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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.

Marion + Brendan Chesterton whose daughter Emily died in November 2022 after suffering a pulmonary embolism
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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.

Emily Chesterton. Pic: Family handout
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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.”

Marion + Brendan Chesterton whose daughter Emily died in November 2022 after suffering a pulmonary embolism, missed by a physician associate

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”.

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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.

Marion Chesterton whose daughter Emily died in November 2022 after suffering a pulmonary embolism which was missed by a physician associate
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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).

British Medical Association (BMA) deputy chair Dr Emma Runswick
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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.

Steve Nash, general secretary of UMAPs trade union
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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.

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Police officer punched in face as masked protesters with children march through Canary Wharf shopping centre

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Police officer punched in face as masked protesters with children march through Canary Wharf shopping centre

A group of masked protesters became “aggressive” towards police at Canary Wharf shopping centre after an anti-asylum demonstration, police say.

A group of people entered the shopping centre around 4.30pm and a “small number of masked protesters” then became aggressive towards members of the public and police, the Metropolitan Police said in a statement.

Police issued an order to “prevent people concealing their identity with masks” and a dispersal order was also put in place.

Video seen on social media showed young children among the protesters, with some of them wearing England flags.

Officers said: “We are aware there are young children in the protest area and while we deal with any criminality our officers are ensuring the safety of them is paramount.”

Police said four people were arrested on Sunday afternoon during the protests, including for common assault by a protester on a member of the public, possession of class A and B drugs, assault on police/public order offences and failure to disperse.

“One of our officers was punched in the face – luckily they did not suffer significant injury,” a spokesperson said.

Commander Adam Slonecki, in charge of policing London this weekend, said: “We had plenty of officers on the ground who moved in swiftly to deal with the criminality that occurred inside and outside the shopping centre. We will not tolerate this kind of behaviour.

“Today’s protest saw many community members attend, including women and children, and we worked to ensure the safety of those there to peacefully represent their views. Those who arrive at protests masked and intent on causing trouble will continue to be dealt with robustly at future protests.”

People protest outside the Britannia International Hotel in Canary Wharf. Pic: PA
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People protest outside the Britannia International Hotel in Canary Wharf. Pic: PA

Counter-protesters also assembled outside the Britannia International Hotel. Pic: PA
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Counter-protesters also assembled outside the Britannia International Hotel. Pic: PA

Read more:
PM promises small boat migrants will be ‘detained and sent back’
Reform deputy leader disagrees with archbishop

Protesters from both sides of the divide over the UK’s immigration policies gathered outside the Britannia Hotel in Canary Wharf on Sunday afternoon.

Around a dozen anti-immigration protesters were joined by about 100 counter-protesters holding banners saying “stand up to racism” and “stop the far right” on the other side of the road.

Demonstrators then left the hotel location – kept apart by police.

Sunday’s events in east London follow an incident in West Drayton, west London, on Saturday when a group of masked men were among those who attempted to enter a hotel housing asylum seekers.

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Reform deputy attacks govt for ‘protecting rights’ of illegal migrants – and fires back at Archbishop of York

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Reform deputy attacks govt for 'protecting rights' of illegal migrants - and fires back at Archbishop of York

Reform UK has hit back at both the Archbishop of York and the government following criticism of its immigration policies.

Leader Nigel Farage announced the party’s flagship immigration plan during a flashy news conference held at an aircraft hangar in Oxford on Tuesday.

The party pledged to deport anybody who comes to the UK illegally, regardless of whether they might come to harm, and said it would pay countries with questionable human rights records – such as Afghanistan – to take people back.

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It also said it would leave numerous international agreements, and revoke the Human Rights Act, in order to do this.

The policy was criticised by the Conservatives, who said Mr Farage was “copying our homework”, while parties such as the Liberal Democrats and the Greens condemned it.

