NHS patients left dangerously unaware of who's treating them

Patients across the NHS are routinely being treated by healthcare professionals without being clearly informed of their qualifications, creating a dangerous lack of transparency that undermines informed consent and patient safety.

Fiona Morrison, Director and Co-founder of TLA Medicolegal and Governor of Oxford University Hospitals NHS Foundation Trust, believes the lack of transparency represents a dumbing down of the NHS. She is calling for better education and communication to ensure patients know from the outset exactly what type of practitioner is reviewing their condition and providing care.

Fiona explains: "The NHS has seen a dramatic expansion in advanced practitioners, physician associates, advanced clinical practitioner radiographers, trainee paramedics, and various other professionals working in roles traditionally filled by doctors.

“Whilst many of these practitioners are highly skilled within their scope of practice, they may not have the comprehensive medical training required for complex diagnosis, which can create pitfalls for patients.”

"Patients have a fundamental right to know who is treating them, what qualifications that person holds, and crucially, the limitations of their training when it comes to diagnosing their condition."

The issue came into sharp focus following the death of Emily Chesterton in 2022. The 30-year-old died from a pulmonary embolism after being misdiagnosed twice by a physician associate whom she believed was a GP. Emily had presented with calf pain and shortness of breath, classic symptoms that should have triggered immediate referral to A&E for suspected blood clots. Instead, she was told she had anxiety and prescribed propranolol. Her family only discovered the practitioner was not a doctor the week before the inquest. 

The deaths of Pamela Marking and Susan Pollitt further underscore the dangers of patients being unaware of who is treating them. In 2024, 77-year-old Pamela Marking died after a physician associate at East Surrey Hospital misdiagnosed her severe abdominal pain as a nosebleed and discharged her without medical supervision. Her family believed she had been seen by a doctor, and she later died following emergency surgery for a bowel obstruction caused by an undiagnosed hernia.

Similarly, in 2023, Susan Pollitt died at Royal Oldham Hospital after a physician associate incorrectly managed an ascitic drain procedure, failing to follow local guidance and increasing her risk of infection. Following six such deaths, Coroner Dr Karen Henderson warned that the unchecked use of physician associates without clear public understanding: “has the potential to devalue and undermine public confidence in the medical profession.”

Recent surveys reveal the scale of the problem. Research by the British Medical Association found that 86% of doctors believe patients cannot distinguish between physician associates and doctors, whilst a Healthwatch poll discovered that only 52% of adults understood the difference. Perhaps most concerning, 29% of patients surveyed did not know whether they had been seen by a physician associate or a doctor.

Fiona says: "This lack of clarity is not just confusing, it’s potentially dangerous. When patients book what they believe is a doctor's appointment, they should be told upfront if they will be seeing an advanced practitioner, physician associate, or trainee instead. Patients also need to understand they have the legal right to refuse and request to see a fully qualified doctor."

Fiona, who brings over 20 years of experience in the medical sector, argues that the NHS workforce transformation has outpaced public understanding. "The structure of NHS teams has changed dramatically. The ratio of fully qualified GPs to other clinicians has shifted from 1:1.1 in 2015 to around 1:2.6 today. Yet there has been no corresponding investment in patient education or transparent communication."

Fiona emphasises that whilst advanced practitioners can provide excellent care within their scope of practice, informed consent requires patients to understand who is treating them. "It's about respect and autonomy. Patients cannot give meaningful consent when they don't know the qualifications of the person examining them or reviewing their scans."

Fiona calls for systematic changes including mandatory disclosure of practitioner qualifications at the point of booking appointments, clear identification badges, and national public awareness campaigns explaining the different roles within modern NHS teams.

Fiona says: "Better communication and transparency aren't optional, they're essential to maintaining patient trust and safety.

"The NHS must prioritise honesty over convenience and ensure every patient knows exactly who is providing their care from the very first interaction."