A coroner has raised concerns surrounding Physician Associates (PAs) following the death of a woman due to an "unnecessary medical procedure" and "neglect" at Royal Oldham Hospital.

Susan Pollitt was 77 years old when she died at the hospital in July last year, two weeks after she was admitted after collapsing at her home in Failsworth.

Following an inquest that concluded on July 29 last month at Rochdale Coroners Court, senior coroner for Manchester North, Joanne Kearsley, has raised concerns regarding the circumstances surrounding Mrs Pollitt's death and the framework around PAs in hospitals and GP surgeries.

The inquest heard that on July 3 last year, Mrs Pollitt collapsed at her home on Shaw Head Drive, Failsworth, and was taken to Royal Oldham Hospital.

She was treated for a number of medical issues including acute kidney injury and during her admission, Mrs Pollitt developed ascites, a condition where fluid collects inside a person's abdomen.

The consultants involved in her care decided an ascitic drain, which is used to treat ascites, was not required at that time.

On July 11, a junior doctor reviewed Mrs Pollitt and decided that an ascitic drain should be placed, however, the inquest found that the procedure was not clinically indicated at that time.

The procedure was carried out by a PA, which according to the NHS Careers website is a role which supports doctors in diagnosing and managing patients in either GP surgeries or hospitals.

The PA who carried out the procedure was not aware of the local hospital guidance on the insertion of ascitic drains, or that the drain should remain in place for no longer than six hours.

Mrs Pollitt’s drain remained in place for 21 hours before it was removed.

The PA had also advised that the drain be clamped due to a concern that the loss of fluid could cause a drop in blood pressure, however, this was unwarranted due to the moderate level of fluid which had been drained.

Clamping a drain can increase the risk of infection, a fact which the PA did not appreciate, the court heard.

Mrs Pollitt developed bacterial peritonitis and died on July 16.

The inquest found that she died due to a number of issues, including spontaneous bacterial peritonitis, prolonged insertion of an ascitic drain, non-alcoholic liver cirrhosis, as well as type 2 diabetes mellitus, osteoarthritis and a fracture of the humerus, or upper arm.

Mrs Pollitt’s health was compounded by the fact she was placed on a respiratory ward instead of a gastroenterology ward as there was a lack of understanding and awareness across all the staff on the respiratory ward, including the medical team, as to the management of ascitic drains.

Following the inquest, Ms Kearsley has written to the Department of Health and Social Care, the chief executive of the General Medical Council and the president of the Faculty of Physician Associates (FPA).

Ms Kearsley said she is concerned that there is no regulatory body which oversees PAs, although this is understood to be the subject of a consultation by the General Medical Council.

She added that there is no national framework as to how PAs should be trained, supervised and deemed competent, which Ms Kearsley said is placing patients, PAs and their employers at risk.

The inquest did hear that the Northern Care Alliance, which manages Royal Oldham, has since put in local trust framework regarding PAs.

Ms Kearsley also mentioned the Physicians Associate Managed Voluntary Register held by the FPA is voluntary, which she said makes it unclear how the FPA would be made aware of concerns regarding PAs.

She added that there is a lack of understanding about the roles of PA, which can cause confusion amongst patients.

Dr Jonathan Moise, Medical Director at the Royal Oldham Hospital, which is run by the Northern Care Alliance NHS Foundation Trust, said:  “We offer our deepest condolences to Susan’s loved ones for their sad loss.   

 “The Trust accepts the findings of the inquest and apologises to Susan’s family that the standard of care she received was not what we would expect. 

“We have taken the learning arising from this investigation extremely seriously.    

“Since this sad case, we have undertaken a considerable amount of work in relation to the training and supervision of Physician Associates. We have developed a Northern Care Alliance NHS Foundation Trust (NCA) Physician Associates governance framework.

"It is planned that the national statutory regulation of Physician Associates will begin under the General Medical Council at the end of this year."