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Times
18-07-2025
- Health
- Times
‘Junior doctors are right to be unhappy with NHS'
Junior doctors are right to be unhappy about the way the NHS treats them, the head of a landmark review into physician associates has said. Professor Gillian Leng, the president of the Royal Society of Medicine, said that there was 'resentment and hostility' felt by some younger doctors towards other healthcare staff. Anger about NHS plans to expand the use of physician associates (PAs) has contributed to 'general unhappiness' driving the British Medical Association to call a five-day strike, she said. Leng was asked by Wes Streeting, the health secretary, to examine the NHS rollout of PAs, amid a bitter row within the medical profession over whether they are replacing doctors. Her review was published on Wednesday and found that PAs have been used as a 'substitute' for fully trained doctors and GPs, despite having only two years of postgraduate training, which is 'risky and confusing' for patients. In an interview with The Times, Leng revealed she found cases including of a PAs 'acting as a GP' at a practice in London, and seeing patients inside a consulting room behind a 'door with their name on'. Leng said: 'The GP practice had clearly tried to appoint GPs but they couldn't. So the physician associate was fulfilling the role.' • Doctors could have student loans written off to avert strikes Leng recommended changes including banning PAs from diagnosing patients, renaming them 'assistants' and ensuring they wear uniforms to distinguish them from doctors. The debate over PAs had become 'toxic' over the past two years, with reports of bullying and harassment on wards, as opposition to PAs has been led by leaders of the BMA. Leng said that the level of 'online hostility' meant she deleted social media while carrying out the review. 'When I started doing the review, I was told to come off social media. I think that was the right thing to do, because I would have been targeted,' she said. PAs have been working in the NHS for two decades, but a row over their roles was ignited by plans in the 2023 NHS Long Term Workforce Plan to expand the PA workforce from 3,000 to 10,000. While carrying out her review, Leng spoke to more than 1,000 people and visited hospitals and GPs around the country, where she was struck by the poor working conditions of young doctors and the contrast with PAs. Doctors have to move around the country and face 'lengthy training, antisocial hours and numerous exams', with thousands finding it difficult to secure jobs in the NHS after completing their foundation training. Meanwhile, PAs have set working hours and stable jobs, meaning they can become valued members of a team. Leng said this contrast was 'undoubtedly one of the reasons why the debate has become so impassioned'. Leng said: 'It's fair enough that doctors are unhappy about the way their training works. It's like being a widget in a factory. You don't have much control where you move around. You are put on a conveyor belt. • Six patient deaths linked to use of physician associates by NHS 'Resident doctors move around so much they don't have a chance to build that relationship [with consultants]. I've been racking my brains to think of any other careers that you might go into where you are one of the brightest members of the system and you'd be treated like that.' Resident or junior doctors — who are launching a five day strike next week — are also furious that PAs start on a salary of £47,000 a year, while a first-year junior doctor earns £39,000. Leng said that this resentment had contributed to the BMA's strike action. 'When you look at some of the big national strikes that we've had in this country — miners, train drivers — it's never just about pay. These issues are always pay plus general unhappiness with terms and conditions. So I don't think this is any different. You've got resident doctors unhappy with the way that their training has become a number on a conveyor belt, and they feel they don't have a team structure.' Leng's 134-page report stressed that evidence regarding the safety and effectiveness of PAs was 'poor', and she said much of the evidence submitted by organisations including the BMA was 'anecdotal' and 'could not be verified'. Leng, who qualified as a doctor at the University of Leeds in 1987, was formerly head of the National Institute for Health and Care Excellence, and became president of the Royal Society of Medicine last year. • Robert Colvile: Striking doctors are really capitalists — and may have a point Streeting said: '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.'
The Independent
16-07-2025
- Health
- The Independent
Physician associates should ‘never be used to replace doctors'
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.
Yahoo
16-07-2025
- Health
- Yahoo
Physician associates should ‘never be used to replace doctors'
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.
