From a physician associate at breaking point: ‘We came to help not harm’
With the publication of the Leng Review, one PA pens a letter to Pulse, urging GPs to focus on reform – not rhetoric – to move forward
Dear all,
I am writing this letter anonymously. Not because I’m ashamed of being a physician associate, but because it’s no longer safe to speak openly. In recent months, the backlash against PAs has been so fierce that some of my colleagues have left their roles entirely. Not because they were unfit for the job, but because the abuse, hostility, and public humiliation became unbearable.
I became a PA to help people. Like most of my colleagues, I work under supervision, within my scope, and with deep respect for the medical profession. I’ve never claimed to be a doctor, nor have I ever wanted to replace one. I left a successful career in pharmaceutical science to support a system in crisis, to be an extra pair of hands, a listening ear and a familiar face for patients who might otherwise go unseen. I chose this path to ease the pressure, not add to it.
We’re not against doctors. We’re not a threat to doctors. We are part of the team, and like you, we’re burned out, overstretched, and trying to hold on to the reason we went into healthcare in the first place.
But when systemic failings are pinned on individual PAs, and when the conversation turns to blame, hostility, and public shaming, people break. And many already have. I know colleagues who have left the profession entirely, not because they lacked ability or compassion, but because they could no longer withstand the abuse. They gave up their jobs, their stability, and in some cases, compromised their families’ financial security, because that felt less terrifying than remaining a PA in this climate.
What makes this even harder is that many of us stood beside our resident doctor colleagues during their fight for better pay and conditions. We respected their struggle. We supported their strikes, both publicly and privately, because we believe in fair pay, safe staffing, and a future where doctors are valued.
In return, we were vilified.
Instead of solidarity, we were met with suspicion. Instead of working together, we were bullied online, in the press, and sometimes in our own workplaces. Many PAs faced targeted abuse, harassment, and exclusion. Not for doing anything wrong, but simply for existing in a role the system created.
The irony is that, for the most part, we’ve all been working toward the same goals: regulation, clearly defined scope, and public understanding. We could have achieved this together. With 5,000 PAs and 75,000 resident doctors in the UK, we never stood a fair chance of gaining traction without your support. But the way this has played out has caused real harm, not only to thousands of PAs, but also to public trust in the medical profession as a whole. It’s not just confidence in PAs that has suffered; it’s also in doctors, some of whom have taken to social media to bully and shame others publicly.
I still believe in this profession. I believe that PAs can offer something good and meaningful when we’re integrated properly. You don’t have to love the role. You don’t even have to agree with its existence. But I ask you to remember that behind the job title is a person who came here to help, not harm.
Let’s have the conversations that matter. Let’s focus on safety, clarity, and accountability. Let’s fix the governance. Let’s listen to and respect the patient voice. But let’s do it without dehumanising the people who are simply trying to make a difference.
I hope the Leng Review can serve as a reset. The evidence is now on the table. Let’s use it to drive informed decisions and shape legislation that reflects reality, not rhetoric.
Sincerely,
A physician associate (now assistant) at breaking point
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READERS' COMMENTS [12]
Please note, only GPs are permitted to add comments to articles
Physician associates have no role in general practice. This is not rhetoric. This is the guideline from our college. I won’t be able to defend anything If I supervise a PA. The problem is that money is limited and there are GPs who cost slightly more and independent.
Sorry but I’m fed up of GP’s being accused of bullying because they have called out a situation that is not safe for patients.
I’m sorry that you got sold a duff deal with the PA qualifications but I don’t feel GPs are to blame for that. Blame the colleges who appear to have been financially embedded in promoting this mess.
Dear PA. There are issue that need addressing. But I feel for you and other diligent capable colleagues. I would only accept critiscism in Primary care area from
GPs who have actually mentored and supervised PA’s as much of what I hear said is second hand and anecdotal . Chin up ,the chaos will Settle And those who persevere will Gain experience and confidence .
Sorry but PA’s training and entry requirements are just inadequate. Even the foundation doctors find it hard.
Who gave PAs the idea that they could treat and manage cases like a GP? Did they think that practicing in General practice is an easy skill that can be learn just with a few years of studying. I am in favour of the idea that they could be help to study medicine and become one day a proper GP. Unless you have hospital and community experience in most areas of medicine you cannot be a safe practitioner.
Sorry general practice really is too dangerous to have physican assistants or other limited qualifications people seeing patient. Need education and experience that is just not possible on 2 years with no medical degree and limited breadth of training. Working with a consultant who can supervise you at all time’s and sign prescriptions as part of a team might (or might not) work.
Dear PA, knowbody is against PAs. We just resent having our entire career and GMC number put at risk pretending to ‘supervise’ you
Total sympathy for you personally and I genuinely hope you obtain a good solution.
I strongly agree with you about the “system” and the attitude of both Blairite Labour and the Tories in fragmenting, diversifying and trying to get on the cheap what GPs do. For the last 30 years, both have been driven by failing neoliberal economic thinking, which is why it’s hard to find any substantial difference between them.
I think the Govt should begin by compensating PAs for any job losses they now face as it was the Govt that encouraged roles without carrying out prior due diligence in strategy, regulation etc. And the Govt could offer a pathway of 2 or 3 years, fully funded, of further structured training to PAs already working in the NHS for them to qualify as doctors.
This will cost money. The Govt will have to shake its magic money tree (MMT, in economic theory) that it usually reserves for its own cock-ups, and for its friends in rich circles in the private sector.
Training and paying GPs is expensive. Much cheaper to employ else to do the work of a GP.
This is a sad consequence of Governments rushing through legislation without due care or consultation with all the stakeholders in NHS. The Human cost is painful and sad to see. Complete utter mess!
Sort of agree with “So the bird flew away”. The universities recruited all these young intelligent people who wished to do a job that would give them a career doing worthwhile things and pay them well. On a promise for the government that there’d be a place for them. What a terrible turn of events to have the rug pulled after all that. Hopefully there is a place for these motivated people somewhere in the system. That needs to be figured out quickly.
To this colleague: thank you for your thoughtful insights and helping GPs who may not have employed a PA a chance to hear your voice. You are clearly empathic and a team player putting patients care first. I wish you were working on the ward where my father-in-law died as he would have received better care than he had. All hospital wards should have a PA working so patients and their families can be listened to. The same applies to primary care where we need help with our elderly especially. I hope Mr Streeting and Professor Leng read this and the comments as they say a lot I think about PAs and some doctors. We need people like you and please do not despair.