Physician associates should ‘never be used to replace doctors'

Independent

16-07-2025

Patient safety will be at the forefront of changes to the roles of NHS physician associates (PAs), who should 'never be used to replace doctors', the Health Secretary has said.
Wes Streeting pledged to implement in full the findings of a review which said PAs must not diagnose patients when they come into A&E or GP practices and must be renamed as 'physician assistants'.
Mr Streeting ordered the review into PAs and anaesthesia associates (AAs) after concerns were raised over whether they were safe and the impact on the training of junior doctors.
The review, chaired by Professor Gillian Leng, who is president of the Royal Society of Medicine, made 18 recommendations.
Mr 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.
'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.'
Prof Leng's review suggested a major change to the role of PAs after it acknowledged they have been used as substitutes for doctors, despite having significantly less training.
More than 3,500 PAs and 100 anaesthesia associates (AAs) are working in the NHS and there have been previous calls for an expansion in their number.
But a general lack of support for both roles from the medical profession – plus high-profile deaths of patients who were misdiagnosed by PAs – led to the review.
Presenting her findings, Prof Leng said: 'Crucially I'm recommending that PAs should not see undifferentiated or untriaged patients.
'If (patients) are triaged, they (PAs) should be able to see adult patients with minor ailments in line with relevant guidance from the Royal College of GPs.'
She said more detail was needed on which patients can be seen by PAs and national clinical protocols will now be developed in this area.
She added: 'Let's be clear, (the role of PAs) is working well in some places, but there indeed has been some substitution and any substitution is clearly risky and confusing for patients.'
Newly qualified PAs will also now work in hospitals for two years before they are allowed to work in GP surgeries or mental health trusts.
The study said safety concerns in relation to PAs were 'almost always about making a diagnosis and deciding the initial treatment, particularly in primary care or the emergency department, where patients first present with new symptoms'.
It added: 'It is here that the risk of missing an unusual disease or condition is highest, and where the more extensive training of doctors across a breadth of specialties is important.
'Making the wrong initial diagnosis and putting patients on an inappropriate pathway can be catastrophic.'
Despite the shorter two years of training for PAs, where local NHS services have struggled with filling roles, 'the easy option in some cases was simply to fill gaps in medical rotas with PAs', the report went on.
When it comes to the safety of PAs and AAs, Prof Leng said the 'evidence is poor', with 'no compelling evidence' in published research 'that PAs were safe to work as doctor substitutes in primary care'.
Prof Leng concluded there were 'no convincing reasons to abolish the roles of AA or PA' but there is also no case 'for continuing with the roles unchanged'.
She recommended that both PAs and AAs should have the opportunity for ongoing training and development, with potential to prescribe medicines in the future, and they should also should have the opportunity to become an 'advanced' PA or AA.
Six patient deaths linked to contact with PAs have been recorded by coroners in England.
One high-profile death involved Emily Chesterton, 30, who died from a pulmonary embolism. She was misdiagnosed by a PA on two occasions and told she had anxiety.
NHS England has written to NHS trusts setting out the new changes, saying PAs currently working in primary care, emergency departments or any other setting must not triage patients or see undifferentiated patients without a diagnosis.