Many PAs ‘clinically depressed’ following Leng review

A large proportion of physician associates meet the threshold for clinical depression following the recent recommendations to change their role in the NHS, it has been claimed.

More than 90% of PAs said the Leng Review into the safety and effectiveness of the roles has ‘negatively affected their mental health’, a survey by the PA trade union found.

According to a survey of 695 PAs carried out by United Medical Associate Professionals (UMAPs), 95% said the Government-commissioned review has had ‘a detrimental effect’ on their mental health, with ‘several associates reporting that they have considered suicide’, according to the union.

The review, which was published last month and accepted in full by the Government, found that PAs should be renamed ‘assistants’, should not see undifferentiated patients outside of clearly determined protocols, and that they should have at least two years’ training in secondary care before being allowed to practise in primary care.   

The survey findings based on responses to the Patient Health Questionnaire-9 (PHQ 9) found that 26% of PAs have felt they would be ‘better off dead’ since the review, with 7% saying they feel this way every day.

And 86% showed some degree of depression based on PHQ-9 questions used to assess mental health, with 21% qualifying as ‘severe’ meaning they would ‘likely meet the criteria for referral to specialist mental health services’, UMAPs said.

As part of the survey one PA said: ‘Since the Leng review outcome, I have had sleepless nights. I took a mortgage out two years ago based on my circumstances.

‘I love my job and I never thought it could be taken away just like that. I have even contemplated suicide.’

Another PA said: ‘The day after the Leng review came out, I had a PV [per vaginal] bleed (I was 11 weeks pregnant at the time) which resulted in an admission to A&E. I should be avoiding stress, and now is the most stressed I’ve been in years.’

In addition to recommendations which limited the role of PAs, the review argued that the Government should consider a ‘fast-track training route’ for current PAs who want to become doctors, as many PAs are ‘keen’ to have opportunities to progress and the roles have attracted ‘highly committed individuals’.

Following the review, GP practices were then asked by NHS England to take ‘immediate actions’ implement the changes, but earlier this month an NHS England document appeared to water down these actions, saying that any changes are contingent on ‘local change management policies’, employment law and discussions with trade unions.

Last month, NHS England failed to change PA role descriptions in the new PCN DES specification, and the document continued to refer to ‘physician associates’ and stating PAs employed under additional roles reimbursement scheme (ARRS) could ‘provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems’. 

According to UMAPs, the failure to change the specification was a result of a legal case UMAPs has brought against NHS England over implementing the review.

UMAPS had also requested interim injunction to stop NHS England issuing instructions to organisations on implementing the review’s recommendations while a judicial review is ongoing, but this was refused.

Commenting on the survey findings, UMAPs general secretary Stephen Nash claimed: ‘The Leng review has left medical associate professionals with a complete lack of certainty about their futures and opened them up to even greater victimisation by the BMA and anti-MAP doctors.

‘By publishing this data and filing our judicial review, we are taking a stand against the bullying of PAs by the medical establishment.’

However, the BMA rejected his allegation and demanded that it was withdrawn.

A spokesperson said: ‘It is sad to hear that many PAs are feeling distressed and uncertain about their future, a predictable result of terrible workforce planning from previous governments and NHS bodies that could not assure patient safety before expanding the role. The BMA has always been clear PAs themselves are not to blame for this rushed rollout, the fault for which lies firmly with those in leadership positions. We have also been clear that any victimisation or bullying of PAs by other NHS staff is to be utterly condemned. 

‘We do not recognise this allegation of bullying or victimisation from the BMA, and we demand the withdrawal of this inflammatory claim.’

A Department of Health and Social Care spokesperson said: ‘We take the wellbeing of all NHS staff extremely seriously. Any healthcare professional experiencing mental health difficulties should seek support immediately through their employer’s occupational health services, their GP, or crisis support services.

‘The Leng Review was commissioned to ensure patient safety remains paramount whilst providing clarity on roles within the NHS. The recommendations were developed following extensive evidence gathering and consultation with healthcare professionals, patients, and safety experts.

‘We are committed to implementing the review’s recommendations in a way that supports both patient safety and workforce wellbeing.’

Pulse recently revealed that more than a fifth of PCNs have cut the number of PAs they employ in the past year. And GP practices in one area have been advised to ‘take HR advice’ when implementing recommendations made by the Leng review.

Professor Gillian Leng also spoke exclusively at Pulse LIVE Birmingham in June, where she criticised the lack of ‘a clear vision’ amid the introduction of PAs in the NHS.