t have a knife crime problem – but we are on the forefront with safeguarding initiatives,” says Mrs Crook.
“I didn’t really think we needed one at first,” says Izzy, 14. “But then I guess at Harvey’s school they wouldn’t think that either and then it did actually happen.”
Joe, 15, says he did find the knife arch “intimidating” at first.
“But after using it a couple of times,” he says, “it’s just like walking through a doorway”.
“And it’s that extra layer of, like, you feel secure in school.”
After Harvey’s death, then home secretary Yvette Cooper said that she would support schools in the use of knife arches.
But there remains no official government policy or national guidance on their use.
Some headteachers who spoke with Sky News feel knife arches aren’t the answer – saying the issue required a societal approach.
Others said knife arches themselves were a significant expense to schools.
But Mrs Crook says they are “well worth the funding” if they prevent “a student making a catastrophic decision”.
“I’m a parent and, of course, my focus every day is keeping our students safe, just as I want my son to be kept safe in his setting and his school.”
Mrs Crook says she thinks schools would “welcome” a discussion at “national level” about the use of knife arches and other knife-related deterrents in schools.
“It’s sad, though that this is what it’s come to, that we’re having lockdown drills in the UK, in our school settings.
“But I suppose some might argue that has been needed for a long time.”
If you eat beef, and ever stop to wonder where and how it’s produced, Jonathan Chapman’s farm in the Chiltern Hills west of London is what you might imagine.
A small native herd, eating only the pasture beneath their hooves in a meadow fringed by beech trees, their leaves turning to match the copper coats of the Ruby Red Devons, selected for slaughter only after fattening naturally during a contented if short existence.
But this bucolic scene belies the turmoil in the beef market, where herds are shrinking, costs are rising, and even the promise of the highest prices in years, driven by the steepest price increase of any foodstuff, is not enough to tempt many farmers to invest.
For centuries, a symbolic staple of the British lunch table, beef now tells us a story about spiralling inflation and structural decline in agriculture.
Mr Chapman has been raising beef for just over a decade. A former champion eventing rider with a livery yard near Chalfont St Giles, the main challenge when he shifted his attention from horses to cows was that prices were too low.
“Ten years ago, the deadweight carcass price for beef was £3.60 a kilo. We might clear £60 a head of cattle,” he says. “The only way we could make the sums add up was to process and sell the meat ourselves.”
Processing a carcass doubles the revenue, from around £2,000 at today’s prices to £4,000. That insight saw his farm sprout a butchery and farm shop under the Native Beef brand. Today, they process two animals a week and sell or store every cut on site, from fillet to dripping.
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Today, farmgate prices are nearly double what they were in 2015 at £6.50 a kilo, down slightly from the April peak of almost £7, but still up around 25% in a year.
For consumers that has made paying more than £5 for a pack of mince the norm. For farmers, rising prices reflect rising costs, long-term trends, and structural changes to the subsidy regime since Brexit.
“Supply and demand is the short answer,” says Mr Chapman.
“Cow numbers have been falling roughly 3% a year for the last decade, probably in this country. Since Brexit, there is virtually no direct support for food in this country. Well over 50% of the beef supply would have come from the dairy herd, but that’s been reducing because farmers just couldn’t make money.”
Political, environmental and economic forces
Beef farmers also face the same costs of trading as every other business. The rise in employers’ national insurance and the minimum wage have increased labour costs, and energy prices remain above the long-term average.
Then there is the weather, the inescapable variable in agriculture that this year delivered a historically dry summer, leaving pastures dormant, reducing hay and silage yields and forcing up feed costs.
Native Beef is not immune to these forces. Mr Chapman has reduced his suckler herd from 110 to 90, culling older cows to reduce costs this winter. If repeated nationally, the full impact of that reduction will only be fully clear in three years’ time, when fewer calves will reach maturity for sale, potentially keeping prices high.
That lag demonstrates one of the challenges in bringing prices down.
Basic economics says high prices ought to provide an opportunity and prompt increased supply, but there is no quick fix. Calves take nine months to gestate and another 20 to 24 months to reach maturity, and without certainty about price, there is greater risk.
There is another long-term issue weighing on farmers of all kinds: inheritance tax. The ending of the exemption for agriculture, announced in the last budget and due to be imposed from next April, has undermined confidence.
Neil Shand of the National Beef Association cites farmers who are spending what available capital they have on expensive life insurance to protect their estates, rather than expanding their herds.
“The farmgate price is such that we should be in an environment that we should be in a great place to expand, there is a market there that wants the product,” he says. “But the inheritance tax challenge has made everyone terrified to invest in something that will be more heavily taxed in the future.”
While some of the issues are domestic, the UK is not alone.
Beef prices are rising in the US and Europe too, but that is small consolation to the consumer, and none at all to the cow.