Practice terminates physician associate’s contract after misdiagnosis leads to patient death

As reported by The Times, a 30-year-old actress whose symptoms were dismissed as anxiety died of a blood clot after being seen by a physician associate

Emily Chesterton believed she had seen a GP, but had in fact been seen twice by a physician associate (PA), a newer type of medical role that involves significantly less training.

Her parents, Brendan and Marion Chesterton, both 64 and retired teachers, said they have serious concerns about plans for thousands more PAs to be employed to combat staff shortages as part of the NHS Long Term Workforce Plan.

Chesterton’s calf pain and shortness of breath should have suggested a pulmonary embolism and meant she was sent to A&E. A coroner concluded this would probably have saved her life. Instead she was told to take anxiety pills. She collapsed that evening. She was taken to hospital but her heart stopped and she could not be revived.

GP practices are already encouraged to use PAs under a scheme that lets them reclaim salary costs. About 3,000 work in the NHS. PAs undertake two years of specialist training after a bioscience-related degree and their work must be overseen by a doctor.

Chesterton, a graduate of Liverpool Institute for Performing Arts and the Royal Academy of Music, came from Boothstown, Greater Manchester, and had moved to the capital to pursue a career in musical theatre.

“She was very sensitive, caring, creative, generous — a beautiful soul, really, inside and out,” her mother said.

Chesterton lived with her partner, Keoni Blockx, only a few doors from the Vale Practice surgery in north London.

She had been feeling unwell for a few weeks before making an appointment for October 31 last year. The PA diagnosed a sprain and possible long Covid. A week later she began to feel extremely unwell, struggling to walk more than a few steps. Her leg was swollen and hot. She made another appointment, and was seen by the same PA. She was sent home and told to take propranolol, which had been previously prescribed for anxiety. Messages sent to her family and partner show she believed she had seen a doctor.

That evening she felt unwell while out for dinner with her parents and partner, and they encouraged her to take one of the pills. “She just suddenly went downhill very fast,” Mrs Chesterton said. They helped her home and her parents started to return to their hotel. “We got a phone call from Keoni saying ‘Come back, please come back’.” Chesterton had collapsed with no pulse. Blockx had performed CPR, and her parents found her on the stairs.

“Emily asked me in a quiet voice to please help her, and I tried my absolute best to keep her calm, stroking her hair, holding and supporting her on the step as best I could, reassuring her that all would be well, not to panic, that I loved her,” Mrs Chesterton said.

At an inquest, the coroner concluded that Chesterton “should have been immediately referred to a hospital emergency unit” on either October 31 or November 7. “If she had been on either occasion, the likelihood is she would have been treated for pulmonary embolism and would have survived.”

A serious incident review by the GP practice found problems including a failure by the PA to introduce herself. It said doctors at the practice were concerned by the PA’s over-confidence and lack of insight into the limitations of her own clinical knowledge and practice. The PA’s contract was terminated and the practice will no longer employ PAs.

Mrs Chesterton said the family wanted “to protect other families . . . We want this never to happen to any more Emilys”.

Mr Chesterton said: “We are concerned that patients are seeing physician associates and not realising that they are not doctors, like Emily.” They suggested that “doctor’s assistant” would be a more accurate title than physician associate.

An NHS spokesman said: “Patient safety lies at the heart of the NHS Long Term Workforce Plan and physician associates are a vitally important part of our staffing mix.”