NHS England fails to update physician associate job description amid legal case

NHS England has not changed physician associate (PA) role descriptions in line with Leng review recommendations in the PCN enhanced service specification.

According to the PA trade union, this is due to the pending legal case it is bringing to challenge the recommendations, although NHS England did not confirm or deny this.

The PCN DES specification, published last month – after the review – continued to state that PAs employed under the additional roles reimbursement scheme (ARRS) could ‘provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems’.

The review into the safety and effectiveness of the role found 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 Government accepted the recommendations in full and instructed NHS England to implement the changes ‘as quickly as possible’. However, the United Medical Associate Professionals (UMAPs) is seeking a judicial review to challenge the implementation.

According to UMAPs it is because of this legal case that that NHS England has not updated the DES specification. It claimed that NHS England has agreed to make ‘no changes’ to the PA or apprentice role description to reflect that PAs should not see undifferentiated patients ‘until the case has been heard’.

UMAPs is challenging five of the Leng review’s eight recommendations for PAs including the name change, requirement for two years’ experience in secondary care, and recommendation that PAs should not see undifferentiated patients.

It said that the changes in the DES could have resulted in ‘approximately 1,900 PAs’ being ‘unfairly dismissed from primary care roles’.

It said: ‘On 28 July 2025, we became aware – via GPC communications – that NHS England intended to amend the job role of physician associates in the Network Contract Direct Enhanced Service (DES), in line with recommendations made in the Leng Review.

‘NHS England has now confirmed that it will not implement any changes to the DES specification affecting physician associates during the course of the legal proceedings.’

UMAPs said the decision meant ‘employers remain free to determine how they utilise physician associates in their team, without externally imposed restrictions’.

UMAPs general secretary Stephen Nash told Pulse: ‘Securing this U-turn is hugely impactful as it means that approximately 1,900 PAs working in primary care will continue to receive ARRS funding.

‘It delivers security for our colleagues while we await the outcome of our judicial review and allows us to continue making a meaningful difference to patients by improving access to primary care.

‘Ultimately, this situation should never have arisen in the first place. NHS England adopted the deeply flawed Leng Review recommendations without consulting UMAPs, the recognised trade union for Medical Associate Professionals.

‘It also failed to carry out any kind of assessment as to how these recommendations would impact patient care.

‘Trying to push through changes via the DES specification was underhanded and it is right that NHS England has now agreed to wait until the legal process concludes.

‘Our goal is to ensure both patient access to safe, high-quality care and the protection of MAPs’ rights in the workplace.’

Dr Steve Taylor, GP spokesperson for the Doctors’ Association UK said: ‘NHS England has created this problem with promotion of PAs in general practice, specifically seeing undifferentiated patients as part of their stipulation in ARRS.

‘The Leng review clearly backed both RCGP and BMA positions on the use of PAs in general practice. It was and remains unsafe for PAs to see undifferentiated patients with limited supervision.’

Both the RCGP‘s and BMA‘s own scopes of practice, published last year, say PAs working in general practice must never see undifferentiated patients.

‘The fact that NHS England has not backed their previous released statement to GPs by doing the same thing, shows how much a mess NHS England is making over this. It leaves GPs in a difficult position medico-legally’, said Dr Taylor.

NHS England said it cannot comment on ongoing legal proceedings.

A spokesperson added: ‘NHS England is committed to working with partners, including all members of general practice teams, and in line with all legal frameworks, for continued improvement in the quality of services and patient outcomes.’

Physician associate responsibilities under ARRS

Where a PCN employs or engages one or more Physician Associates under the Additional Roles Reimbursement Scheme, the PCN must ensure that each Physician Associate has the following key responsibilities, in delivering health services:

a. where their named GP supervisor is satisfied that adequate supervision, supporting governance and systems are in place, provide first point of contact care for patients presenting with undifferentiated, undiagnosed problems by utilising history-taking, physical examinations and clinical decision-making skills to establish a working diagnosis and management plan in partnership with the patient (and their carers where applicable).The GP supervisor must take into account a Physician Associate’s knowledge, skills and experience gained through their training and development;

b. support the management of patient’s conditions through offering specialised clinics following appropriate training including (but not limited to) family planning, baby checks, COPD, asthma, diabetes, and anticoagulation;

c. provide health/disease promotion and prevention advice, alongside analysing and actioning diagnostic test results;

d. develop integrated patient-centred care through appropriate working with the wider primary care multi-disciplinary team and social care networks;

e. utilise clinical guidelines and promote evidence-based practice and partake in clinical audits, significant event reviews and other research and analysis tasks;

f. participate in duty rotas; undertaking face-to-face, telephone, and online consultations for emergency or routine problems as determined by the PCN, including management of patients with long-term conditions;

g. undertake home visits when required; and

h. develop and agree a personal development plan (PDP) utilising a reflective approach to practice, operating under appropriate clinical supervision

Source: Network Contract DES

UMAPs has announced it has added Patrick Green KC, who represented 555 sub-postmasters in litigation against the Post Office, to its legal team for the case.

The BMA GP committee issued advice to GP practices saying that they should review their PA terms of employment to determine whether change needs to be made in light of the review.

The BMA has also threatened the GMC with new legal action over the regulator’s use of the term ‘medical professionals’ to cover both PAs and doctors, following the review.

UMAPs was officially recognised as a trade union for physician associates and other medical associate professionals by the Government earlier this year.

Pulse has analysed what the Leng review means for general practice and attempted to answer the burning questions GPs have about PAs.

Leng review recommendations for PAs

Positioning of the role: The role of physician associate should be renamed as ‘physician assistant’, positioning the role as a supportive, complementary member of the medical team.
Credentialling: Physician assistants should have the opportunity for ongoing training and development in the context of a formal certification and credentialling programme. This should include the ability to take on added responsibilities that are commensurate with that training, including the potential to prescribe and order non-ionising radiation.
Career development: Physician assistants should have the opportunity to become an ‘advanced’ physician assistant, which should be one Agenda for Change band higher and developed in line with national job profiles.
Undifferentiated patients: Physician assistants should not see undifferentiated patients except within clearly defined national clinical protocols.
Initial deployment in secondary care: Newly qualified physician assistants should gain at least two-years’ experience in secondary care prior to taking a role in primary care or a mental health trust.
Teamworking and oversight: The physician assistant role should form part of a clear team structure, led by a senior clinician, where all are aware of their roles, responsibilities and accountability. A named doctor should take overall responsibility for each physician assistant as their formal line manager (‘named supervisor’).
Identifying the role: Standardised measures, including national clothing, lanyards, badges and staff information, should be employed to distinguish physician assistants from doctors.
Professional standards: A permanent faculty should be established to provide professional leadership for physician assistants, with standards for training and credentialling set by relevant medical royal colleges or the Academy of Medical Royal Colleges.