Editor Sofia Lind on what comes after the ‘physician associates in general practice’ debate, ahead of Professor Leng’s interview at Pulse LIVE next week
The debate over physician associates (PAs) in general practice may finally be drawing to a close. The safety review led by Professor Gillian Leng was expected to report at the start of this month but has now been delayed until later in June.
Still, GPs may not have to wait that long to find out what’s going on. Professor Leng will be joining us live on stage at Pulse LIVE Birmingham next week in a special appearance – and we’re giving GPs the opportunity to put their questions to her directly. Very little has been revealed about what the review will recommend, but we hope to learn more on the day.
This debate has, at times, been toxic. But I do feel we are now approaching its core. Both the BMA and the RCGP have recommended that PAs be withdrawn from general practice altogether – and from what we’re hearing, this is already starting to happen on the ground.
It’s hard to argue with the logic when fully qualified GPs are unable to find work. As Pulse has reported repeatedly, GP unemployment is no longer rare – it’s systemic. While PAs were brought in to plug workforce gaps, that solution now looks increasingly at odds with reality. Shortcuts, as ever, tend to be just that: short-term, and short-sighted.
I’ve previously argued that the minimum requirement is a clear statutory scope of practice. Without it, the profession and patients are left in the dark about responsibility, boundaries and safety. But even that now feels like the floor, not the ceiling, of what’s needed. Renaming them will not be sufficient.
The bigger decisions still lie ahead. If PAs are to be scaled back or removed from general practice, practices will need serious investment to rebuild their GP teams. The BMA is calling for ringfenced funding for staffing in the new 2028 GMS contract, and is urging the Government to commit to this in next week’s Spending Review – conveniently landing on the same day as Pulse LIVE.
Meanwhile, NHS England is due to update its Long Term Workforce Plan later this year. If that plan is to have any credibility, it must reflect what’s happening in general practice. That means a major shift away from attempts to replace GPs, and back to training, supporting and retaining them.
I’ll be speaking to Professor Leng on stage at Pulse LIVE Birmingham, and I want to reflect your concerns. If there’s a question you’d like me to put to her – on the review, scope of practice, or the future of the GP workforce – please get in touch.
Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn
If we say goodbye, as you have already decided, to PAs in primary care then we also must say goodbye to nurse practitioners too. They do not have a national examination of competence nor the safety of being non-prescribers and working under supervision of a doctor. Do you really believe doctors only will see minor illness( at least 30% primary workload) , advise about preventive health or take time with elderly frail who need comprehensive geriatric assessments ? Are doctors the right professional to see these patients? Perhaps you should ask Professor Leng this question: How will removing PAs and nurse practitioners from primary care help our NHS care for our elderly ahead?
above highlight important tensions within the evolving workforce model in primary care. However, the concern many doctors have is not simply about protecting roles, but about ensuring patient safety, clinical accountability, and sustainability of care.
Physician Associates (PAs), and to some extent Nurse Practitioners (NPs), have been brought into primary care without the same rigorous, standardised training and national regulatory oversight that doctors undergo. While NPs have nursing regulation, their scope varies widely and they, like PAs, are often deployed in roles that blur lines of responsibility — including the diagnosis and management of complex conditions.
Doctors are trained over many years to manage risk, uncertainty, and complexity — which are the daily realities of general practice. While minor illness and preventive care seem straightforward, they often mask more serious pathology or involve nuanced decision-making that depends on a depth of training not yet matched by other roles.
The central issue is this: if we delegate core clinical tasks to less-trained staff, do we risk fragmenting care and compromising safety? Doctors are not saying they should do everything alone — but they are saying the current model of task-shifting has outpaced safe supervision and governance.
Removing or reducing the roles of PAs and NPs may appear regressive, but it might prompt a necessary recalibration: investment in more doctors, proper team structures, and clear lines of accountability — all of which are crucial if we’re to look after frail older patients and manage rising demand safely and effectively.
Ultimately, the question isn’t just who can see these patients — but who should, when it comes to both quality of care and long-term system resilience
Just ask Chat GPT and see what it says..
J S, excellent, thoughtful and respectful comments. Hopefully, the Govt will realise that they cannot substitute the complex probabilistic working of GPs with other roles and still expect to get the same medically (and cost) effective outcomes.
You can’t replace a symphony with segued jingles and expect to have the same joyful experience.
I agree with all the above.
I want to see ‘Care Navigators’ eliminated before they get a chance to properly usurp the roles of our Specialist Receptionists.
Then I want to see the elimination of ALL kinds of ‘Practitioners’. A ‘practitioner’ is just someone who ‘practices’ because they are not expert yet. A fully qualified GP Doctor is an expert in many forms of medicine, surgery, specialties and care navigation. They should not be called ‘practicing doctors’ any more than any hospital consultant is called a ‘practicing doctor’.
All the othe rsuperfluously named ‘practitioners’ are dreadfully misnamed.
If my patient needs a Nurse, or an Art Therapist, they need a Nurse or an Art Therapist, not a ‘practitioner’. This would remove the tendency for some ‘practitioners’ to use that title to imply they are medically qualified doctors or specialists, when they are not.
I have worked with some excellent staff burdened with the title of ‘practitioner’, but I have also been exposed to the horrors of an ‘Advanced Nurse Practitioner’ who was dangerously overconfident yet actually not as good as our experienced and common-sense State Enrolled Nurse.
Perhaps to avoid ‘Practitioner’ whilst stcking with what is familiar to patients, we could call those Doctors “Geepies”
The linking of PAs to ANPs is not valid. Apart from the difference between the NMC (ANPs) and GMC (PAs) approaches to regulation, ANPs aren’t described using terms suggesting they are a doctor eg “physician associate” or “trained in the medical model” or “medically trained”. Let’s not get unfocussed.
In the USA a Nurse Practitioner is a qualified Nurse. In the UK the title ‘Nurse’ is due to be statutorily protected. A medical practitioner is a protected title (but a medical professional is not). So Nurse Practitioner title does also raise considerable confusion over exactly whom a patient is seeing.
I agree with JS’s comments.