The independent Leng Review is the latest chapter in a saga that still threatens to split one of the world’s oldest medical colleges.
The United Kingdom’s physician associates (PAs) should be renamed physician assistants to reposition their role as a “supportive, complementary member of the medical team”, according to an independent review released last week.
PAs have been a bone of contention for British doctors over the last few years, amid a massive expansion of the role across the National Health Service.
While Australia has no official training programs for PAs, that has not stopped politicians from citing the role as a potential fix for Australia’s health workforce shortage as recently as January this year.
In November 2024, English secretary of state for health and social care Wes Streeting commissioned an independent review led by health administrator and Royal Society of Medicine president Professor Gillian Leng.
The final report from Professor Leng’s review was released last week.
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Her findings included that PAs have been used to fill roles designed for doctors and that the published research did not make a compelling case that PAs were either safe or unsafe in terms of outcomes.
She did, however, include views from families of patients who had died after consulting with a PA.
“Relatives feel strongly that confusion between the PA role and that of the doctor was an important contributory factor in their relatives’ deaths,” Professor Leng wrote.
“They were clear that, had they known a doctor had not been consulted, they would have responded differently and sought further help.
“Sadly, no one can turn back the clock, but I have listened to their experiences to help make improvements for the future.”
Professor Leng’s recommendations were somewhat of a mixed bag, and the review itself noted that its conclusions were “unlikely to be universally popular”.
On one hand, she recommended that PAs not see undifferentiated patients except within clearly defined national clinical protocols and that they wear a standardised uniform clearly distinguishing them from doctors.
On the other hand, she also recommended PAs be given opportunities for ongoing training and development in the context of a formal certification program.
PAs who completed this extra training could then possibly take on added responsibilities like prescribing medicines and ordering non-ionising radiation, the only two tasks that PAs are currently specifically prohibited from doing.
Mr Streeting accepted the recommendations from the review, saying he “took seriously the concerns” being raised about PA roles.
Social media platform X, formerly known as Twitter, has become a hotbed of discussion about the potential risks of the PA workforce.
“It is important to use the opportunity of this review to reset the hostility surrounding this debate and stimulate effective collaboration for the future,” the review read.
“Clear leadership will be essential, plus a vision that includes a service model for the future, effective communication, and local support for change management.
“… Some national agencies and professional bodies will need to take forward some specific recommendations and others will need to work together to ensure effective leadership, to ensure that the medical professions move forwards in a more productive fashion that improves the working environment for professionals and provides better care and more clarity for patients.”
In a section specifically addressing the rising hostility between the medical profession and PAs, the independent review pointed to the unprecedented strain of the covid-19 pandemic and the resulting low morale within the NHS.
“General unhappiness was exacerbated by the NHS Long Term Workforce Plan, which committed to a substantial expansion in numbers of PAs and [anaesthesia associates],” the report said.
“This, alongside gaps in workforce exacerbated by industrial action, resulted in some areas triggering an unplanned rollout of PAs into new areas of work to fill gaps in medical rotas.”
The debate, which the review said was roundly being described as “toxic”, has been particularly focussed within the UK’s Royal College of Physicians, the oldest medical college in England.
In March 2024, the RCP called the third Extraordinary General Meeting in its 500-year history to discuss its position on PAs.
At that time, the college had a Faculty of Physician Associates from which it received membership fees.
Many attendees of the EGM were critical of the RCP’s approach, with college councillor Dr Partha Kar ultimately penning an open letter asking for senior leadership to reconsider the RCP’s position on the issue.
Earlier this month, Dr Kar was removed from the RCP council and barred from standing for elections for 12 months.
He alleged that the reason for his suspension was for “exposing chicanery around PAs”.