More on Migrant Crossings

Archbishop Stephen Cottrell and Richard Tice MP. Pics: PA
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Archbishop Stephen Cottrell and Richard Tice MP. Pics: PA

But the plan came under fire from an altogether different angle on Saturday, when the Archbishop of York accused it of being an “isolationist, short-term kneejerk” approach, with no “long-term solutions”.

Stephen Cottrell, who is the acting head of the Church of England, told Sunday Morning With Trevor Phillips that he had “every sympathy” with those who find the issue of immigration tricky. But he said Reform UK’s plan does “nothing to address the issue of what brings people to this country”, and would in fact, make “the problem worse”.

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In full: Richard Tice on Sunday Morning With Trevor Phillips

Speaking on the same programme, Richard Tice, Reform’s deputy leader, responded to the archbishop’s criticisms, saying that “all of it is wrong”.

The MP for Boston and Skegness said he was a Christian who “enjoys” the church – but that the “role of the archbishop is not actually to interfere with international migration policies”.

Mr Tice then turned his fire on the government, accusing ministers of being “more interested in protecting the rights of people who’ve come here illegally… than looking after the rights of British citizens”.

He accused ministers of having “abandoned” their duty of “looking after the interests of British citizens”.

Mr Tice reaffirmed his party’s policy that the UK should leave the European Convention on Human Rights (ECHR), calling it a “70-year-old, out-of-date, unfit-for-purpose agreement”.

The Reform UK deputy leader also:

• Defended plans to pay the Taliban to take migrants back, comparing it to doing business deals with “people you don’t like”

• Said the Royal Navy should be deployed in the English Channel as a “deterrent”, but added: “We’re not saying sink the boats”

• Urged the government to call an early general election

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Farage ‘wants to provoke anger’

Meanwhile, Bridget Phillipson, the education secretary, told Sky News that Reform “want to provoke anger, but they don’t actually want to solve the problems that we face in front of us”.

She told Sunday Morning With Trevor Phillips the UK had a “proud tradition [of] supporting those facing persecution”.

But she added: “We will make sure that people who have no right to be in this country are removed from this country. That’s right. It’s what people expect. It’s what this government will deliver.”

Ms Phillipson also insisted there “needs to be reform of the ECHR” and said the home secretary is “looking at the article eight provisions”, which cover the right to a private and family life, to see “whether they need updating and reforming for the modern age”.

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However, she refused to say what the government would do if it is found that the ECHR is unreformable. Instead, she defended Labour’s position of staying in the governance of the convention, saying that honouring the “rule of law” is important.

She added: “Our standing in the world matters if we want to strike trade deals with countries. We need to be a country that’s taken seriously. We need to be a country that honours our obligations and honours the rule of law.”

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Sunday Morning With Trevor Phillips

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Asylum seekers to remain at Bell Hotel

Ms Phillipson was also drawn on the recent court ruling in favour of the Home Office, which overturned an injunction banning The Bell Hotel in Epping from housing asylum seekers.

Challenged on whether the government is prioritising the rights of asylum seekers over British citizens, she said it “is about a balance of rights”.

The cabinet minister also repeated the government’s plans to end the use of hotels to house asylum seekers by 2029.

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‘We should have overruled law’

Shadow Cabinet Office minister Alex Burghart said the Conservatives would be willing to leave the ECHR – if this route is recommended to them.

The Tories have asked a senior judge to look into the “legal intricacies” of leaving the convention, which he said is “not straightforward”. He said when the party receives that report, it will then make a decision.

Challenged on whether the Tories will leave if that is what the report recommends, he added: “If that’s what’s necessary, we will do it.”

Mr Burghart also said he believed the previous Conservative government’s biggest mistake was that “we did not go far enough on overruling human rights legislation”, which prevented it from “taking the tough action that was absolutely necessary”.

But he added the Conservatives have now “put forward very clear legislation that would solve this problem” – though he concluded Labour “isn’t going to do it” so the problem “is going to get worse”.

