'Fails to meet the urgency' - Doctors and PAs react to Leng review

Professor Gillian Leng’s long-awaited review into physician associate safety has been published, with all her recommendations. We will be featuring all the reaction to this news from the BMA to grassroots GPs. This will be constantly updated. If you would like to send in your reaction, email [email protected]

Professor Kamila Hawthorne, chair of the Royal College of GPs:

‘Our position is that the College opposes a role for PAs in general practice. Nevertheless, recognising there already are PAs working in general practice, we developed guidance on their induction, preceptorship, supervision and scope for working in general practice. These, together with the current Council position, were approved by College Council in September 2024, helping to spark a national review of the issues, with a letter to the Secretary of State for Health from the Academy of Medical Royal Colleges.

‘We’ll be considering the Leng Review’s findings and recommendations but any change to our position would need to be agreed by College Council.’

‘Legitimate concerns about patient safety have been ignored for too long – that’s why I sought out the very best clinical advice to review physician associates and anaesthesia associates’ roles in the NHS.

‘I want to thank Gillian Leng, one of the UK’s most experienced healthcare leaders, for her comprehensive, thorough report.

‘We’re accepting all of the recommendations of the Leng review, which will provide clarity for the public and make sure we’ve got the right staff, in the right place, doing the right thing. Patients can be confident that those who treat them are qualified to do so.

‘Physician Assistants, as they will now be known, will continue to play an important role in the NHS. They should assist doctors, but they should never be used to replace doctors.

‘Our Plan for Change will build on its findings and we will work to implement these findings in the interests of staff and patients alike.’

Dr Tom Dolphin, chair of BMA council:

‘Today, Professor Leng has laid bare the catastrophic failures in NHS leadership that have put patients at serious risk of harm. But unfortunately this review’s recommendations do not adequately protect patients.

‘Professor Leng has succeeded in exposing how NHS England introduced these roles and encouraged their expansion without any robust evidence of their safety. The report reveals inadequate national leadership, no accountability and no attempt to listen to the concerns raised by doctors, patients and coroners. The blurring of lines between doctors and non-doctors, aided and abetted by the GMC, has been an unfolding disaster for all to see, and many doctors today will be relieved to see that they were right to raise the alarm.

‘Unfortunately, while the diagnosis is strong, the prescription fails to meet the urgency of the moment. Despite the alarming way these roles were introduced and expanded unsafely there are significant gaps in the report where strong patient safety recommendations should have appeared. Most worryingly, a major opportunity has been missed to end the postcode lottery of what PAs can and can’t do. By failing to recommend authoritative, nationally-agreed scopes of practice, Professor Leng has ignored the most urgent demand of the medical profession, and left patients at the mercy of local decisions by employers who can still choose where and how assistants can work.

‘This is deeply disappointing, and we call again on NHS England to act now and adopt the BMA’s safe scope of practice guidance as an interim measure until this can be properly addressed. The GMC too must urgently act on Professor Leng’s criticisms about how its decisions are blurring the lines between doctors and assistants.

‘There are some helpful recommendations. It is good to see that our longstanding call to change the job title to “assistant” has been listened to. It should not have needed a report like this to tell NHS leaders that the title “physician associate” is confusing and misleading for patients. We urge Government and employers not to waste any time in making this change from associate to assistant.

‘Despite correctly recommending that assistants shouldn’t be the first person seeing patients coming straight through the doors in GP practices or in A&E, the report then contradicts itself by saying that PAs can act as a first point of contact in primary care for minor and common conditions. It is not clear how these two recommendations can coexist, and this must be urgently clarified. Minor complaints are only minor in retrospect and serious conditions can present in subtle or unusual ways.

‘No doubt doctors will look back at this report as a moment when historic failures could have been addressed and patients finally protected – but sadly will see this as an inadequate response to what is a patient safety scandal. We hope that the Government will follow our advice beyond what this report has recommended, for the sake of patients.’

Charlie Massey, chief executive and registrar of the General Medical Council:

‘My thanks to Professor Gillian Leng and her team for their detailed and thoughtful work on this important Review. The Review brings much-needed clarity and offers a timely opportunity for a reset across healthcare.

‘As the regulator for PAs and AAs we work with them to ensure good, safe patient care. Our regulation has been helping provide assurance to patients, employers – and doctors that PAs and AAs have the right level of education and training, meet the standards that we expect, and that they can be held to account if serious concerns are raised.

‘The findings of the Review will be pivotal to how we work with others and continue to improve our regulatory practices. We look forward to working on the aspects of the report that relate to the GMC and with others where there is a shared responsibility to deliver change.

‘As always, patient safety remains our absolute focus and priority.’

