Doctor says children 'deserve better' after Alder Hey revelation

Concerns have been raised after Alder Hey Children's Hospital confirmed that a staff member employed in the role of physician associate was involved in child sexual abuse medicals over a period of four years.

The Liverpool children's hospital was responding to a Freedom of Information request when it said that between May 2019 and October 2023, a physician associate jointly undertook child sexual abuse medicals with a forensic medical examiner (FME).

Physician associates are healthcare professionals who work under the supervision of a doctor to provide care. While they have some medical training, they cannot prescribe medicine. People can qualify for the position after a part-funded two-year master's degree.

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There is controversy about the growing use of physician associates within the National Health Service. There around 4,000 working in the health service at present, with plans to increase this number to 10,000. Both the Royal College of GPs and the British Medical Association (BMA), have called for a halt of the recruitment of physician associates while rising concerns are addressed.

Earlier this year the BMA said it would be taking legal action against the General Medical Council (GMC) over what it labelled the 'blurring of lines' for patients between doctors and assistant roles.

In the recent Freedom of Information request, Alder Hey was asked about the use of physician associates within Alder Hey's Rainbow Centre, which is a paediatric sexual assault referral centre (SARC) for all children under the age of 16 from across Merseyside who have experienced sexual abuse.

When asked if physician associates conduct paediatric forensic examinations - either alone or with another clinician - at Alder Hey, the trust initially answered no. However, following an internal review of the response and evidence from other public documents, a new response explained that one physician associate jointly undertook child sexual abuse medicals with a forensic medical examiner between May 2019 and October 2023.

The Trust added that the SARC at Alder Hey operates a two clinician model whereby a forensic medical examiner will carry out examinations, but where another clinician will support and review the child/young person holistically for any health needs. The trust added: "From May 2019 until October 2023, one physician associate was available alongside their doctor colleagues to support the FME as part of this model however will not have undertaken the forensic examination. Since October 2023, the physician associate is not part of this model of provision."

Alder Hey has since clarified to the ECHO that physician associates previously worked within its safeguarding and statutory services but that this ended in March 2024. The hospital said that the role previously involved supporting the team in performing basic examinations and management plans and was closely supervised by a clinical consultant.

The ECHO has seen a written post from a physician associate working at Alder Hey which was posted on the Cheshire and Merseyside Health and Care Partnership website in January 2022.

In the post, the staff member describes her work, stating: "I see any child protection referral that comes in on this day and I can see up to five cases in a day. These range from cases of neglect and physical assault to child sexual assault; assisting with STI testing and forensic swabs to abusive head trauma. I perform a top to toe medical as well as systems examination, take detailed histories. I interpret the findings from examination and formulate an opinion on the injuries to make recommendations with social care, as part of the medical team, including support from the safeguarding on call consultant."

Dr Matt Kneale, former chair of the Doctor's Association added: "This is flagrantly unsafe. I have no confidence that those cases have been assessed to the same competence of a senior paediatric doctor. Children deserve better."