Disclaimer: This is independent research and commentary. It is not advice.
The Leng Review, published on 16 July 2025 by Professor Gillian Leng CBE, was an independent examination of the physician associate (PA) and anaesthesia associate (AA) roles in the NHS. Commissioned amid growing public and professional debate, it assessed whether these roles are safe and effective within multidisciplinary teams (MDTs), what changes might build confidence, and whether the rollout supported safe deployment.
This article summarises the review’s key points for patients and the public, with particular attention to primary care (where many PAs work) and what the findings mean when you or a family member seeks care.
Background and Why the Review Happened
PAs and AAs were introduced in the early 2000s to help address workforce pressures, allowing doctors to focus on more complex cases while expanding access. Their shorter training pathways were intended to provide a quicker route into the workforce than traditional medical training.
Numbers grew significantly, especially after the 2023 NHS Long Term Workforce Plan.
Concerns then intensified about role clarity, supervision, impact on doctor training, and patient safety.
High-profile cases and media attention, including accounts from bereaved families, contributed to the decision to commission the review.
Evidence on Safety and Effectiveness – What the Review Found
The review conducted an extensive search of published research, local audits, national datasets (including from the Care Quality Commission), a large survey of over 8,500 frontline staff, patient focus groups, and expert panels.
Key finding
Research on safety and effectiveness was limited, generally of low quality, and often inconclusive or mixed. Studies frequently failed to account properly for differences in patient case mix, levels of supervision, or the complexity of presentations.
In primary care, safety evidence was limited and provided neither a clear case that PAs were safe nor unsafe on the measures examined. On effectiveness, there were no major differences in some outcomes compared with doctors, but PAs tended to give more advice and sometimes had longer consultations. PAs were associated with fewer hospital admissions and readmissions in some studies — an outcome that requires careful interpretation as it could reflect either appropriate care or under-referral.
In secondary care (mostly emergency departments in the studies), safety findings were small and inconclusive, showing no clear difference versus comparators such as Foundation Year 2 doctors. More PAs than expected were named in coroners’ Prevention of Future Death (Regulation 28) notices, but fewer in “never events.”
For anaesthesia associates, there was no published research on safety. Local trust audits (often pre-pandemic, small sample sizes, limited case-mix adjustment) suggested performance in line with national standards when compared with consultants or anaesthetists in training, but the evidence quality was low to very low.
Patient and public perspectives (from focus groups and other feedback):
Many patients reported being satisfied after seeing a PA and feeling listened to. However, three recurring concerns stood out:
- Lack of clarity about the role, including identification and confusion with a doctor.
- Practical barriers (e.g., needing a prescription that a PA could not independently provide at the time).
- Uncertainty about whether they were seeing the most appropriate professional for their needs.
Bereaved families who contributed to the review were clear that role confusion had been a contributory factor in some cases. They stated that, had they known a doctor had not been directly involved or consulted, they would have responded differently and sought further help.
Role Clarity, Identification and Consent
The review highlights that confusion between PAs and doctors undermines trust and can affect how patients and families act on clinical information.
This connects directly to the legal standard established in Montgomery v Lanarkshire Health Board (2015): informed consent requires that patients receive information material to their decision, including an understanding of who is providing care and the limits of their role and qualifications.
The review’s recommendations aim to address this:
- Rename “physician associate” to “physician assistant” to position the role clearly as supportive and complementary.
- Standardised national measures (clothing, lanyards, badges, staff information) to distinguish physician assistants from doctors.
- Physician assistants should not see undifferentiated patients (those with new or unclear symptoms) except within clearly defined national clinical protocols.
- A named doctor should take overall responsibility for each physician assistant as their formal line manager (“named supervisor”).
For anaesthesia associates, the review recommends renaming to “physician assistant in anaesthesia” (PAA) and continuing within the interim scope set by the Royal College of Anaesthetists, with similar identification and oversight measures.
Future credentialling programmes are proposed that could, in time and with appropriate training, allow expanded responsibilities including prescribing and ordering non-ionising radiation. Until such programmes exist and are regulated, current limitations remain.
Practical Steps Patients and Families Can Take
While this is not advice, the review’s findings support patients feeling empowered to ask questions. Reasonable steps many people find helpful include:
- Asking directly: “Can you tell me your role and qualifications?” and “Will a doctor be reviewing my case or involved in decisions about investigations or treatment?”
- Requesting to see a doctor, particularly for new, undifferentiated, or complex symptoms, or where a prescription or specialist referral is likely to be needed.
- Keeping clear records of who you saw, what was said, and any advice given — this can be valuable if concerns arise later.
- In hospital or theatre settings, confirming the supervision arrangements for any anaesthesia associate involved in your care.
These steps align with the review’s emphasis on clarity and the named-supervisor model.
Implications for Women’s Healthcare Experiences
Women are frequent users of primary care across the life course — for menstrual and gynaecological health, contraception, pregnancy planning and care, perimenopause and menopause symptoms, mental health linked to hormonal transitions, and the management of conditions where sex differences in presentation or risk exist (e.g., cardiovascular disease). Primary care is often where the “dots are joined” between these interconnected experiences.
The review notes that PAs in primary care were sometimes associated with longer consultations and more advice-giving, which some patients experienced positively. Consistent presence on wards (in secondary care) was also viewed as supporting continuity. However, the evidence reviewed did not examine whether these patterns or any safety signals differed by sex, age, or stage of life. Role confusion or unclear supervision arrangements may have particular impact where women are navigating fragmented pathways between primary care, gynaecology, endocrinology, mental health, maternity and later-life services.
The review’s focus on clear team structures, named supervisors, and protocols for undifferentiated presentations is relevant precisely because women’s health journeys are often longitudinal and cross specialty boundaries. Where clarity is lacking, the risk is that trust erodes at the very points where listening and continuity matter most.
Looking Ahead
The Leng Review provides a pragmatic set of recommendations to bring greater clarity and structure. It does not call for abolition of the roles but argues strongly against continuing unchanged. Implementation will depend on clear national leadership, medical engagement, and local change management — areas the review itself identifies as having been weak in the original rollout.
Patients and families have a legitimate interest in knowing exactly who is providing their care and what that person is qualified and authorised to do. The review’s recommendations on identification, named supervision, and scope for undifferentiated patients reflect that interest.
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 (accessed via official gov.uk publication).
NHS Long Term Workforce Plan (2023) – referenced throughout the Leng Review as context for expansion and subsequent debate.
Montgomery v Lanarkshire Health Board [2015] UKSC 11 – legal context on informed consent (publicly available judgment).