Physician Associates in the NHS — A Watershed Moment

Introduction

Physician associates (PAs) have been part of NHS care for over two decades, initially introduced in 2003. In 2025, with their numbers at around 3,500 (plus around 100 anaesthesia associates, AAs), concerns over patient safety and role clarity prompted a government-commissioned independent investigation led by Professor Gillian Leng CBE.

Key Findings of the Leng Review

1. Mortality and Misdiagnosis - The report identified six patient deaths linked to incorrect diagnoses by PAs deployed as substitute doctors.

2. Role Confusion and Public Misunderstanding - The term "physician associate" was widely seen as misleading. Many patients believed they were seeing a doctor, undermining trust and compromising safety. 

3. Evidence and Safety - While the review found no substantial evidence to abolish the roles, it observed that limited evaluation leaves uncertainties about their overall safety and effectiveness.

Leng's Recommendations

• Rename the roles: PAs → "Physician Assistants", AAs → "Physician Assistants in Anaesthesia". 

• Restrict clinical exposure: No diagnosing or managing patients who haven't been triaged by a doctor, especially in primary care and A&E settings. 

• Post-qualification deployment: Newly graduated assistants should work at least two years in secondary care before transitioning to primary or mental health care. 

• Uniform and identification: Standardised badges, lanyards, and uniforms to clearly distinguish assistants from doctors. 

• Named supervision: Each assistant must have a designated supervising doctor responsible for oversight and governance. 

• Career development: Establish a credentialing programme, opportunities to become an "advanced physician assistant" with a higher Agenda for Change grade. 

• National standards and leadership: Define clinical protocols, scopes of practice, and provide supervisory training for doctors. 

NHS Response

NHS England formally accepted all Leng's recommendations on 16 July 2025, asking trusts and boards to implement immediate changes—from deploying new titles to restructuring roles and supervision.

Stakeholder Perspectives

• British Medical Association (BMA) and doctors welcomed clarity but criticised the report for failing to mandate safe practice standards nationwide. 

• Royal College of Physicians echoed support, emphasising national consistency and stronger supervision. 

• Healthwatch and patient advocates called for greater transparency and better public understanding of the assistants' role. 

Why This Matters Now

• Patient Safety: Raising clarity helps prevent tragic outcomes linked to misdiagnosis.

• Workforce Dynamics: With projected PA expansion to 10,000 by 2036, a more precise scope is critical to avoid misuse and workforce tensions.

• Training and Supervision: Moving forward, doctors will need protected time and formal training to supervise assistants effectively.

What Comes Next?

Practical steps are underway:

• Roll-out of new titles and identification tools in clinical settings.

• Employment adjustments: assistants in primary care or A&E to comply with new role limitations.

• Development of national clinical protocols and credentialing frameworks.

• Ongoing monitoring and auditing to ensure guidelines are followed and patient outcomes are improved.

Conclusion

Professor Gillian Leng's review marks a pivotal reset in the NHS's approach to integrating physician associates (soon to be physician assistants). Her 18 evidence-based recommendations seek to redefine the roles—emphasising support, clear boundaries, supervision, and patient safety.

As clinical negligence solicitors, Graystons welcomes these changes as patient safety is paramount. Now comes the challenging but essential task of implementation, collaboration, and ongoing evaluation.