Move comes after government review found PAs were being used as ‘substitute’ doctors

The NHS has significantly scaled back its use of physician associates after a major government review found they were being used as a “substitute” for doctors, new research suggests.

The number of physician associates (PAs) averaging more than 11 patient interactions – including consultations, follow-ups, results and referrals – per shift, has dropped since publication of the Leng review in July.

Professor Gillian Leng was asked by Wes Streeting to examine the role of PAs – a group of 3,500 NHS staff who assist doctors but do not have a medical degree.

Concerns over patient safety

It was commissioned due to concerns over patient safety and role clarity following high-profile deaths of patients under the care of associates.

Leng’s 134-page report concluded that there have been cases where PAs have been used as a substitute for doctors in the NHS, which is “clearly risky and confusing for patients”.

Leng found “no good evidence” that PAs were safe and effective, but there were also “no convincing reasons to abolish the roles” for safety reasons, as demanded by some medical leaders.

Survey of 457 ‘physician associates’ 

The results are based on a survey of 457 associates by United Medical Associate Professionals (UMAPs), the physician associates union and which was conducted in England over December and January. 

The survey found that two in five PAs report worsening patient waiting times in their departments while PAs in general practice say there has been an increase in longer patient waiting times of one to four weeks and four to eight weeks, and a drop in patients being seen within days. 

More than three-quarters (76 per cent) of PAs say their scope of practice has been restricted in recent months.

The findings also reveal that the workload of more than half (51 per cent) of the PAs’ consultant or supervisor has increased as a result of the Leng Review. 

‘Toxic debate’ around physician associates, Prof Leng found

In her review, Professor Leng acknowledged that much of the available evidence was affected by the “toxic” debate around PAs. However, her recommendations called for major changes to the work of both PAs and Anaesthesia Associates (AAs).

Among her recommendations, Leng said PAs should be barred from treating undiagnosed patients which UMAPs said “drastically limits the role they can play on the frontline of the health service.” 

The union said PAs have been left unable to carry out vital work they are trained to do.

Health Secretary Wes Streeting accepted the recommendations on the same day the review was published, but UMAPs said he did so with no assessment of how it will affect patients’ access to care or NHS backlogs. 

‘Terrible impact should be clear to Govt’

UMAPs General Secretary, Stephen Nash, said: “The terrible impact of the Leng Review recommendations should have been entirely obvious to both the government and NHS England.

“Effectively sidelining some 3,500 highly qualified medical professionals was clearly going to be disastrous for patients, associates, and doctors alike. Yet at no point did the Health Secretary make any assessment of how this would harm medical associates or restrict patients’ access to care.

Challenging ‘irrational’ recommendations

Nash added: “Far from protecting patients, it is increasingly looking like these changes were cooked up to mollify the increasingly radical BMA, which at the time of the review was threatening major strike action. That is why we are challenging the irrational recommendations in our judicial review, ensuring that PAs and AAs can go back to caring for patients and helping our doctor colleagues to shoulder the burden.”

Associates are semi-autonomous clinicians who work across GP surgeries, hospitals, mental health trusts, and emergency departments under supervision from a named consultant or senior doctor.

Their role includes taking medical histories, conducting physical examinations and developing treatment plans. 

They are not authorised to prescribe medicines nor to order scans involving ionising radiation, such as X-rays or CT scans. 

3,500 physician associates in England conduct 20 million appointments

Some 3,500 PAs work across the NHS in England carrying out approximately 20 million appointments annually, but their role has been controversial with critics calling them “substitute doctors” who are cheaper to employ amid an ongoing staffing crisis.

The General Medical Council took over the regulation of physician associates and anaesthesia associates in December 2024 following tragedies where patients died following interaction with PAs.

The British Medical Association (BMA) has said the undefined use of PAs is “fundamentally unsafe” and has said they should not be employed in general practice.

Bromsgrove GP: ‘Patients continue to suffer’

Dr David Law, a senior GP partner in Bromsgrove, said: “Physician Associates, working under direct supervision from a named senior doctor, are a major asset to primary care. But this only works if they are able to work to the full extent of their training, including being able to treat undiagnosed patients. So long as the Leng Review recommendations remain in place, GP practices and their patients will continue to suffer.”

Professor Leng also recommended PAs be renamed to “Physician Assistant,” or potentially “Doctor’s Assistant,” to reduce patient confusion with fully qualified doctors. The change will require legislation which is being delayed due to legal action taken by UMAPs against Streeting, Leng and NHS England.

The case is led by Patrick Green KC, who formerly represented subpostmasters in the Horzion IT scandal. A permission to proceed hearing is expected in the spring and the full case will likely be heard later this year.

Government response

A spokesperson for the Department of Health and Social Care said: “Physician assistants play an important role in our NHS. The Leng Review makes it clear that both physician assistants and physician assistants in anaesthesia can continue to work as supportive, complementary members of medical teams. We’re committed to implementing the recommendations from the Leng Review and getting this transition right so both patients and staff benefit.”