Oral Answers to Questions

Debate between Will Quince and Baroness Keeley

Tuesday 11th July 2023 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I have received a wave of concern from clinicians on the safety of using physician associates, following my Adjournment debate last week in which I raised the death of Emily Chesterton, the 30-year-old daughter of my constituents Marion and Brendan. Emily died of a pulmonary embolism after being seen twice by the same physician associate at her GP practice. The physician associate failed to refer her to a doctor or to a hospital emergency unit for tests, which the coroner concluded could have prevented her death.

Yesterday, on “Good Morning Britain”, the Secretary of State boasted of increasing the number of people working in primary care, presumably including the workforce plan proposal to triple the use of physician associates. Will he look urgently at the details of Emily Chesterton’s case and ask himself whether lessons can be learned to avoid other preventable deaths?

[Will Quince]

Having responded to the hon. Lady’s Adjournment debate last Thursday, I hear the calls she has made. I know that she has also written to the Secretary of State, and I will ensure that she gets a full response, with answers to all the questions she raises.

Physician Associates

Debate between Will Quince and Baroness Keeley

Thursday 6th July 2023 Commons Chamber

[Barbara Keeley]

I take what the Minister has said about the training and voluntary registration aspects, which I did speak to, but could he comment on the situation we seem to have been in? The GP practice had concerns about the physician associate’s knowledge and understanding of what investigations she should perform, her ability to recognise an unwell patient, and her overconfidence and lack of insight into the limitations of her own knowledge. Those are the issues that the GP practice itself reported. Does the Minister share my concern that it is a very serious thing to have had a system like that, and, surrounding that, to have the fact that the reception function in that practice did not realise that it should not refer an unwell patient to a physician associate twice within a short period of time? If these are meant to be safety measures, they are not working, are they?

[Will Quince]

I hear what the hon. Lady says. In response to her questions, we very much need to look into the exact details, and I hope I will be able to respond to her with full answers when I have received both the coroner’s report and further information from NHS England regarding the practice itself. On the face of what she has just said, the situation is concerning and it certainly adds weight to her calls for the register to be non-voluntary and for regulation and legislation in this space. I will come on to that issue in a moment, because it is a case well made.

The physician associate role is in no way a replacement for any other member of the general practice team—that is an important point to make. They work in conjunction with the existing team, and are complementary to it. Physician associates can help broaden the capacity and skill mix within the practice team to help address the needs of patients in response to the growing and ageing population faced by constituencies up and down the country, including the hon. Lady’s constituency and, indeed, mine. However, let me be clear: the employment of a physician associate does not in any way mitigate the need to address the shortage of GPs, nor does it reduce the need for other practice staff.

I will talk, not about the specific case that the hon. Lady described—I do not have those details—but about the generalities of the responsibilities of a supervising doctor, which may be relevant in this case. Physician associates are dependent practitioners: they are working with a dedicated consultant or GP supervisor. They are able to work autonomously but, vitally, with appropriate support, and the General Medical Council has published guidance for doctors who supervise physician associates. The supervision of a qualified physician associate is similar to that of a doctor in training or a trust-grade doctor, in that the physician associate is responsible for their actions and decisions. However, the medical consultant or GP supervisor ultimately retains responsibility for the patient.

The hon. Lady has called for regulation. As she alluded to, the General Medical Council is well advanced in developing regulatory processes for physician associates once the necessary legislation is in place, and regulation will give the GMC responsibility for, and oversight of, physician associates and anaesthesia associates in addition to doctors. That will enable a more coherent and co-ordinated approach to regulation and make it easier for employers, patients, and of course the public to understand the relationship between the roles. The hon. Lady asked specifically when that legislation will come forward. We intend to lay legislation before the House at the end of this year, which will allow the GMC to commence the regulation of physician associates by the end of 2024—legislation by the end of this year, and then a year for it to be put in place.

The General Medical Council has published future professional standards for physician associates. Among other things, that includes working within the bounds of professional competence and knowing when to refer, or indeed to escalate, to a colleague within the practice. Those standards also cover communication with patients, including the importance of physician associates explaining what they do and how their role fits in with other members of the medical team. Once regulation commences, the GMC will be able to investigate concerns raised about physician associates, and in serious cases will be able to prevent a physician associate from practising, either on a temporary or a permanent basis.

[Barbara Keeley]

I want to go back to the point I made to the Minister about the title of physician associate, which I have used a lot and so has he. The point is that it does sound rather grandiose as the name of a role in clinical practice for a person who has trained for only two years, and it is confusing. I have been steeped in health and social care matters in this place—I have been a member of the Health Committee and had Front-Bench responsibility for it—and I had never heard of physician associates, so it does seem confusing. The title itself is confusing.

[Will Quince]

I thank the hon. Lady for her intervention, and I gave careful thought to the point she raised in her speech. Although the terms she used were doctors in training or trainee doctors, physician associates are not doctors in training and they are not doctors. They are very different, but they are a part of a multidisciplinary team. I will take away what she says. She is right that they have been in place for well in excess of 10 years, but nevertheless there is still a relatively small number of them. However, there are plans to significantly grow their number, so I will take that away.

