The data on physician associates in the UK, and speaking up in the NHS
Mar 12, 2025
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Trish Greenhalgh, a leading expert in primary care from Oxford, shares insights from her review on the effectiveness of physician associates in the NHS. Habib Naqvi highlights the ongoing impact of racism in healthcare and the vital need for reform to support ethnic minority patients and professionals. Katie Bramall-Stainer discusses the critical barriers that prevent NHS staff from speaking up, including hierarchical culture and psychological safety issues. Together, they explore solutions to enhance communication and equity in healthcare, making it safer for all.
The recent review on physician associates in the UK highlighted a critical lack of empirical research on their safety and efficacy in practice.
Addressing systemic racism in healthcare through the NHS Race and Health Observatory is vital for improving health outcomes for all communities.
Deep dives
Research on Physician Associates
A recent rapid systematic review on physician associates and anaesthetic associates in the UK revealed substantial gaps in the existing literature. Most identified papers were not empirical research but rather opinions and editorials, with a significant portion of research conducted outside the UK. The review found a lack of studies assessing the performance and safety of these associates in real-world settings, particularly concerning safety incidents and potential harm. This absence of rigorous research raises concerns about the efficacy and safety of physician associates, especially since they undertake roles traditionally filled by more highly trained medical professionals.
Challenges of Racism in Healthcare
The NHS Race and Health Observatory focuses on addressing systemic racism within health care and its detrimental effects on patient outcomes. It emphasizes that racism influences social determinants such as education, housing, and employment, which in turn affects health and well-being. The observatory aims not only to identify these inequalities but to provide actionable solutions to mitigate them, making it clear that improving health outcomes for marginalized communities benefits the entire population. The call to prioritize racial equity in healthcare underscores the belief that resolutions will enhance care for all patients, not just minority groups.
Barriers to Speaking Up in the NHS
NHS staff experience significant barriers when it comes to voicing concerns about patient care, often due to a culture of fear and hierarchy. A survey indicated that a majority do not feel safe to speak up, leading to feelings of moral injury as they are unable to deliver the quality of care expected. The findings suggest that leadership and organizational responses to concerns are inadequate, contributing to a culture where staff feel their input is neither valued nor acted upon. This environment ultimately impacts patient safety and organizational effectiveness, emphasizing the need for systemic change in how concerns are managed.
Importance of Psychological Safety
Creating a psychologically safe environment is crucial for NHS staff to feel empowered to speak up about their concerns. Leaders must foster a culture where authenticity and integrity are prioritized, allowing employees to express their uncertainties and challenges without fear of retribution. Discussions revealed that many leaders struggle to engage in open dialogues about issues, often focusing solely on results rather than the experiences of their teams. By addressing the need for supportive frameworks that promote collaboration and communication, the NHS can enhance staff well-being and, in turn, improve patient outcomes.
We've just published a new rapid review on the safety and efficacy of physician and anaesthetic associates in the UK, which was commissioned to support the ongoing Leng review of these new roles in the NHS. Trish Greenhalgh, professor of primary care at the University of Oxford, joins us to discuss the data she found.
Habib Naqvi is director of the NHS Race and Health Observatory, and is holding up a mirror to the NHS on it's support for ethnic minority patients and doctors - he joins us to talk about the work they've done, and why Reform UK's manifesto pledge to disband the Observatory is a matter of pride.
Finally, our annual trip to the Nuffield Summit is not complete without a roundtable, this year we asked the question "What is stopping staff from speaking up?". Our panellists raised the usual issues of hierarchy and psychological safety, but also how the lack of positive change from senior leadership has habituated people into thinking "why bother".
Our panel;
Katie Bramall-Stainer, chair of the General Practice Committee of the BMA
Jugdeep Dhesi, consultant in geriatric medicine at Guys and St Thomas Hopsital
Henrietta Hughes, the UK's patient safety commissioner
Thea Stein, chief executive of the Nuffield Trust