A government-commissioned Leng Review, recently published, has reignited the debate over physician associates (PAs) in the NHS, proposing new ways of working, but it does not support calls to abolish the role.
Key Findings
- There is insufficient high-quality evidence on safety and outcomes, and no convincing reasons to abolish the roles of AA or PA; it is working well in some areas; however, change must still occur.
- Substitution for doctors is risky and confusing for the public. Gaps in medical posts were sometimes filled by PAs, without considering their more limited training.
- The review examined coroner and whistleblower reports, along with serious incident data, and flagged cases—particularly in secondary care—where PA deployment lacked clarity or sufficient oversight.
Key Recommendations
- PAs who hold a two-year postgraduate qualification but no medical degree should not diagnose undifferentiated/untriaged patients
- Recommends renaming the profession to “physician assistants” and introducing uniform and badge protocols to reduce role confusion
- Proposes a minimum of two years of experience working in a hospital before working with GPs, and formalised supervision by a named doctor
Split Voices
The British Medical Association (BMA) reacted sharply, describing the review as exposing “catastrophic failures in NHS leadership” but stopping short of fully safeguarding patients. Its chair, Dr Tom Dolphin, said the findings “do not adequately protect patients” and that “a nationwide scope of practice” is urgently needed. In a 2025 survey submitted earlier to the review, 95% of doctors backed national standards for PA duties, and 77% doubted NHS bodies could deploy them safely, especially in unsupervised roles. BMA.
NHS England welcomed the review as a chance to “reset” and create a safer, more clearly defined workforce, while the Royal College of Physicians (RCP) described the review as “thorough” and called for quick implementation of measures to promote national consistency, role clarity, and patient safety.
United Medical Associate Professionals a specific trade unions that represents Physician Associates (PAs) and Anaesthesia Associates (AAs) welcomed the reports findings that PAs have a
“a crucial role in improving access to healthcare and freeing up capacity in the NHS.”
Reflecting on the controversy,
“we support Professor Leng’s assessment that the debate around MAPs has become “toxic”. One of the driving forces behind this review being carried out was a coordinated, vindictive, and highly political campaign against MAPs by radical factions within the BMA and other professional bodies. “
The Secretary of State for Health and Social Care, Wes Streeting, accepted the findings of the report in full.
Human Cost
Central to the controversy are the tragic deaths of Emily Chesterton (30) and Ben Peters (25), both seen by PAs.
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- Emily was mistakenly treated for anxiety instead of a pulmonary embolism after contacting her GP twice; she died shortly after. The coroner concluded that she “should have been immediately referred to a hospital emergency unit”. And that would have likely saved her life.
- Ben, seen in A&E, received a panic-attack diagnosis and was sent home—he died less than 24 hours later from an aortic dissection. As reported by the BBC, there was no misdiagnosis and all the correct procedures were followed, but the case did highlight that a patient under the care of a PA could be discharged without being seen by a doctor.
A Role Under Scrutiny
PAs were introduced in the early 2000s to ease staffing shortages. Last year, the GMC approved PA qualifications and assumed regulatory oversight—yet concerns persisted about misdiagnoses and patient safety. The NHS Long-Term Workforce Plan aims to grow the PA workforce to 10,000 by 2035, but many doctors view this as task-shifting driven by cost, rather than a safe addition to clinical staffing.
“The rise of MAPs, without clear scope of practice and regulation, looks like a workforce strategy built on shifting risk downward while saving money.” – BMJ editorial.
What Happens Next
- Official changes: Expect mandatory uniform requirements and supervisory rules to be rolled out. Newcomers to the PA profession are likely to need to complete hospital training before entering GP roles.
- Monitoring safety: Coroners’ data, CQC findings, and patient safety reports will track whether recommendations lead to clear improvements.
- Policy and legal updates: Professional bodies, such as the BMA, RCP, and RCGP, will push for national standards; legal definitions may emerge regarding prescribing and diagnostic authority.
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