Disclaimer
This is independent research and commentary. It is not advice. Clinical and professional decisions must be made in accordance with current GMC guidance, royal college standards, employer policies and individual clinical judgement.
Introduction
The Leng Review (July 2025) examined the physician associate (PA) and anaesthesia associate (AA) roles from the perspective of safety, effectiveness and integration into multidisciplinary teams (MDTs). Its findings and recommendations have direct implications for doctors who supervise, work alongside, or train with these colleagues.
Evidence Base and Limitations
The review synthesised published research, local audits, CQC data on Prevention of Future Death reports and never events, a survey of 8,558 frontline staff, and wider engagement.
Core quantitative evidence on safety and effectiveness was limited in volume and quality.
Many studies were small, lacked robust case-mix adjustment, and predated or post-dated the pandemic in ways that complicated interpretation.
Post-pandemic evidence on PAs was more likely to show negative findings, though reasons were unclear.
In primary care, safety data neither clearly supported nor refuted safety on the outcomes measured.
Effectiveness studies showed no major outcome differences in some metrics, but PAs were associated with longer consultations, more advice-giving, and fewer admissions/readmissions (though interpretive caution is required).
In secondary care (largely ED-focused), safety studies were small and inconclusive versus FY2 comparators. More PAs than expected appeared in Regulation 28 notices, but fewer in never events.
For AAs, only low-to-very-low quality local audits existed; these suggested performance in line with comparators (consultants or anaesthetists in training) but were not generalisable.
Clinician survey responses and interviews revealed marked differences in perspective: PAs were significantly more likely than doctors to view certain activities as appropriate for their role.
Doctors raised consistent concerns about the time required for supervision, lack of training in how to supervise effectively, and the reality that supervising doctors often identify and prevent potential safety incidents.
Key Recommendations Relevant to Clinical Practice
The review does not support abolition but concludes there is no case for continuing unchanged. Headline recommendations include:
Physician assistants (recommended new title for PAs):
- Should not see undifferentiated patients except within clearly defined national clinical protocols (Recommendation 4).
- Newly qualified physician assistants should gain at least two years’ experience in secondary care before moving to primary care or mental health trusts (Recommendation 5).
- Must work within a clear team structure led by a senior clinician, with a named doctor as formal line manager (“named supervisor”) taking overall responsibility (Recommendation 6).
- Standardised national identification measures (clothing, lanyards, badges) to distinguish them from doctors (Recommendation 7).
Physician assistants in anaesthesia (recommended new title for AAs):
- Continue within the interim scope of practice set by the Royal College of Anaesthetists (Recommendation 9).
- Further expansion only in conjunction with the Royal College to build models supported by the consultant community (Recommendation 12).
- Ongoing national audit of safety outcomes in anaesthesia practice (Recommendation 13).
Wider system recommendations with clinical impact:
- Doctors should receive training in line management and leadership and be allocated additional time to fulfil supervisory roles (Recommendation 16).
- GMC requirements for regulation and reaccreditation should be presented separately to reinforce differences from doctors (Recommendation 15).
- A time-limited DHSC working group should set out multidisciplinary models of working (Recommendation 17).
- Safety systems should routinely collect information on staff group to enable national monitoring (Recommendation 18).
Credentialling and career development pathways (Recommendations 2, 3, 10, 11) are proposed, potentially including future prescribing rights and ordering of non-ionising radiation once appropriate training and governance are in place.
Implications for Supervision, Training and Team Dynamics
The review explicitly acknowledges that postgraduate medical training has become fragmented, with loss of mentorship and teamwork — issues raised forcefully by resident doctors. The contrast with the more stable, supported environment for PAs and AAs was noted as one driver of tension.
For supervising clinicians, the named-supervisor model formalises accountability. It requires protected time, training in supervision, and clarity about when escalation must occur. The review stresses that good local leadership and human resources support were often missing in the original rollout, particularly for PAs, where service models were sometimes less developed than for AAs.
In areas with high diagnostic uncertainty (primary care, emergency departments), the restriction on undifferentiated patients unless national protocols exist is significant. Clinicians will need to work with royal colleges and the regulator to develop and embed such protocols. Clinical curiosity about the individual patient remains essential; no protocol replaces it.
For anaesthesia, the recommendation for consultant-supported models and ongoing national audit reflects the high-stakes environment and existing high competition ratios for anaesthesia training.
Professional Standards and Future Development
The review proposes permanent faculties (under Royal Colleges or the Academy of Medical Royal Colleges) to provide professional leadership and set standards for training and credentialling. This aims to create clearer career pathways while maintaining medical oversight.
Many clinicians will welcome the emphasis on distinguishing the doctor’s role, formalising supervision, and addressing the training and time burdens on supervisors. Others will note that successful implementation depends on genuine medical leadership and adequate resourcing, which are points that the review itself highlights as lessons from the rollout.
Relevance to Women’s Health Practice
Primary care and many secondary care settings where PAs work are central to women’s health across the life course. Presentations involving hormonal transitions, reproductive history, mental health, autoimmune conditions, cardiovascular risk, and multimorbidity often cross traditional specialty boundaries.
The review’s evidence base did not disaggregate safety or effectiveness findings by sex or life stage.
Clinicians working in these areas will therefore need to apply the same rigorous, individualised clinical curiosity they bring to all patients, while supporting the development of protocols that reflect the complexity of real-world presentations.
The named-supervisor and clear-team-structure recommendations, if implemented well, could strengthen accountability in pathways where continuity has historically been lost.
Mandatory disclaimer
This article is for general information and discussion only. It is not medical or legal advice, nor a substitute for professional advice. To contribute evidence, ideas, or corrections, please email womenshealthproject@outlook.com. Please do not share personal data when emailing. Individual cases cannot be reviewed.
This project does not offer any form of legal service and cannot assist with complaints, claims or individual advocacy. This platform is independent and not affiliated with any law firm, regulator, inquiry or clinical body.
© 2026 Women’s Health Inquiry Project (WHIP). This article includes original analysis of material from publicly available national sources. It may not be reproduced without permission.
References
Leng, G. (2025) The Leng review: an independent review into the physician associate and anaesthesia associate professions. Published 16 July 2025. Available at: https://www.gov.uk/government/publications/independent-review-of-the-physician-associate-and-anaesthesia-associate-roles-final-report
NHS Long Term Workforce Plan (2023) – context for expansion and debate, as cited in the Leng Review.
GMC regulatory framework for PAs and AAs (transition period from December 2024; full registration requirement from December 2026) – referenced in the review.