Health secretary Wes Streeting announced the Leng Review in November, following a debate over the roles.

Review author Prof Gillian Leng, the president of the Royal Society of Medicine, talked to doctors, patients and the patients to collect evidence on the safety and effectiveness of the roles of PAs and AAs.

She said a clear vision ‘was largely missing' when of PAs and AAs were introduced in 2000 and there was no national plan for how the new roles would fit into existing teams, resulting in growing ‘confusion about the roles' purpose and remit.

The review's recommendations for physician associates include:

• physician associates should be renamed physician assistants to reflect their supportive role in medical teams, while anaesthesia associates should be renamed physician assistants in anaesthesia or PAAs
• not see new patients in primary or emergency care or make a new diagnosis
• have at least two years' hospital experience before working in a GP surgery or mental health trust
• be part of a team led by a senior doctor
• wear badges, lanyards and clothing to set them apart from doctors
• patients should be given clear information about the role of a PA and there should be a faculty to represent PAs and set standards for training.

Prof Leng concluded: ‘In considering all the factors, there were no convincing reasons to abolish the roles of AA or PA, although, from a workforce perspective, there is some doubt about the need for the training of further AAs.

‘There was also no case for continuing with the roles unchanged, as there are several significant issues that need to be addressed to effectively embed the PA and AA roles into the NHS workforce.'

In response, health and social care secretary Wes Streeting, said: ‘Patients should always know who they are being treated by and should always receive appropriate care.

‘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.'

He added: ‘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.'

Dr Claire Fuller, co-national medical director (primary care) at NHS England, said: ‘We welcome the publication of this review and the clarity it provides on how these vital and valued roles can best support high-quality care for patients as part of multidisciplinary teams.

 

‘Following legitimate concerns raised, it is right this review has gathered expert insight and evidence from across the health service and internationally and we will now work with the service and government to fully consider and implement its recommendations.'

Reaction

Caroline Waterfield, director of development and employment at NHS Employers, said: ‘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.'

Dr Tom Dolphin, chair of BMA council, said: ‘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.'

United Medical Associate Professionals' trade union general secretary, Stephen Nash, said: ‘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', ie, 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. 

He added: '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.'

Professor Kamila Hawthorne, chair of the Royal College of GPs, said: ‘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.'

She added: ‘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.'

Unison head of health Helga Pile said: ‘It's vital those in associate roles are treated fairly, with good supervision, in order for them to thrive and contribute to the NHS.

‘Although there are still many issues to work through, this review has provided the opportunity for a much-needed reset.'