A legal challenge is taking place at the Royal Courts of Justice about the role of physician associates (PA) in the NHS.
The case has been brought against the General Medical Council (GMC) by retired teachers Marion and Brendan Chesterton, whose daughter Emily died in 2022 after a blood clot was missed in two appointments with a PA.
Along with Anaesthetics United, they are seeking more clarity from the GMC about the scope of the PA role in a bid to improve patient safety amid concerns about how PAs and anaesthesia associates (AA) are being deployed in healthcare settings.
The GMC took over the regulation of physician associates and anaesthesia associates in December.
Speaking outside the central London court ahead of Wednesday's hearing, Mrs Chesterton said she did "not want anyone to go through the torture we've endured".
She called on the GMC to "end the confusion" over the scope of the PA role, adding: "We all deserve better."
What do physician associates do?
Physician associates and anaesthesia associates started working in the NHS in 2003, and it is thought it currently employs more than 5,000 of them.
PAs and AAs qualify after completing a master's degree and may be eligible for grants or bursaries through NHS England. They usually need a bioscience-related undergraduate degree, but that is not always a requirement.
Their role includes taking medical histories, conducting physical examinations and developing treatment plans.
They are not authorised to prescribe medicines nor to order scans involving ionising radiation, such as X-rays or CT scans. They work as part of a multidisciplinary team with supervision from a named senior doctor.
When the government appointed the GMC to regulate PAs and AAs last year, the regulatory body's chief executive Charlie Massey said it would help to ensure they "have the necessary education and training, meet our standards, and can be held to account if serious concerns are raised".
'No more Emilys'
Ms Chesterton, from Salford, died after a blood clot was missed in two appointments with a PA whom she had believed was a GP. She was 30 years old.
She was seen by the physician associate after she called her GP practice, in Crouch End in north London, complaining of pain in her calf, which had become hard. The PA recommended Ms Chesterton should take paracetamol.
But her condition became worse. Mrs Chesterton told the BBC that her daughter had "difficulty walking" and "was breathless and lightheaded".
She said: "In the second appointment, the PA diagnosed her with a calf sprain, long Covid and anxiety. The PA did not examine Emily's calves, and did not make it clear that she was not a doctor."
Ms Chesterton had a blood clot in her left leg, which led to her dying of a pulmonary embolism.
The coroner's conclusion was that she "should have been immediately referred to a hospital emergency unit" and, if she had been seen, it was likely that she would have survived.
Mrs Chesterton told the BBC: "To lose a child is so very painful. It is not the right order of this world." She added that she hoped the High Court case would mean there will be "no more Emilys".
How does GMC regulation work?
Government legislation governing PA and AA regulation means GMC registration will not become a legal requirement for PAs and AAs to be able to practise until December 2026.
From that point it will be an offence to practise either role in the UK without registration.
A GMC spokesperson said: "Regulation will help to assure patients, colleagues and employers that they are safe to practise and can be held to account if serious concerns are raised.
"To register with us, physician associates and anaesthesia associates need to show that they have the knowledge, skills and experience to treat patients safely, and that there are no outstanding concerns about their fitness to practise."
The GMC said it strongly encouraged those who were not already registered to ensure they do so.
There are currently 2,479 physician associates and 109 anaesthesia associates registered with the GMC.
In January, the secretary of state for health and social care started an independent review of the PA and AA roles "to agree recommendations for the future". The Leng review states it will consider "the safety of the roles and their contribution to multidisciplinary healthcare teams".
United Medical Associate Professionals (UMAPs), a trade union set up in 2023 to represent PAs and AAs, said in a statement: "We would like to acknowledge the strength and resolve of the Chesterton family. Whilst we may not agree with all of the public positions that have emerged around their case, we admire their determination at a time of profound personal grief."
The statement added that PAs were "highly trained healthcare professionals", many of whom had previously held senior roles as nurses, pharmacists or within the clinical sciences.
It continued: "The current judicial review brought by Anaesthetists United against the GMC is of concern, not only because it seeks to impose disproportionately restrictive scope-of-practice conditions on one profession alone, but because, if successful, it would set a dangerous precedent for regulating all clinicians through rigid, written scopes."
Mrs Chesterton told the BBC that when she found out her daughter had been seen by a physician associate, she did not know what one was. She said: "To lose a child is absolutely devastating, but to find out your child's death was preventable is heart-breaking."
Ms Chesterton's father Brendan said: "It's against protocol that Emily was seen twice by a physician associate for the same issue, and she shouldn't have been prescribing."
Her GP surgery, The Vale Practice, told the BBC it was "deeply saddened" by Ms Chesterton's death, and said it now only provided appointments with GPs, nurses and pharmacists after a "thorough" review.
It added that staff had been told to ensure that "a patient understands their role at the start of each appointment".
'They should recognise their responsibility'
The Chestertons told the BBC that since the GMC took over regulation, the scope of the PA role had not become clearer, despite them being told by the body that "supervision would be more defined".
The GMC has said it is not appropriate for it to provide advice on how individual PAs and AAs might develop their skills over time.
It said this was "a matter for employers and will vary depending on the clinical context and workforce needs".
"We would expect employers to be aware of – and have regard to – relevant guidance on scope of practice produced by the royal colleges and other professional bodies when they are making decisions about deployment."
