The Leng Review: Physician Assistants in General Practice – what has changed

Key changes from the Leng Review on Physician Assistants in General Practice, and what practices need to do now.

Date published:
Date last updated:
Next review date:

The Leng Review has set out major changes to the role of Physician Associates, now to be renamed Physician Assistants, in General Practice. NHS England has already issued guidance and is expected to adopt most of the recommendations in full.

Key changes for practices

  • The role is renamed as Physician Assistant. Employers should adopt this terminology in all communications, pending legislation.
  • Newly qualified Physician Assistants are expected to gain early post-qualification experience in secondary care before moving into primary care roles.
  • Physician Assistants should not assess undifferentiated patients except within nationally approved clinical protocols. Practices should ensure clinical deployment reflects current national guidance and local governance arrangements.
  • Each Physician Assistant must work within a clear team structure with a named supervising GP taking overall responsibility.
  • Physician Assistants must be readily identifiable, with badges, lanyards, and patient information that clearly distinguish them from GPs.
  • Practices should continue to provide training and development within a recognised framework of skills and expertise.
  • The GMC will regulate Physician Assistants, but requirements will be distinct from doctors. Updates to GMC publications are expected.
  • Patient safety reporting should use the new LFPSE process for general practice so that incidents can be analysed by professional group.

What practices need to do now

  1. Update terminology to Physician Assistant in staff lists, websites, job descriptions, and patient information.
  2. Review clinical deployment to ensure PAs are not allocated undifferentiated patients or triage roles. If taking a different approach, record clear reasons and justification.
  3. Confirm and document the named supervising GP for each PA.
  4. Check patient communications and identification measures so patients understand who they are seeing.
  5. Continue to support training and CPD opportunities.
  6. Monitor GMC guidance and adapt policies once new requirements are published.
  7. Use the LFPSE system for recording safety incidents by staff role.
  8. Take HR advice before making any contractual or employment changes for existing PAs. Remember that PAs may also be taking advice from their union (UMAPs).

LMC advice letter

Written: 28 August 2025

I am writing to draw colleagues attention to the publication of the Leng Review, available at: The Leng review: an independent review into the physician associate and anaesthesia associate professions

The review was set up to consider the future role of both Anaesthetic Associates (AAs), who work entirely within a hospital setting, and Physicians Associates (PAs) who work within both primary and secondary care. In June 2015 the then Secretary of State, Jeremy Hunt, announced that 1000 PAs would be recruited within General Practice to assist in tackling workforce pressures. At the time there were fewer than 20 PAs employed in primary care. This process was accelerated by the inclusion within the ARRS reimbursement programme of PAs, resulting in a peak workforce of over 2000 FTE PAs in June 2024. These were employed within 577 practices and over 400 PCNs covering all seven NHS Regions, but proportionally highest in London. Since then recruitment has fallen gradually.

As colleagues will appreciate, there has been increasing concern and scrutiny of PA roles over the past few years, but this has primarily focussed on the impact that PAs [and AAs] might have on other professionals, particularly doctors in training, rather than concerns about the quality of work that is being undertaken by PAs. Patient satisfaction with PA consultations is usually positive. This dichotomy has created challenges for those who work with PAs in General Practice, where they are usually valued colleagues within the practice team. There have also been well publicised individual tragic incidents involving patients who received care from PAs, but the main concerns raised by the public focussed on a confusion over the role with many patients assuming they had seen a doctor.

Significant further developments were the disasterous Royal College of Physicians EGM in March 2024, essentially leading to the resignation of the College President, the opposition of the Royal College of General Practitioners to Physicians Associates working within General Practice, and the BMAs development of ‘scope of practice’ guidelines which the LMC encouraged all colleagues employing PAs to review at the time.

Fundamentally, however, the Leng Review has concluded that an overwhelming lack of confidence from within the medical profession, even if not so widely discernable in General Practice in comparison with other branches of practice, makes it impossible to continue current arrangements, since any lack of medical support for PAs and AAs on a professional basis, even if not an individual personal view, means the roles need to be modified to enable both sets of professional colleagues to work successfully together. At the same time, the Leng Review does not advocate the abolition of the roles.

Following the publicaiton of the Leng Review the BMA and RCGP will be reconsidering their guidance, but continue to advise that PAs should not see undifferentiated patients as the first responsible clinician. The DHSC have acted very promptly and the day after the Review was published sent the following letter to NHSE: Response to the recommendations of the Independent Review of Physician Associates and Anaesthesia Associates (the Leng Review).

