NHS physician associates should not diagnose untriaged patients, review finds

NHS physician associates should be banned from diagnosing patients who have not already been seen by a doctor, a government review has concluded.

The review calls for the government to overhaul the role of physician associates (PAs), who it says have been substituted in for doctors to fill staffing gaps despite having significantly less training.

Prof Gillian Leng, the president of the Royal Society of Medicine, spoke to more than 1,000 people for the review and concluded there were “no convincing reasons to abolish the roles of AA or PA” but there was also no case “for continuing with the roles unchanged”.

She wrote in the report: “Despite the significantly shorter training, PAs and to a lesser extent AAs have sometimes been used to fill roles designed for doctors. The rationale for doing this is unclear, and was probably one of pragmatism and practicality, relying on medical staff to provide the additional expertise when required.

“This lack of planning may have been responsible for driving the resentment felt by some resident [doctors] and potentially exposed patients to unnecessary risk.”

One of her main recommendations is that PAs should not see “undifferentiated or untriaged patients”, meaning those who have not yet been diagnosed by a doctor. Leng recommended further work to establish which patients they should be able to see and to set clinical protocols that would enable PAs to diagnose patients with mild ailments.

The report found that “relatively few doctors felt it was appropriate for PAs to diagnose illness” and it identified disparities between the tasks PAs considered right for them to carry out and what doctors thought.

Leng recommended that newly qualified PAs work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts, enabling them to start their careers where there are more training opportunities and supervision.

She also recommended more leadership training for doctors, who shared concerns about the lack of preparation for supervision duties, and better career development for PAs and AAs. She suggested a named doctor supervise each PA, while uniforms, lanyards, badges and staff information should be standardised to “distinguish physician assistants from doctors”.

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Source: The Guardian, 16 July 2025

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