Patient safety will be strengthened across the country, as the government accepts all the recommendations of an independent review into physician associates (PAs) and anaesthesia associates (AAs).

The review chaired by Professor Gillian Leng CBE – an experienced leader in the UK healthcare system – has made 18 recommendations aimed at providing clarity to patients and improving patient safety.

Launched in November 2024, it looked into the safety of the roles of PAs and AAs and how they support wider health teams.

Professor Leng sought evidence from a range of voices including patients, staff groups, employers within the NHS, professional bodies and academics. The review’s recommendations cover recruitment and training, supervision and professional regulation.

Health and Social Care Secretary Wes Streeting said:

Patients should always know who they are being treated by and should always receive appropriate care.

Legitimate concerns about patient safety have been ignored for too long – that’s why I sought out the very best clinical advice to review physician associates and anaesthesia associates’ roles in the NHS.

I want to thank Gillian Leng, one of the UK’s most experienced healthcare leaders, for her comprehensive, thorough report.

We’re accepting all of the recommendations of the Leng review, which will provide clarity for the public and make sure we’ve got the right staff, in the right place, doing the right thing. Patients can be confident that those who treat them are qualified to do so.

Physician assistants, as they will now be known, will continue to play an important role in the NHS. They should assist doctors, but they should never be used to replace doctors.

Our Plan for Change will build on its findings and we will work to implement these findings in the interests of staff and patients alike.

Dr Claire Fuller, Co-National Medical Director (Primary Care) at NHS England, said:

We welcome the publication of this review and the clarity it provides on how these vital and valued roles can best support high-quality care for patients as part of multidisciplinary teams.

Following legitimate concerns raised, it is right this review has gathered expert insight and evidence from across the health service and internationally and we will now work with the service and government to fully consider and implement its recommendations.

Professor Gillian Leng said:

I’m pleased the government is implementing the recommendations in full.

My review provides the opportunity of a reset, but this must be the start of the conversation, not the end.

Now it’s time to focus on delivery: bringing clarity for patients, complementarity between doctors and assistant roles, collaboration across teams, focussed on ensuring safe and effective high-quality care.

The Health and Social Care Secretary today confirmed he would accept all the recommendations and begin work to bring them in as quickly as possible, directing NHS England to write to systems leaders setting out the immediate actions for them to take. 

Resident doctors have raised concerns about the safety and lack of clarity for PA and AA roles – and the government is listening to them.

Implementing the review’s recommendations will provide clarity for the public and – crucially – improve patient safety and quality of care. PAs and AAs still have a vital role to play in wider teams and caring for patients, with many hard-working PAs and AAs making a vital contribution across the healthcare system. These recommendations will provide certainty and options for their career development.

At the same time, clear guidance will be offered to other healthcare professionals and patients about the contributions and limits of these roles.

PAs will in future be identified as physician assistants and AAs will be renamed as physician assistants in anaesthesia, reflecting their role as supportive members of medical teams. They will also not be able to treat undiagnosed patients, except within clearly defined cases.

Permanent faculties will be established to provide professional leadership and set standards for PAs and PAAs. They will also form part of a clear team structure – led by a senior clinician – where everyone is aware of their roles, responsibilities and accountability.

Doctors will receive training in line management and leadership, ensuring they can properly fulfil their supervisory roles.

Collaboration will be vital in the face of increasing NHS demand and the recommendations should serve as a reset – encouraging greater teamwork across healthcare teams. These reforms all form part of the Plan for Change’s mission to build an NHS fit for the future, and one which works for patients and staff. 

Lessons learned from the review will feed into the government’s upcoming workforce plan, ensuring the NHS has the right staff in the right place at the right time.

The 10 Year Health Plan will also ensure that new and expanded roles are rolled out in a way which ensures that public, patient and professional confidence is maintained.