Stephen Nash, general secretary of United Medical Associate Professionals (UMAPs):

‘United Medical Associate Professionals (UMAPs) broadly welcomes the findings of the Leng Review into the safety and effectiveness of physician associates and anaesthesia associates, particularly the conclusion that PAs play a crucial role in improving access to healthcare and freeing up capacity in the NHS.

‘As Medical Associate Professionals (MAPs), our work is absolutely crucial to meeting NHS delivery targets, including reducing waiting times, and we wholeheartedly endorse Professor Leng’s view that PAs and AAs are “part of the solution” to staff shortages in the health service.

‘Far from being unsafe, Professor Leng’s review shows that PAs and AAs help to uphold the high standards of the NHS by ensuring similar outcomes in patient care to other medical professionals.

‘However, we do have concerns about some of the recommendations included in Professor Leng’s review, which we believe could in fact limit rather than increase patients’ access to care if they are adopted without proper consultation. In particular, we object to the recommendation that PAs only treat ‘differentiated patients’ i.e. those who have already received a diagnosis. We believe this will only compound the backlog for appointments with GPs and consultants and entirely negates the benefit of having such highly trained medical professionals available on wards and in local surgeries.

‘At the same time, we support Professor Leng’s assessment that the debate around MAPs has become “toxic”. One of the driving forces behind this review being carried out was a coordinated, vindictive, and highly political campaign against MAPs by radical factions within the BMA and other professional bodies.

‘While these factions claim to be protecting patient safety, in fact they are primarily concerned with promoting a radical agenda that supports unsustainable pay demands and unfettered strike action by the BMA. Because MAPs are not part of the BMA, we do not strike with doctors and our pay negotiations are separate. Forces within the BMA therefore see MAPs as an ‘enemy within’ that must be eliminated.

‘We hope that Professor Leng’s conclusion that there is no good case for abolishing PA and AA roles will draw a line under attempts by these factions to have MAPs removed from the health service. However, we do not see this as likely. Just as they continue to ignore the majority of the country who do not support further strike action, individuals within the BMA will strive to campaign against MAPs at the expense of improving access to medical care. At present, we believe the BMA is the biggest risk to patient safety in Britain.

‘That is why UMAPS will continue to stand up for PAs and AAs across the country, ensuring legal support against unfair dismissal, unnecessary reduction in scope, and workplace bullying that many MAPs continue to face.’

Dr Hilary Williams, incoming Royal College of Physicians (RCP) clinical vice president and chair of the RCP PA oversight group:

‘This is a thoughtful, detailed and thorough review of a very complex issue, and we want to thank Professor Leng and her team for their hard work and balanced approach. This report is very clear that reform is urgently needed to ensure safe multiprofessional teamworking in the NHS, and we welcome a strong focus on national consistency, patient safety, collaboration, and clarity of role and scope.

‘Professor Leng’s observation that postgraduate medical training in the UK is “fundamentally unsatisfactory” with “residents often feeling isolated and unsupported” is spot on. Our next generation campaign was set up in response to the debate around the future of medical training and we strongly welcome and endorse her statement that doctors must be trained as “leaders of the future” – that is, senior decision-makers who are trained and supported to provide whole-person holistic care throughout the patient journey.

‘High quality patient care must be our priority and we’re very pleased to see that the final report echoes many of the recommendations made by the RCP and our Resident Doctor Committee in our response to the Leng review, especially proposals to:

Change the name of the role to physician assistant (PA) to reduce patient confusion
Introduce national job descriptions and clinical protocols to improve consistency of scope
Support and resource senior doctors to supervise PAs and lead multiprofessional teams in a safe and effective way
Ensure that PAs cannot see undifferentiated patients and are accountable to a named, senior doctor.

‘We will now consider the Leng report in full and will work in partnership with our fellows and members, especially our resident doctors, to ensure that any changes are implemented in a way that supports patient safety and the medical workforce. Now is the time for clear timelines, funding and engagement with doctors and patients on the implementation of these important recommendations.

‘We are mindful that PAs already in role must be supported during this transition period, and we look forward to working closely with governments, the GMC, the NHS, royal colleges and other stakeholders on the next steps.’

Caroline Waterfield, director of development and employment at NHS Employers:

‘The review has been a well-led, careful and thorough examination into the safety concerns that have been raised regarding the roles of physician associates and anaesthesia associates. Professor Leng’s recommendations challenge us all to do better in deploying new roles to our teams, and in properly supporting those undertaking the roles. We look forward to working with members to support the response to the helpful and constructive recommendations.

‘The review also reinforces that many of the issues of greatest concern for resident doctors relate to their experiences of access to education and the impact on education and training for the future. The Secretary of State for Health and Social Care’s continued and clear focus on addressing these issues with the British Medical Association is therefore very welcome.’