A recent report by the parliamentary and health service ombudsman has uncovered alarming failings in the healthcare treatment of a five-year-old girl who suffered severe distress after being incorrectly prescribed a vaginal pessary. The investigation revealed that the physician associate involved did not consult with a supervising GP prior to the prescription, raising serious concerns about patient safety and the oversight of medical personnel.
A Traumatic Incident
The young girl was taken to a GP practice in the East Midlands after her mother raised concerns about itching and vaginal discharge. The physician associate, suspecting a case of thrush, recommended both a vaginal pessary and an accompanying cream. Confusion ensued when the mother, mistakenly believing her daughter was being examined by a qualified GP, voiced her concerns regarding the treatment and the appropriate size of the pessary. She was assured that the prescription was suitable for her daughter.
However, as the ombudsman’s report highlights, physician associates do not possess prescribing rights independently; their work must be supervised by a doctor who should approve any prescriptions. Alarmingly, there was no dialogue between the physician associate and the GP prior to the prescription being authorised. Furthermore, vaginal pessaries are not appropriate for prepubescent children, and the symptoms presented by the girl aligned more with vulvovaginitis rather than thrush.
Devastating Consequences
Following the insertion of the pessary, the child began to bleed and scream in agony. The cream caused further irritation, leading her mother to seek help from an out-of-hours doctor. The level of distress exhibited by the girl was significant; she even requested the doctor not to conduct an internal examination. This reaction prompted the GP to express concerns about potential sexual abuse, leading to the involvement of safeguarding services.
Ultimately, it was determined that the girl’s symptoms were a direct result of the pessary and cream, rather than any form of abuse. The experience left the mother feeling guilt-ridden, questioning her trust in healthcare professionals. “I had huge guilt for doing what the PA, who I thought was a GP, told me,” she said. “But I trusted what they told me. How are we meant to trust healthcare professionals now?”
Recommendations and Responses
Rebecca Hilsenrath, the chief executive of the parliamentary and health service ombudsman, described the situation as “deeply troubling,” emphasising that such incidents could have been easily avoided. The report recommended that the GP compensate the mother with £1,000 and the pharmacy with £500, in addition to urging both organisations to implement measures to prevent future occurrences.
This incident took place in 2023, prior to a government-commissioned review which suggested that physician associates should be prohibited from diagnosing patients without prior consultation with a doctor. The British Medical Association (BMA) has reiterated that this case underscores the dire consequences stemming from inadequate supervision and clinical oversight.
Dr Emma Runswick, deputy chair of the BMA council, stated, “This is a deeply distressing case in which a young child suffered significant and entirely avoidable harm. It is particularly concerning that the child’s mother believed her daughter had been seen by a GP when she had actually been assessed by a physician associate. Patients and families have a right to know who is treating them and whether they are or are not a doctor.”
The Future of Physician Associates
In light of the findings, Prof Gillian Leng, president of the Royal Society of Medicine, has recommended renaming physician associates to “physician assistants” to clarify their status. She also suggested that stricter definitions of patient eligibility for treatment by physician associates be established, and that newly qualified PAs should undergo a two-year period working in hospitals before being allowed to practice in GP surgeries.
The BMA continues to advocate for a reevaluation of the role of physician associates in general practice, insisting on clear limitations regarding their scope of practice, enhanced transparency for patients, and robust supervisory measures to prevent similar incidents from occurring in the future.
A spokesperson from the Department of Health and Social Care acknowledged the gravity of the situation, stating, “Patient safety is our number one priority – this case is unacceptable and our sympathies go out to the patient and her family. We are now working at pace to implement each of the Leng Review’s recommendations, with some changes already delivered, and its findings will also inform our forthcoming 10-year workforce plan.”
Why it Matters
This distressing case serves as a stark reminder of the critical need for stringent oversight and clear communication in the healthcare system. The ramifications of this incident extend beyond the immediate trauma experienced by the child and her family; they underscore the importance of trust in medical professionals and the safeguards necessary to protect patients, especially vulnerable children. As healthcare practices evolve, ensuring that patients understand who is treating them and the qualifications of those practitioners is paramount to maintaining safety and trust within the medical community.