The speed of their response suggests the Leng Review is likely to be accepted either in full of almost completely.

The full list of recommendations is within the review, but those of most relevance to General Practice are:

  • Renaming the role as Physicians Assistant rather than Physicians Associate; the DHSC has already requested all employers do so, pending legislative changes to be made.

  • Continuing the opportunity for on-going training and development within a recognised framework of expected skills and expertise; General Practices should continue to offer this as to all employees.

  • Physician Assistants should not see undifferentiated patients [“except within clearly defined national clinical protocols”] which do not currently exist as NHS England recommentations. The NHSE has already (as above) advised that PAs should be withdrawn from “EDs and primary care” in terms of both triaging patients and seeing undifferentiated patients. Current guidance is likely to be developed by the RCGP and BMA; however, it is important colleagues consider the implications of responding to a patient complaint or claim if not following such NHS England guidance – that is, there would need to be a clear, documented, set of reasons to justify why an alternative approach was taken within practices.

  • Physician Assistants should be part of a clear team structure with a named doctor
    taking overall responsibility for their role; this should already be the norm in General Practice.

  • Physician Assistants should be readily identifiable as such, with badges, lanyards, and staff information that in particular distinguishes them from General Practitioners.

  • GMC requirements for regulation of Physician Assistants should be distinguished from doctors even though the GMCs role in Regulating these professionals will continue. The GMC , if this is accepted, will need to rewrite its guidance and information material.

  • Safety reporting across the NHS should be reconfigured to enable a review of data on patient safety incidents by professional groups, since this was a question asked of the Leng Review in relation to PAs, that could not be properly answered because of the way centrally accessible information was recorded. I would remind colleagues the LFPSE process has been introduced for General Practice within the 2025/26 Contract.

Colleagues who currently employ PAs should be aware many may be members of United Medical Associate Professionals (UMAPs), the Union supporting PAs. They have issued a series of updates for their members following publication of the Leng Report, and the NHS guidance noted above. These are available at: UMAPs.org.uk.

Finally, I would like to also highlight a more recent NHSE FAQ document, available at: leng-review-nhs-england-faqs-on-actions-for-nhs-organisations.pdf

This reminds colleagues of the LMCs own advice, that GPs should take HR advice before making any substantive changes in the employment arrangements of current PAs within their practices or PCNs, and this also reflects the advice UMAP members are receiving from their Union.

I hope this background is helpful; obviously it is for individual practices, supported by ARRS funding if appropriate, to decide whom to recruit in a way that best meets the needs of their practice and patients. However, the Leng Review was commissioned to try and address the widespread concerns about the role of PAs and hopefully these recommendations, if properly implemented, will do so.

Dr Julius Parker, Chief Executive

CNSGP

The below advice can be seen on the CNSGP FAQ pages by expanding the Clinical Negligence Scheme for General Practice

NHS Resolution can confirm that Physician Associates (PAs) working for general practice who are carrying out activities connected to delivering NHS primary medical services on behalf of the provider under a primary care contract in England, namely one which falls within Part 4 of the NHS Act 2006 (GMS, PMS and APMS arrangements), will be indemnified under the Clinical Negligence Scheme for General Practice (CNSGP) for clinical negligence liabilities arising from incidents that occurred on or after 1 April 2019.  This is because CNSGP provides indemnity cover for all GPs and staff working under an NHS GP contract in England in respect of liabilities in clinical negligence.

This indemnity extends to activities carried out by PAs which are connected to the delivery of other NHS services provided by general practice and known as ‘Ancillary Health Services’ where these services fall within the relevant definition in regulation 2 of the CNSGP Regulations.

GP partners/GP principals and other clinical staff responsible for the supervision of PAs within general practice can also be reassured that they will be indemnified as above, in respect of incidents involving PAs which result in a clinical negligence claim that is brought against the partners/principals or practice, or where their role in the incident involving the actions of a PA and resulting in a claim was limited to supervision of the PA.

Please note that indemnity under CNSGP is for liabilities in clinical negligence only. The scheme does not provide indemnity cover for non-clinical matters, advice or professional (regulatory) matters. We would recommend indemnity cover be obtained from an MDO or other indemnity provider for those matters outside the scope of CNSGP, such as non-NHS work.

For any enquiries please contact:[email protected]
You may also find the following resources helpful:
CNSGP (GPI) scheme scope document
GPI reporting flowchart


Related content