Disclaimer: This is independent research and commentary. It is not advice. Governance decisions must be made in accordance with statutory duties, regulatory requirements, and organisational risk frameworks.
The Leng Review (July 2025) was commissioned to inform a refreshed NHS workforce plan. Its recommendations address not only the PA and AA roles themselves but also the system conditions required for their safe and effective deployment. This article examines the governance, regulatory, workforce planning and implementation implications.
Lessons from the Rollout – Governance Failures Identified
The review is candid about what went wrong in the expansion of these roles:
- No nationally described vision for how the new roles would integrate into existing teams and services.
- Inconsistent medical leadership voice.
- Weak local change management, particularly for PAs (service models were less developed than for AAs).
- Gaps in medical posts sometimes filled by PAs without adequate accounting for training differences or supervisor capacity and capability.
These shortcomings produced role confusion among patients and professionals, contributed to a toxic debate in some settings, and left supervisors without the time, training or clarity needed. The review notes that effective change requires clear vision, medical leadership, ongoing engagement, and proper local HR and leadership support.
Regulatory and Accountability Framework
Regulation by the GMC began in December 2024 (transition period; full registration requirement from December 2026). The review recommends that GMC requirements for regulation and reaccreditation be presented separately from those for doctors to reinforce role differences (Recommendation 15).
Key governance recommendations include:
- Named doctor as formal line manager (“named supervisor”) with overall responsibility for each physician assistant (Recommendation 6).
- Doctors to receive line management and leadership training plus allocated time for supervisory duties (Recommendation 16).
- Safety systems to routinely collect staff-group data to enable national monitoring and interrogation against agreed patient safety standards (Recommendation 18).
- Ongoing national audit of anaesthesia practice outcomes (with and without PAAs) via the Healthcare Quality Improvement Partnership (Recommendation 13).
These measures aim to strengthen accountability and create data for system-level learning — areas where current incident reporting systems have structural limitations (they are not designed to assign individual responsibility easily).
Workforce Planning and Multidisciplinary Team Design
The review sits against the backdrop of the 2023 NHS Long Term Workforce Plan and the (then forthcoming) 10 Year Health Plan for England. It notes that the NHS already has more types of staff role than any other healthcare system and that clarity about interaction is essential.
Recommendations relevant to system leaders:
- Any further expansion of physician assistants in anaesthesia only in conjunction with the Royal College of Anaesthetists and supported by the consultant community (Recommendation 12).
- DHSC to establish a time-limited working group to set out multidisciplinary models of working in different settings, with input from experienced leaders across medicine, other professions, management and HR (Recommendation 17).
- Credentialling and career development pathways (Recommendations 2, 3, 10, 11) to be developed with royal college or Academy involvement, potentially including future expanded scope once governance is assured.
The review is explicit that there were no convincing reasons to abolish the roles, but equally no case for continuing unchanged. It positions the recommendations as a pragmatic reset.
Implementation Considerations
The review stresses that the mistakes of the past must not be repeated: clear leadership, a vision that includes service models, effective communication, and local support for change management are essential. Medical leadership is described as a crucial element of success.
National bodies (royal colleges, Academy of Medical Royal Colleges, GMC, CQC, NHS England, DHSC) and trusts will each have roles. The permanent faculty proposals for professional leadership and standards (Recommendations 8 and 14) aim to provide ongoing oversight beyond the immediate implementation phase.
Safety reporting by staff group (Recommendation 18) will require changes to incident systems and analytical capacity at national level. Trusts will need to ensure that “never event” and other safety data can be disaggregated meaningfully.
Relevance to Women’s Health Governance
Primary care has seen significant PA deployment, often in hard-to-recruit areas. Primary care is the setting where much of women’s longitudinal health – menstrual health, contraception, pregnancy planning, perimenopause, menopause, mental health, and sex-influenced long-term conditions – is managed. Fragmented pathways between primary care, gynaecology, endocrinology, mental health and maternity services are well documented.
The review’s evidence did not include sex-disaggregated analysis of safety, effectiveness or deployment patterns, nor did it examine differential impacts across the female life course.
Governance leaders implementing the recommendations will therefore need to consider how new team structures, protocols for undifferentiated patients, and named-supervisor models support (or risk undermining) continuity and understanding for women whose health needs cross traditional organisational and specialty boundaries.
The proposed DHSC working group on multidisciplinary models offers an opportunity to design with these realities in mind, rather than layering additional roles onto existing fragmented structures.
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.
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© 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) – cited extensively in the Leng Review as the policy context for expansion.
Care Quality Commission analyses of Prevention of Future Death reports, whistleblower files and LFPSE data – as commissioned for and reported in the Leng Review.