PA trade union taking legal advice on ‘how to dispute’ Leng recommendations

The trade union for physician associates is taking legal advice on how to dispute recommendations laid out by the independent review into the safety and effectiveness of the roles.

Professor Gillian Leng’s review, which was published last week, did not set out a ‘scope’ of practice but suggested a severely limited job description for newly-qualified PAs, alongside a name change to physician assistant.

All recommendations, including that PAs 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, have now been accepted in full by the Government.

Following the review, NHS England wrote to ICBs and PCNs asking them to take some ‘immediate actions’ (see box), including adopting the updated terminology recommended, specifying that the change will formally be made in ‘forthcoming legislation’ and subject to parliamentary approval.

It added that in line with the review’s recommendations, PAs currently working in primary care ‘must not triage patients’ and ‘not see undifferentiated patients’.

Organisations should ensure that ‘all new PAs entering primary care have completed a minimum of two years’ employment’ in secondary care settings prior to their employment, it added.

The letter said: ‘Current PAs should remain in post, with their deployment aligned to the activities described in the review’s template job descriptions if they are new in post.

‘This includes their ongoing involvement in the management of patient care. More experienced PAs should have their roles reviewed by their named supervisor to confirm they have the appropriate skills and training, and to modify the roles if necessary.’

But United Medical Associate Professionals (UMAPs), which became an official trade union for the PA profession at the end of 2024, said that it does not accept the recommendations and that it is seeking legal advice on how to dispute them.

It said that the recommendations and the response from NHS England – in particular the instruction that PAs must not see undifferentiated patients – ‘completely contradicts the training, competency and job role of the profession’.

In advice to members, UMAPs said: ‘We want to make it explicitly clear, that we do not accept the recommendations of the Leng review.

‘The review is unable to substantiate a legitimate patient safety concern and relies on conjecture to fill this void without referencing any of the real-world data submitted by UMAPs.

‘We are also seriously concerned that the recommendations of the Review far exceed its original remit and will continue to engage with our legal teams to assess the options available to us.’

In its advice to PAs, UMAPs said that they should not sign a new contract or job description and ‘await further advice’.

It further advised PAs to provide ‘a letter of protest’ to their employers to ‘protect their position’, stating that they will continue to ‘fulfil their professional duties’.

The guidance added: ‘This means that you do not agree to the changes and are “working under protest”.  

‘It is important that you “work to rule” – this means no deviation from the conditions of the new job role/description, as doing so may put you at risk of legal implications.  

‘This includes not seeing any undifferentiated patients. There is currently dispute around the nomenclature of undifferentiated patients. Until this resolves, it is our position that any new suspected diagnosis should be discussed with a supervisor for confirmation.’

UMAPs also recommended that ‘in the initial phase of any changes’, PAs should be ‘allowed to take time off to come to terms with the change’, including ‘any mental distress that has been inflicted on them through no fault of their own’.  

General secretary of UMAPs Stephen Nash told Pulse: ‘We are currently taking advice on how best to dispute the recommendations in the Leng Review that seek to redefine the role of PAs without proper consultation.

‘We are very grateful for the support we are already receiving from employers towards this goal and we welcome all PAs, AAs, and healthcare organisations who want to join us in protecting fast, reliable access to care across the NHS.’

He also clarified that the Leng Review ‘has not impacted’ the claims UMAPs is pursuing against GP practices as a result of RCGP and BMA scopes of practice.

Earlier this year, GP surgeries began facing legal claims of discrimination from PAs based on the documents, but the Leng Review has now clarified that those scopes of practice should inform job descriptions for PAs and echoed the RCGP and BMA recommendations for PAs not to see undifferentiated patients. 

In response to the review, the RCGP reaffirmed its opposition to the role of PAs in general practice.

Pulse has looked in depth at what the Leng review will mean for general practice, and attempted to answer the burning questions GPs have about PAs.