The Leng Review: Implications for Primary Care

The role of Physician Associates (PAs) has drawn significant attention in both medical and national press over the summer following the review undertaken by Professor Gillian Leng, the final version of which, along with its recommendations, was published in July 2025.

This article examines the review, paying particular attention to the implications for Physician Associates working in a primary care setting. It covers the main aspects of the review, the professional responses it evoked, and the implications going forward.

Overview of the Review

The aims and scope of the review were succinctly stated, yet necessitated a wide-ranging and lengthy review. As per the report’s introductory remarks,

“The principal aim of the review was to determine whether the roles of PA and AA were safe and effective as members of an MDT.”

To summarise the main conclusions of the review, Professor Leng stated there was no compelling evidence found either supporting or opposing the safety and outcomes associated with PA intervention; however, it was noted that they did tend to have longer consultations, tender more advice and were associated with fewer hospital admissions than GPs. Overall, Patient feedback was positive, but concerns were raised in 3 areas:

1. Lack of clarity about the PA role, including identification and confusion with a doctor
2. Barriers to care, for example, if a prescription was required
3. Lack of confidence in whether they were seeing an appropriate medical professional

Doctors had their own separate concerns, particularly about supervision in practice, and differing understandings between PAs and doctors regarding appropriate clinical activities and boundaries. Issues relating to the regulation and training of PAs were also identified, among other matters. The results of an RCGP survey cited in the review found that 81% of respondents believed PAs had a negative effect on patient safety.

Key Recommendations

Ultimately, Professor Leng concluded there was no clear justification for abolishing the PA role, but recommended changes to address the identified issues and “effectively embed the PA and AA roles into the NHS workforce.” Key recommendations relevant to PAs in primary care included:

• PAs should be renamed Physician Assistants and have a certification route to prescribing and ordering non-ionising radiation tests.
• PAs should not see undifferentiated patients except as defined in national protocols.
• PAs should have two years’ experience in secondary care first, and should have a named doctor appointed as their supervisor.
• Doctors should receive training in line management and leadership, with allocated time for supervisory duties and effective service management.

Responses and Implications

The review has generated considerable debate amongst professionals, with Dr Tom Dolphin, chair of the BMA, stating the report, “laid bare the catastrophic failures in NHS leadership that have put patients at serious risk of harm… The blurring of lines between doctors and non-doctors, aided and abetted by the GMC, has been an unfolding disaster for all to see, and many doctors today will be relieved to see that they were right to raise the alarm”

On the PA side, the United Medical Associate Professionals (UMAP) stated in response, “We want to make it explicitly clear, that we DO NOT accept the recommendations of the Leng Review. The review is unable to substantiate a legitimate patient safety concern and relies on conjecture to fill this void without referencing any of the real-world data submitted by UMAPs and CMAPs which demonstrated MAPs’ track record of safety.”

Implementation of the recommendations is complicated, as the report represents proposals rather than binding legislation or regulatory guidance. Responsibility for delivery rests with the Department of Health and Social Care, with some aspects delegated to organisations such as NHSE, GMC, Royal Colleges, and Unions. Recent communications from NHSE to practices have reportedly confused previous guidance, further contributing to uncertainty.

The current position of NHSE in terms of implementing changes is to leave decisions regarding changes to local policy and HR advice, although there is no definition of who might provide this, risking inconsistency in advice across the UK. In response UMAP has advised its members not to sign any new or varied contracts and instead lodge a “letter of protest” with their manager or HR representative if asked to do so as a result of the review.

Conclusion

This is a very brief overview of some of the issues, but like much of NHS reform, it appears that whilst the aims may be admirable, it is in the detail and practicality of execution that matters fall down.

Practices should navigate these waters with care, as not only may there be matters of patient safety or provision of services to contend with, attracting regulatory attention, but any proposed variations to employee contracts or working conditions need appropriate consideration and advice, as contravention of employees’ rights could ultimately result in claims or legal action.

How DR Solicitors can help

For support navigating the implications of the Leng Review and its recommendations for your practice, contact DR Solicitors for expert guidance and planning.

Sources

• The Leng Review
• RCGP PA Survey
• BMA statement by Dr Tom Dolphin, chair of the BMA council
• UMAPS statement