Professor Gillian Leng CBE 
The Leng Review 
Department of Health and Social Care 

Dear Professor Leng, 

Re: Status of the recommended national protocols for Physician Associates, and clarity for experienced Physician Associates 

I am writing formally as President of the Office of Physician Associates at the College of Medical Associate Professionals (CMAPs), the professional standards body for Physician Associates (PAs) and Anaesthesia Associates (AAs), to seek clarification on the status of the recommended national protocols for PAs arising from your review. With the first anniversary of the review’s publication now imminent, and given the continued uncertainty experienced by Associates, employers and supervisors, we believe it is important to seek clarification at this stage.  

In the interests of transparency for our members and the wider community of Associates, employers and patients, we intend to publish this letter as an open letter on the CMAPs website. We wanted to make you aware of this in advance and would of course welcome your response being shared in the same way. 

We understand that publication of the national protocols was anticipated by the end of June to early July 2026. We now approach mid-July, and the first anniversary of the publication of your review is only days away. We would be most grateful for an updated timeline regarding publication. As I’m sure you can appreciate, we anticipate publication of your protocols to have consequences comparable to the Leng Review 2025 and need to be as prepared as possible to support our members and the whole profession.  

Separately, during the CMAPs-hosted webinar in June 2026, you confirmed that you “have no power to say what happens with experienced PAs,” and that where a PA is working in a supported role, and their supervisor considers them safe to do so, “they should continue to do so.” We were grateful for this clarification, but this position has not, in our view, been communicated clearly, consistently or authoritatively over the past twelve months to PAs, their employers, supervisors, or patients.  

We are therefore writing to formally request the following. We would be grateful if your response addressed each point in turn, in writing, by 28th July 2026 (two weeks from the date of this letter): 

1. A status update. A clear statement of the status of the national protocols, together with a realistic, dated timeline for their publication. 

2. Sight of the process mapping. Access, as a recognised stakeholder, to the process mapping that underpins the recommendations, including the outputs of the Multidisciplinary Team (MDT) discussions and the summaries of Clinical Advisory Panel (CAP) input. This has previously been requested of the secretariat via email.  

3. An unambiguous, written statement on experienced PAs. Written confirmation, suitable for onward publication to PAs, employers, supervisors and patients, that the forthcoming protocols apply to newly qualified PAs, and that experienced PAs working in supported roles, where their supervisor judges them safe to do so, should continue to do so as they were prior to the Leng review publication. We would ask that this confirmation specify how and by when it will be actively communicated to these audiences, rather than left to be inferred from webinar remarks or informal channels, as has been the case for the past twelve months. 

Should any of these three requests not be capable of being met in full by the date above, we would ask that you set out clearly, in writing, the specific reasons why, and an alternative date by which it can be met, so that we may provide our members, employers and patients with accurate and timely information. 

We recognise the scale and complexity of the work you and your team are undertaking, and we do not underestimate it. Our aim in writing is constructive: to ensure that Associates, supervisors and patients are supported through this process with the clarity and transparency they deserve. We would welcome a response and would be glad to discuss any of the above with you or your team at a mutually convenient time. 

We look forward to hearing from you. 

Yours sincerely, 
Alice Fitzpatrick 
President, Office of Physician Associates 
College of Medical Associate Professionals (CMAPs)