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Archbishop of York Stephen Cottrell tells Nigel Farage ‘kneejerk’ migrant deportation plan won’t solve problem

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Archbishop of York Stephen Cottrell tells Nigel Farage 'kneejerk' migrant deportation plan won't solve problem

The Archbishop of York has told Sky News the UK should resist Reform’s “kneejerk” plan for the mass deportation of migrants, telling Nigel Farage he is not offering any “long-term solution”.

Stephen Cottrell said in an interview with Trevor Phillips he has “every sympathy” with people who are concerned about asylum seekers coming to the country illegally.

But he criticised the plan announced by Reform on Tuesday to deport 600,000 people, which would be enabled by striking deals with the Taliban and Iran, saying it will not “solve the problem”.

Mr Cottrell is currently acting head of the Church of England while a new Archbishop of Canterbury is chosen.

Pic: Jacob King/PA Wire
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Pic: Jacob King/PA Wire

The Archbishop of York, Stephen Cottrell in 2020.
File pic: PA
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The Archbishop of York, Stephen Cottrell in 2020.
File pic: PA

Phillips asked him: “What’s your response to the people who are saying the policy should be ‘you land here, unlawfully, you get locked up and you get deported straight away. No ifs, no buts’?”

Mr Cottrell said he would tell them “you haven’t solved the problem”, adding: “You’ve just put it somewhere else and you’ve done nothing to address the issue of what brings people to this country.

More on Migrant Crisis

“And so if you think that’s the answer, you will discover in due course that all you have done is made the problem worse.

“Don’t misunderstand me, I have every sympathy with those who find this difficult, every sympathy – as I do with those living in poverty.

“But… we should actively resist the kind of isolationist, short term kneejerk ‘send them home’.”

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What do public make of Reform’s plans?

Nigel Farage at the launch of Reform UK's plan to deport asylum seekers. Pic: PA
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Nigel Farage at the launch of Reform UK’s plan to deport asylum seekers. Pic: PA

Asked if that was his message to the Reform leader, he said: “Well, it is. I mean, Mr Farage is saying the things he’s saying, but he is not offering any long-term solution to the big issues which are convulsing our world, which lead to this. And, I see no other way.”

You can watch the full interview on Sunday Morning with Trevor Phillips on Sky News from 8.30am

Mr Farage, the MP for Clacton, was asked at a news conference this week what he would say if Christian leaders opposed his plan.

“Whoever the Christian leaders are at any given point in time, I think over the last decades, quite a few of them have been rather out of touch, perhaps with their own flock,” he said.

“We believe that what we’re offering is right and proper, and we believe for a political party that was founded around the slogan of family, community, country that we are doing right by all of those things, with these plans we put forward today.”

Sky News has approached Mr Farage for comment.

Farage won’t be greeting this as good news of the gospel – nor will govt ministers

When Tony Blair’s spin doctor Alastair Campbell told journalists that “We don’t do God”, many took it as a statement of ideology.

In fact it was the caution of a canny operator who knows that the most dangerous opponent in politics is a religious leader licensed to challenge your very morality.

Stephen Cottrell, the Archbishop of York, currently the effective head of the worldwide Anglican communion, could not have been clearer in his denunciation of what he calls the Reform party’s “isolationist, short term, kneejerk ‘send them home'” approach to asylum and immigration.

I sense that having ruled himself out of the race for next Archbishop of Canterbury, Reverend Cottrell feels free to preach a liberal doctrine.

Unusually, in our interview he pinpoints a political leader as, in effect, failing to demonstrate Christian charity.

Nigel Farage, who describes himself as a practising Christian, won’t be greeting this as the good news of the gospel.

But government ministers will also be feeling nervous.

Battered for allowing record numbers of cross- Channel migrants, and facing legal battles on asylum hotels that may go all the way to the Supreme Court, Labour has tried to head off the Reform challenge with tougher language on border control.

The last thing the prime minister needs right now is to make an enemy of the Almighty – or at least of his representatives on Earth.

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