Personally, as part of my own experience of the NHS, I have never seen a physician associate, but when I have been in general practice, I have often seen a paramedic, a physiotherapist or a pharmacist and they have made their position very clear at the outset of the appointment. I think we need to ensure that, regardless of the title— I will take that away and look in some detail at whether it needs to be changed—they are properly introducing themselves and their role, making it very clear to patients that they are not a doctor but are working under the close supervision of one, and making it very clear that they are not able to prescribe but a doctor can. I think that is the most important point, but the hon. Lady raises a very good point about the title and I will consider that very carefully.

[Barbara Keeley]

I think this is actually related to the confidence one has or does not have. The Minister says he takes advice from pharmacists, as do most of us, but we tend to know in that circumstance that it is a pharmacist we are talking to. There are receptionists, physios and all these types of people working in GP practices, but this was a person who to all intents and purposes looked like a doctor. That knowledge of the short period of their training, and of what they can actually do and not do, really ought to be more visible.

[Will Quince]

I hear what the hon. Lady says, and I will certainly take that away and give it considerable thought. If she has any particular ideas in this regard, given her experience on this matter, I would of course be very happy to meet her to discuss this further. It is really important, certainly ahead of legislation, that we get this right.

Before I close, I would again like to reiterate my deepest condolences to the family of Emily, and I thank the hon. Lady once again for bringing this debate to the House. As we develop and progress with changes to the NHS workforce, it is absolutely vital that robust governance and supervision sit at the heart of the multidisciplinary model, because at the heart of everything we do must be patient safety.

Question put and agreed to.

NHS Strikes

Debate between Will Quince and Baroness Keeley

Monday 6th February 2023 Commons Chamber

[Will Quince]

The right hon. Gentleman says that many who work in the NHS are worried about patients: I spend every single day worrying about patients; I spend every single day ensuring the NHS has the resources it needs to provide the level of care and service our constituents rightly expect. I have a budget, and that budget has already taken into consideration a 4.75% on average pay award, with more than 9% for some of the lowest earners. There is an independent pay review body process for a reason; it is only two months away, in April, and I encourage the unions to take part in it. Of course I meet with unions, and of course I do and will meet with nurses and those who work in our NHS. I believe some of the points the right hon. Gentleman makes are correct, and I know those who work in the NHS genuinely want to ensure we are attracting and retaining the very best; that is all the more reason for us to get it right, and the way to get it right is the independent pay review body process.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

There were no strikes in the NHS over 13 years of the last Labour Government, and the cavalry is coming to rescue our health service with the next Labour Government. The Minister just asked where the funding is coming from to pay for NHS staff: we will train a new generation of NHS staff paid for by abolishing non-dom tax status so that the NHS has the workforce it desperately needs. Why will the Government not do as the Chancellor has suggested and adopt this policy now?

[Will Quince]

The hon. Lady says the cavalry is coming; how many more unfunded pledges—[Interruption.] Labour Members say they are fully funded: absolute tosh. I have heard the Opposition spend that non-dom money more times—

Edenfield Centre: Treatment of Patients

Debate between Will Quince and Baroness Keeley

Thursday 13th October 2022 Commons Chamber

[Will Quince]

The Government are absolutely committed to ensuring that all patients receive safe and high-quality care in all settings. As the hon. Lady pointed out, we are investing more than ever before in NHS mental health services through the NHS long-term plan, which will see an additional £2.3 billion in funding per year by 2023-24.

The hon. Lady asked what work is underway. There is work under way at a national level to improve the way we safeguard patients and ensure they receive high-quality care through a new mental health safety improvement programme, which has set up new mental health patient safety networks across all regions in England. We are reviewing everyone with a learning disability and all autistic people in long-term segregation in a mental health in-patient hospital. The Care Quality Commission is introducing a new approach to inspections from next year, which will be more data driven and targeted, and we have commenced the Mental Health Units (Use of Force) Act 2018.

I can absolutely assure all hon. Members that this Government will continue to work with our partners across the NHS, social care and other sectors to consider what more action is needed to tackle toxic and closed cultures, looking at the available evidence base and, most importantly, hearing from the people affected and their families.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

NHS guidance has been clear for many years that abuse of this kind, including punitive seclusion and overuse of restraint, should never be allowed, yet it has persisted, as other hon. Members have said, including at Winterbourne View, Whorlton Hall, Cygnet Yew Trees, Cawston Park and now the Edenfield Centre. There will be other places, too, that have not had media attention, but where families of patients are seeing abuse and have no mechanisms to change things.

Harley is a young autistic woman who was detained at the Edenfield Centre and experienced punitive seclusion for weeks at a time. She said in the programme:

“Staff provoke a patient and then my reaction is used against me. But they’re provoking us. It’s disgusting. I’ve been treated like I’m an animal.”

There are over 2,000 autistic people and people with learning disabilities locked in inappropriate in-patient units in this country, often for 10 years or more. The policy of the use of inappropriate in-patient units for autistic people and people with learning disabilities is a choice. They could have support in the community with skilled and experienced staff. Will the Minister promise to end the culture of abuse for Harley and so many people like her?

[Will Quince]

The hon. Lady is right. I believe what I saw to be disgusting too. She specifically referenced those with learning disabilities and autistic people in long-term segregation. NHS England is undertaking independently chaired care education and treatment reviews for everyone with a learning disability and all autistic people in long-term segregation in mental health in-patient hospitals. A senior intervenor pilot is also underway. These actions will help support people in long-term segregation to move to a less restrictive setting or to leave hospital. A programme of safety and wellbeing reviews for the care and safety of people with learning disabilities and autistic people is now complete, and NHS England will be publishing the findings of a national thematic review later this year.