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Physician associates ‘illegally’ prescribe opiates to hospital patients

a female nurse and a male doctor standing in a hospital corridor
a female nurse and a male doctor standing in a hospital corridor - SDI Productions/E+

Physician associates have “illegally” prescribed drugs to patients at NHS hospitals, The Telegraph can reveal.

The support staff at Calderdale and Huddersfield NHS Trust prescribed medications including opiates and sedatives to patients on 22 occasions, according to a Freedom of Information (FoI) request.

Physician associates (PAs) are healthcare workers meant to assist doctors by carrying out basic clinical tasks. They are only trained for two years and have no legal right to prescribe drugs.

The trust says the prescriptions were the result of an IT blunder that gave PAs access to the electronic prescribing system for seven months.

The role of PAs in the NHS is increasingly contentious, with critics arguing their two-year postgraduate course provides insufficient training and could put patients at risk.

On Wednesday night, the hospital trust would not confirm whether any PAs who prescribed these medications without legal authorisation had lost their jobs as a result.

In nearly all circumstances, it is a serious criminal offence for anyone other than a doctor, dentist, pharmacist or vet to supply controlled drugs under the Misuse of Drugs Act 1971. The Telegraph understands that the trust has not referred any of the PAs involved in this incident to West Yorkshire Police.

Conservative peer Baroness Foster said the “practice of PAs illegally prescribing” uncovered by The Telegraph added to concerns already raised about the risk that PAs pose to patient safety.

The Telegraph has previously published allegations from doctors at 24 trusts who alleged that PAs had illegally prescribed drugs and ordered scans with ionising radiation. But this is the first time an NHS hospital group has admitted to inadvertently giving associates the ability to prescribe.

Between July 2023 and January this year, PAs at the trust – which runs two hospitals – prescribed controlled medications to patients including the opiate painkillers oxycodone and codeine.

They also prescribed the sedatives lorazepam, diazepam and midazolam, the latter of which is often used in end-of-life care. The medications are classed as “controlled” by the Government because of their risk of harm and addiction.

The data was released in response to an FoI request from a member of the public.

Calderdale and Huddersfield said that “a hard control has now been implemented to prevent any further PA prescribing incidents” and insisted that no patients had been harmed. But the disclosure has fuelled concerns among critics of the amount of power being handed to PAs.

Peers to debate PA regulation

On Monday, peers will debate a motion that could derail government plans to bring PAs under the General Medical Council (GMC). Allowing them to be regulated by the GMC could lead to PAs later being given the authority to prescribe drugs.

Solicitor Sean Caulfield at Hodge Jones & Allen explained that: “If a physician associate has innocently carried out acts of supplying controlled drugs, which they were not authorised to do, it might not be in the public interest to prosecute them.

“However, if anyone, physician associate or otherwise, intended to supply or did supply controlled drugs, knowing it would be illegal, that would be different. In those circumstances, the Crown Prosecution Service may think it is in the public interest to prosecute.”

Calderdale and Huddersfield stressed that their PAs, who work in medicine, surgery and accident and emergency, “are instructed that they are not legally able to prescribe”.

The regulation of controlled substances in healthcare was greatly strengthened after an inquiry found that serial killer Harold Shipman used strong painkillers to murder at least 215 people without detection.

This is however not the first time the trust has been criticised over its management of controlled drugs. In 2018, the Care Quality Commission watchdog gave its two hospitals – Calderdale Hospital and Huddersfield Royal Infirmary – a safety rating of “requires improvement” in part because, “medicines, including controlled drugs, were not managed effectively in critical care and the urgent and emergency services”.

‘Go back to the drawing board’

At the debate next Monday, Green Party peer Baroness Bennett will be “begging the Government to go back to the drawing board to find a different way forward that has the support of medical professionals, communities and patients”.

The British Medical Association wants the draft legislation to be amended so that the Health and Care Professions Council have oversight of PAs instead of the GMC, claiming licensing doctors and non-doctors together “increases the risk of patients mistakenly believing PA care equals doctor expertise”.

Baroness Brinton, the former Lib Dem health spokesman, who also opposes GMC regulation of PAs, said the “very worrying” incident raised serious governance questions: “There are very senior clinical managers in the hospital trust who should have been all over this.”

A Trust spokesman said they “fully understand the prescribing rights for different parts of our workforce” and they “investigate [any issues] and take immediate action under the appropriate policies and procedures”.

The Department for Health and Social Care said GMC regulation of associates had “cross-party support and will boost patient safety” and that the council “will operate strict fitness-to-practice procedures and set education and training standards.”

They added that the role of PAs is “to support doctors, not replace them” and that the staff “carry out clinical duties such as taking medical histories, carrying out physical examinations, and developing and delivering treatment and management plans.”

West Yorkshire Police said, if made aware of concerns, they would work with trusts “to understand if criminal offences have been committed” and all reports are “assessed according to threat, risk and harm”.