Medicine and Science from The BMJ

The data on physician associates in the UK, and speaking up in the NHS

Mar 12, 2025

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.

47:02

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Episode guests

Katie Bramall-Stainer

Habib Naqvi

Trish Greenhalgh

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Quick takeaways

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.

Intro

2min

Evaluating Physician Associates in UK Healthcare

10min

Racism's Impact on Healthcare

3min

Inclusive Health Interventions: Benefits for All Communities

2min

Diversity in Healthcare: Bridging Health Disparities

4min

Healthcare Inequities and the Fear to Speak Up

7min

Voices of Safety: Establishing Open Dialogue in Healthcare

19min

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

Reading list

Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research

Together we can challenge the racism that persists in healthcare