Telegraph
16-07-2025
- Health
- Telegraph
Physician associates ‘should be banned from diagnosing patients'
Physician associates should not diagnose patients, a government-commissioned review has said. The review examined six patient deaths that coroners' reports had directly linked to physician associates (PAs). The report's author said misdiagnosing patients and giving them the wrong treatment plan was 'catastrophic'. The review found there was 'inconclusive' evidence that physician associates were safely deployed in the NHS, but equally none to suggest it was so unsafe that the role should be abolished. It said the role should be renamed as 'physician assistant' to reduce confusion among the public who have often mistaken them for doctors. The review proposes giving all NHS staff, including the renamed physician assistants, their own uniforms and lanyards that clearly state their job, because of the vast range of roles operating within the health service, and a tendency for PAs to wear doctors' scrubs and stethoscopes. The recommendations make up part of an independent review of PAs and anaesthesia associates (AAs) by Prof Gillian Leng, the president of the Royal Society of Medicine. Wes Streeting, the Health Secretary, ordered the review last year after a series of scandals involving PAs either causing patient harm or death, practising beyond what they are qualified to do, or being used in place of doctors. Doctors have also criticised the NHS plans to increase the around 3,500 PAs employed to more than 10,000 as an attempt to replace them.
Yahoo
15-07-2025
- Health
- Yahoo
Physician associates ‘should be banned from seeing patients without review'
Physician associates (PAs) should be banned from seeing patients who have not been reviewed by a medic to prevent the risk of 'catastrophic' misdiagnoses, a Government-ordered report has found. The study suggests 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 the roles from the medical profession – plus high-profile deaths of patients who were misdiagnosed by PAs – led Health Secretary Wes Streeting to order a review. Presenting her findings, Professor Gillian Leng, president of the Royal Society of Medicine, 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 should 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.' Prof Leng also recommended PAs should be renamed 'physician assistants' to position them 'as a supportive, complementary member of the medical team', while AAs should be renamed 'physician assistants in anaesthesia'. Newly qualified PAs should also 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. 'This seems to have been done without taking into account the more limited training of the PAs and how the roles would interact, other than with the caveat that they would be supervised by doctors. 'This lack of planning may have been responsible for driving the resentment felt by some resident (doctors) and potentially exposed patients to unnecessary risk.' The study noted concerns in the medical profession about the impact on training and employment of resident doctors when PAs take on tasks. 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'. She also said the evidence was poor when it came to cost effectiveness. The report said that while research suggests patients are satisfied after seeing a PA, some did not know they were not seeing a doctor. Many doctors also told the review they were concerned about the time required to supervise PAs and AAs and the lack of training for supervisors about the role of PAs. A survey conducted for the report found 'relatively few doctors felt it was appropriate for PAs to diagnose illness', with only 29% of those working with PAs in primary care backing this, and 14% in secondary care. The survey also found 'marked differences in which tasks were considered appropriate in primary and secondary care, with PAs significantly more likely than doctors to believe that certain activities were appropriate for them to carry out'. When it came to AAs, there were also questions over whether the role was actually needed as fully qualified anaesthetists already face tough competition to find a job. 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. A named doctor should take overall responsibility for each PA, while clothing, lanyards, badges and staff information should be standardised to 'distinguish physician assistants from doctors'. 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. Unison head of health, Helga Pile, said: 'By working closely with doctors and other healthcare professionals, these roles can make a real difference to the improvement of services and reduction of waiting lists. 'Clearer identification of physician associates and anaesthesia associates will give patients a greater understanding of who's delivering their care and what they can expect. ' Dr Tom Dolphin, chair of BMA council, said the review 'laid bare the catastrophic failures in NHS leadership that have put patients at serious risk of harm' but said its recommendations 'do not adequately protect patients'. He added: 'Despite correctly recommending that assistants shouldn't be the first person seeing patients coming straight through the doors in GP practices or in A&E, the report then contradicts itself by saying that PAs can act as a first point of contact in primary care for minor and common conditions. 'It is not clear how these two recommendations can coexist, and this must be urgently clarified. Minor complaints are only minor in retrospect and serious conditions can present in subtle or unusual ways. 'No doubt doctors will look back at this report as a moment when historic failures could have been addressed and patients finally protected – but sadly will see this as an inadequate response to what is a patient safety scandal.'
