The Office of Physician Associates (OoPA) at College of Medical Associate Professionals (CMAPs) acknowledges the publication of the final report from Professor Leng’s review into the roles of Physician Associates (PAs) and Anaesthesia Associates (AAs), following an eight-month consultation process. The report is now publicly available via the UK Government website.
Context and Acknowledgement
This report marks a significant moment for the future of Medical Associate Professionals within the UK’s healthcare landscape. The review was conducted amid a period of intense scrutiny and public discourse regarding the evolving contribution of PAs and AAs. Professor Leng herself has acknowledged that no other profession has faced such scrutiny in their existence. Throughout this process, PAs and AAs have continued to deliver safe, effective, and patient-centred care across a wide range of clinical settings.
Constructive Acknowledgements
OoPA acknowledges the report’s confirmation that there is no basis for abolishing the roles of Physician Associates or Anaesthesia Associates. The review appropriately recognises the contribution of PAs in improving care access and delivering continuity for patients.
OoPA also welcomes the report’s recommendations to support the development of advanced roles, including potential prescribing authority and t request non-ionising radiation. These are critical steps in modernising the profession and integrating it effectively into the wider NHS workforce.
Career Framework & Advanced Practice
OoPA welcomes the review’s endorsement of a structured career framework for Physician Associates, with clear pathways to advanced-level practice. The recommendations acknowledge the need to formalise progression opportunities for PAs, supporting both professional development and workforce sustainability.
Specifically, the report outlines the potential for a two-year consolidation period post-qualification, during which PAs would undertake further training and demonstrate increasing levels of autonomy within supervised practice. Building upon this foundation, PAs would then be eligible to pursue accredited training modules, which in time may be sanctioned by relevant faculties or educational bodies, to attain advanced practice status. At present, there is no clarity on how this be applied to currently working experienced PAs, and OoPA implores Professor Leng to consider this with urgency.
The inclusion of prescribing rights and the ability to request non-ionising within this advanced scope reflects a meaningful step toward recognising the evolving clinical contribution of the PA profession. OoPA strongly supports this direction and stands ready to assist in shaping and delivering these advanced training pathways in collaboration with medical and regulatory stakeholders. However, the report lacks clarity on why PAs are not recommended to request ionising radiation, with appropriate IR(MER) training and robust guidance. The rationale for excluding the ability to order ionising radiation remains unclear.
Areas of Serious Concern
OOPA has grave reservations about several key recommendations emerging from the review.
1. Proposed Title Reversion
The recommendation to revert the professional title from Physician Associate to Physician Assistant is misaligned with current legislation, professional identity, and public understanding. It risks introducing ambiguity into workforce planning and public communication. The title Physician Associate was established in UK statute to reflect the unique nature of the role within this healthcare system. A name change of this kind would undo years of progress in role clarity and professional engagement. The department of health have recently announced that a ‘physician associate’ should now be referred as a ‘physician assistant’ with immediate effect.
2. Clinical Scope Restrictions
The recommendation that PAs should not see undifferentiated or untriaged patients is a significant constraint on the operational flexibility of multidisciplinary teams. Such restrictions are not consistent with current safe practice or the supervisory frameworks under which PAs already operate. Professor Leng’s review highlights evidence that proves the safety and effectiveness of PAs in these settings, and such a rrecommendation in contrast to the evidence, without further immediately available instruction on how experienced PAs are to practice is deeply troubling. Any new practice standards must be evidence-based, proportionate, informed by frontline realities and available with urgency to safeguard practising PAs and their patients.
3. Professional Leadership and Representation
OoOPA is particularly disheartened by the recommendation to establish a permanent faculty to provide professional leadership for Physician Associates, to be led by a relevant medical royal college or the Academy of Medical Royal Colleges. This proposal would effectively strip PAs of an independent, representative voice at a time when such input is more critical than ever.
CMAPs is a functioning, collaborative, and forward-facing professional body, founded specifically to represent the unique needs of Medical Associate Professionals. It has actively sought to work alongside medical royal colleges and regulatory stakeholders to develop shared, clinically appropriate standards. To bypass this established institution, in favour of structures that do not include dedicated PA leadership, is both counterproductive and disheartening.
This is not a hypothetical risk. A previous iteration of such a model under the Royal College of Physicians (RCP) failed to provide meaningful representation for PAs and ultimately led to the censorship of their professional voice. To repeat this approach now, rather than build upon existing, inclusive infrastructure, risks compounding past mistakes.
Commitment to Engagement
CMAPs remains open and willing to engage with the Department of Health and Social Care, NHS England, statutory regulators, and relevant medical institutions such as royal colleges to address the implications of this report. We remain steadfast in our commitment to ensuring that any structural, regulatory, or policy changes protect the safety of patients, the effectiveness of clinical teams, and the dignity of Medical Associate Professionals across the UK.
