The Leng Review: an independent review into physician associate and anaesthesia associate professions (16 July 2025)

Summary

This review, led by Professor Gillian Leng CBE, considers the safety of physician associate and anaesthesia associate professions and their contribution to multidisciplinary healthcare teams in the NHS. It makes a number of recommendations to inform future government policy in this area.

Content

Physicians associates

Recommendation 1: positioning of the role

The role of physician associate should be renamed as ‘physician assistant’, reflecting the role as a supportive, complementary member of the medical team.

Recommendation 2: credentialling

Physician assistants should have the opportunity for ongoing training and development in the context of a formal certification and credentialling programme. This should include the ability to take on added responsibilities that are commensurate with that training, including the potential to prescribe and order non-ionising radiation.

Recommendation 3: career development

Physician assistants should have the opportunity to become an ‘advanced’ physician assistant, which should be one Agenda for Change band higher and developed in line with national job profiles.

Recommendation 4: undifferentiated patients

Physician assistants should not see undifferentiated patients except within clearly defined national clinical protocols.

Recommendation 5: initial deployment in primary care

Newly qualified physician assistants should gain at least 2 years’ experience in secondary care prior to taking a role in primary care or a mental health trust.

Recommendation 6: teamworking and oversight

The physician assistant role should form part of a clear team structure, led by a senior clinician, where all are aware of their roles, responsibilities and accountability. A named doctor should take overall responsibility for each physician assistant as their formal line manager (‘named supervisor’).

Recommendation 7: identifying the role

Standardised measures, including national clothing, lanyards, badges and staff information, should be employed to distinguish physician assistants from doctors.

Recommendation 8: professional standards

A permanent faculty should be established to provide professional leadership for physician assistants, with standards for training and credentialling set by relevant medical royal colleges or the Academy of Medical Royal Colleges.

Anaesthesia associates

Recommendation 9: positioning of the role

Anaesthesia associates should be renamed as ‘physician assistants in anaesthesia’ or PAA and should continue working within the boundaries set in the interim scope of practice published by the Royal College of Anaesthetists.

Recommendation 10: credentialling

Physician assistants in anaesthesia should have the opportunity for ongoing training and development in the context of a formal certification and credentialling programme, with the ability to take on added responsibilities that are commensurate with that training, including the potential to prescribe and order non-ionising radiation.

Recommendation 11: career development

Physician assistants in anaesthesia should have the opportunity to become an ‘advanced’ physician assistant in anaesthesia, which should be one Agenda for Change band higher and developed in line with national job profiles.

Recommendation 12: workforce planning

Any further expansion in the deployment of physician assistants in anaesthesia should be taken forward in conjunction with the Royal College of Anaesthetists to build safe and effective models of anaesthesia delivery that are supported by the consultant community.

Recommendation 13: ongoing monitoring of safety

There should be an ongoing national audit of safety outcomes in anaesthesia practice in conjunction with the Healthcare Quality Improvement Partnership to provide assurance of the safety of the physician assistants in anaesthesia role, in teams with and without physician assistants in anaesthesia.

Recommendation 14: professional standards

A permanent faculty should be established to provide professional leadership and set postgraduate standards for physician assistants in anaesthesia, under the auspices of the Royal College of Anaesthetists.

Wider system

Recommendation 15: regulation and accountability

The General Medical Council requirements for regulation and reaccreditation of physician assistants and physician assistants in anaesthesia in Good medical practice should be presented separately to reinforce and clarify the differences in roles from those of doctors.

Recommendation 16: supporting doctors as leaders and line managers

Doctors should receive training in line management and leadership and should be allocated additional time to ensure that they can fulfil their supervisory roles, and to ensure effective running of the health service.

Recommendation 17: redesigning medical and multidisciplinary teams

DHSC should establish a time-limited working group to set out multidisciplinary models of working in different settings. The group should include input from a small group of experienced leaders covering medicine, other relevant healthcare professionals, management, and human resources.

Recommendation 18: safety reporting

Safety systems should routinely collect information on staff group to facilitate monitoring and interrogation at a national level, against agreed patient safety standards, to determine any system-level issues in multidisciplinary team working.