College response to the Leng Review

The College extends our thanks to Professor Gillian Leng for undertaking this independent, evidence-based review of physician associates (PAs) and anaesthesia associates (AAs). We particularly appreciate her openness, willingness to engage with the medical profession and other stakeholders, and her recognition that although her work was commissioned by the Department of Health and Social Care (DHSC), the challenges relating to PAs and AAs span all four nations of the UK.

Professor Leng’s report echoes many of the points we made in our original position statement in January 2024, when we stated, amongst other things, that physician associates are not doctors and must not be regarded as substitutes for doctors. Instead, they should be regarded as supplementary members of the multiprofessional team, who can support doctors to work at the top of their range of capabilities. 

As such, we agree with much of the report, whilst acknowledging that more work is now required. 

As the report states: 

“….there is limited data demonstrating safety, and some significant concerns and challenges have been raised by the medical profession that cannot be ignored. Some changes to the future role are therefore required to facilitate a more supportive relationship between doctor and PA. In particular, a vision is essential to demonstrate how the role sits as a distinct function in the wider medical team that is valued and respected.”

Standards of patient care are at the heart of our College’s charitable purpose. Because of this, we believe that much more thought should now be given to the integration of PAs into multiprofessional teams, their safe supervision, and the scope and ceiling of their roles. As such we agree with the concept of establishing of a national working group and we agree that the GMC should make clearer distinctions between PAs and doctors within Good Medical Practice. We will continue to advise that PA roles, responsibilities and scope of practice should be defined nationally, rather than at a local level and hope and expect that all four UK nations will accept and take forward all of Professor Leng’s recommendations.

Finally, we agree with Professor Leng that the healthcare professions must now come together to move these issues forward. Over the past two years, we have articulated doctors’ and patients’ concerns, while calling for a calm and measured debate, and we also recognised that PAs have come under extraordinary professional scrutiny and deserve our understanding. We hope that Professor Leng’s report will usher in a new period of healing, collaboration and respectful debate, while concentrating our minds on how we can best work together to develop the workforce that meets the needs of our patients. 

We encourage all Fellows and Members to read the report in its entirety. Our Council will also do so and determine what further statements we release or actions we take.

Commenting, Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh said:

When evidence to guide clinical decision making is limited, doctors must do two things – listen to their patients’ perspectives and apply their professional judgement. This proves to be the case in Professor Leng’s detailed review – good evidence is extremely limited, and the perspectives of patients and professional judgement is therefore required.

In our judgement, the following recommendations are all entirely appropriate and in the best interests of safe, effective patient care:

- The role title should be changed to “Physician Assistant”;

- Doctors must be allocated additional time in their job plans to fulfil any and all supervisory roles;

- PAs should not see undifferentiated patients;

- Standards for the postgraduate practice and training of PAs should lie in the hands of doctors, in a national faculty hosted by one or more Colleges.

We reemphasise our view that Physician Assistants must never be seen as substitutes for doctors. We also remain clear that the three imperatives for medical workforce planning in the NHS are:

- To expand, and fund structured postgraduate training places for doctors;

- To reform doctors’ postgraduate training;

- To ensure that trainers have adequate time in their working days to support, mentor, teach and train the doctors who will follow them. 

The debate surrounding PAs has been extraordinarily divisive. Whilst this report may not completely satisfy all colleagues and, predictably, leaves unanswered questions and more work to be done, it is vital that the medical profession can now unite around its broad recommendations and collaborate to improve the integration of the role of the Physician Assistant into our multiprofessional teams. To fail to do so will neither be in the best interests of our patients nor our profession.