I was recently sent some medico-legal instructions relating to the role of physician associates in primary care. It’s an area that’s becoming increasingly relevant as healthcare systems evolve and roles expand.
Earlier in my career, my team published work (link: https://pubmed.ncbi.nlm.nih.gov/32010218/) on nurse-led diagnostic clinics in prostate cancer, demonstrating that with the right structure and training, outcomes can match those of junior doctors. We demonstrated both high patient satisfaction and cost savings. There are many areas in medicine where this model works well. We demonstrated both high patient satisfaction and cost savings. There are many areas in medicine where this model works well.
That said, it only works when there is proper structure, supervision, and clarity.
I have come across a small number of cases where, unfortunately, the system has not worked as intended.
In one case, a young man with a testicular tumour was seen several times and reassured, but was not correctly diagnosed. He was reviewed by more than one practitioner before eventually being seen by a doctor. By that point, what should have been a straightforward operation became far more complex. He required major chemotherapy and additional treatment, although thankfully he now appears to be cured.
In another case, a patient with a kidney stone and associated infection was not referred to hospital when he should have been. The delay, combined with communication difficulties, led to a severe infection and eventual removal of the kidney. This is something that would normally be managed with far less invasive treatment if addressed promptly.
What struck me in both situations was how certain the patients were that they had been seen by a doctor. In the first case, the reassurance given was strong enough that the patient ignored ongoing symptoms for some time.
Physician associates and nurse practitioners clearly have a role to play in modern healthcare. This is true not just in the UK, but internationally. When used appropriately, they can improve access to care and support overstretched systems.
However, patients should always be aware of who is treating them. This is not about undermining confidence in non-doctor roles, but about ensuring transparency.
In situations where there is a risk of serious or complex diagnosis, there must be clear pathways for supervision, escalation, and review by senior doctors.
Patients deserve clarity, not assumptions.
True patient-focused care means that individuals understand who they are seeing, what level of training that person has, and when a case may need escalation.
Consent is not just about agreeing to treatment. It is about understanding the context of that care. When roles are clearly explained and systems are well structured, patients can feel confident in the care they receive.
But without that clarity, even well-intentioned systems can lead to misunderstanding, delay, and in some cases, harm.