This submission provides a comprehensive evaluation of the role, impact, and governance of Medical Associate Professionals (MAPs) within the United Kingdom healthcare system. The report, submitted by the United Medical Associate Professionals (UMAPs) and the College of Medical Associate Professionals (CMAPs), draws on extensive research, audits, and feedback from clinicians, supervisors, and patients. It serves as a key contribution to the Leng Review, a national inquiry assessing the safety and effectiveness of Physician Associates (PAs) and Anaesthesia Associates (AAs) in primary and secondary care settings.

The report contains evidence relating to these arms: Patient Access, Patient Safety, Patient Protection, and Colleague Impact.

MAPs play a crucial role in alleviating workforce pressures, particularly in primary and secondary care specialties experiencing recruitment shortages. Their presence has enhanced continuity of care by providing long-term stability in clinical teams, unlike rotating resident doctors. Supervisors report high satisfaction with PAs and AAs, citing their ability to manage patient caseloads effectively under appropriate supervision.

PAs improve patient access, reduce appointment backlogs, and contribute to chronic disease management. AAs enhance perioperative services, ensure theatre efficiency and reduce reliance on locum anaesthetic staff.

PAs provide essential support by addressing physical health concerns in patients with severe mental illness, assisting in clozapine titration, diabetes management, and reducing restrictive interventions. The Royal College of Psychiatrists were recently expanding PA recruitment in mental health settings, reinforcing their value within multidisciplinary teams.

Clinical audits confirm that MAPs deliver safe and effective care, with comparable patient outcomes to their medical colleagues. From a small sample size, no significant increase in serious incidents or never events have been associated with the employment of PAs, reinforcing their safety within their scope of practice. Supervisors overwhelmingly trust MAPs’ clinical decision-making abilities, provided appropriate governance structures are in place. Patient satisfaction is high, with MAPs receiving positive feedback for communication, thorough assessments, and holistic care. However, delays in patient care have arisen due to scope of practice restrictions, including the lack of prescribing rights and the inability to request ionising radiation.

Governance structures for MAPs vary significantly across NHS Trusts and Primary Care, with inconsistent policies on supervision, career progression, and professional development. Most MAPs have structured supervision, but dedicated educational supervision time is inconsistently allocated, with some supervisors reporting lack of Supporting Professional Activities (SPA) time. Recent changes to the Royal College of Anaesthetists’ Scope of Practice for AAs have created uncertainty, with some NHS Trusts reducing AAs’ clinical responsibilities. Supervisors support clearer national guidance on MAP integration, advocating for structured frameworks similar to medical training pathways.

PAs contribute significantly to improving the efficiency of hospital discharge processes by assisting with Transfer of Care letters, reducing administrative burden on doctors and expediting safe patient discharges. In one study, PA involvement in documentation was found to save up to 320 hours of resident doctor time per week with 92 per cent of respondents (50 per cent strongly agreed, 42 per cent agreed) that PA involvement speeds up discharges and reduces workload.

Public perception of MAPs remains an area requiring improvement. Media narratives have contributed to misconceptions about MAPs, particularly concerning their autonomy and role within multidisciplinary teams. Patient confusion about the PA role persists, with some assuming they are doctors, despite efforts to clarify professional identity. Structured public education campaigns are needed to enhance awareness and acceptance of MAPs within the NHS.

Further evidence highlights the considerable wellbeing impact experienced by MAPs in the current professional climate. Survey data submitted as part of this review show that 96 per cent of MAPs reported their mental health had been negatively affected by the prevailing environment, which many described as ‘an anti-MAP campaign’. These impacts extend to both home and work life, with many respondents citing media coverage, social media hostility, and restrictive scope of practice guidance issued by professional bodies as key contributors to their distress.

Workplace bullying and harassment were alarmingly common. Thirty-eight per cent of qualified MAPs reported bullying in the workplace, 36 per cent experienced online harassment, and 40 per cent of student MAPs experienced bullying during clinical placements. The consequences have been severe, with 46 per cent of respondents reporting that these experiences contributed to them either leaving their post or seriously considering doing so. Female MAPs and those from ethnic minority backgrounds were disproportionately affected, with 35 per cent of dismissals occurring amongst MAPs from Black, Asian or minority ethnic groups despite lower overall representation in the workforce.

The impact on patient care has also been significant. Scope of practice restrictions have directly impeded MAPs’ ability to provide timely care, with respondents reporting increased waiting times, delays in diagnosis, and rising dissatisfaction among patients. Many described a reduction in job satisfaction and feelings of being undervalued, with negative effects on both professional engagement and team cohesion.

Support from employers was perceived as lacking. Nearly one quarter of respondents rated their institutional support at the lowest level on a scale of one to ten. In contrast, confidential and MAP-specific support initiatives received overwhelming endorsement. Respondents strongly supported the establishment of a CMAPs-backed counselling service and a national Mental Health Hub to provide targeted, accessible, and ongoing psychological support for MAPs.

Statutory regulation for MAPs was urgently demanded by supervisors to standardise professional accountability and enhance public confidence. Now that the General Medical Council has commenced regulation of the roles, this development is expected to foster greater confidence and stability. Prescribing rights and the ability to request ionising radiation should be granted, allowing MAPs to work more efficiently within their competencies. Nationally standardised post-qualification training and career progression frameworks should be developed, ensuring consistency in MAP supervision and development. CMAPs and UMAPs have commenced the production of such governance and should be supported in continuing that work. Further investment in workforce planning is needed to expand MAP roles strategically, ensuring alignment with NHS service demands. 

MAPs have the potential to work as part of a multidisciplinary team to improve training for resident doctors rather than detract from it. Enhanced interprofessional collaboration and leadership support will optimise MAP integration, fostering a cohesive multidisciplinary workforce that benefits clinicians and patients. CMAPs is also looking to institute the Medical Associate National Audit to utilise anonymised submitted MSF and Patient Feedback forms through the e-portfolio to obtain a yearly live audit that can be reported on to stakeholders and the public. 

The findings of the national wellbeing survey make clear that MAP wellbeing is not a matter of individual resilience, but a systemic workforce issue. Policies from professional bodies must be developed in collaboration with MAP leadership and subjected to scrutiny for discriminatory or exclusionary impacts. Professional dignity and psychological safety are essential preconditions for workforce retention, patient safety, and service delivery.  

With appropriate policy reform, mental health investment, and structural inclusion, MAPs can continue to contribute effectively to high-quality patient care and NHS sustainability. 

On behalf of the UMAPs & CMAPs National Enquiry Research Group, 

PA Stephen Nash
UMAPs & CMAPs National Enquiry Research Group Lead
General Secretary UMAPs TU

 

National Enquiry Research Group: 

PA Alice Fitzpatrick	PA Mobashar Rashid
AA Anna Hardy	PA Nellie Redman
PA Brogan Guest	PA Ross Raymond-Jones
PA Emma Glen	PA Sandra Ukah
AA Emma Pelech	PA Sophie Newbold
PA James Pawsey	PA Victoria Lefeuve
PA Krishna Gnanaseelan	Maria Herdt (MAC COO)
PA Michelle Reston