Classification: Official
Publication reference: PRN02074
To:
- Physician associates
- Anaesthesia associates
Dear colleagues
Response to the recommendations of the Independent Review of Physician Associates and Anaesthesia Associates (the Leng Review)
We are writing to you following the publication of the independent review into the roles of physician associates (PAs) and anaesthesia associates (AAs), led by Professor Gillian Leng.
As you will know, the Secretary of State for Health and Social Care commissioned this review to explore a number of key areas, including the relative safety of the roles, their contribution to effective and productive multidisciplinary teams, and their impact on delivering high quality and efficient patient care across a range of settings.
We recognise that the national conversation around your roles has, at times, been difficult. We welcome the findings of the review as a pivotal moment to provide a clear reset, enabling us all to move forward with greater clarity, confidence, and support.
We want to begin by acknowledging the vital and valued contributions that PAs and AAs make every day in supporting the NHS to deliver safe and effective care. The future of the NHS depends on a skilled, multidisciplinary workforce, and this review has helped bring together the views of patients, clinicians, and international experts. Its insights have informed recommendations about how we can better integrate your roles into clinical teams in a way that is safe, sustainable, and supported, with the right supervision and professional development in place.
We understand that the recommendations set out in the report may raise some questions. We have written to employers setting out their responsibility to continue to support their PA and AA workforce as we work collectively to implement the recommendations of the review. This letter is intended to provide clarity on what those recommendations mean for you, both in the immediate and longer term.
Immediate changes
In the short term, we expect employers to continue to support you with the following immediate actions, in line with the review’s findings:
- New role titles should be adopted with immediate effect. If you are:
- a ‘physician associate’, you should now be referred to as a physician assistant (PA)
- an ‘anaesthesia associate’, you should now be referred to as a physician assistant in anaesthesia (PAA)
- Changes to deployment – PAs currently working in primary care, emergency departments, or any other setting must:
- not triage patients
- not see undifferentiated patients
- Your employment will continue and your employer will work with you to realign your role to the activities described in the review’s template job descriptions if you are new in post. This will include your ongoing involvement in the management of patient care. More experienced PAs should have their roles reviewed by their named supervisor to confirm they have the appropriate skills and training and to modify the roles if necessary.
- We expect that your employer will continue to support you with professional and pastoral care, and we encourage you to speak with your supervisor or line manager about how to access this.
As set out in the review, there are a number of longer-term recommendations that require further engagement and collaboration to inform a medium to longer term implementation plan. This will include the development of national clinical protocols and professional standards to support you further in developing and executing your role.
We want to make sure that you have the support you need to carry out your role as a PA or PAA to the best of your ability for your patients, just like any other member of staff working in the NHS.
If you have any concerns or are worried in any way, we encourage you to speak with your supervisor or line manager. NHS England has also introduced a confidential text support service for all NHS staff that can be accessed by texting SHOUT to 85258. This service is available 24/7, alongside a range of additional support offers to suit a range of different health and wellbeing needs. More information can be found on our Supporting our NHS people web pages.
Supporting our multidisciplinary workforce
As Co-National Medical Directors, we want to be clear about the culture we expect to see reflected in everyday behaviours across all organisations: a culture grounded in listening, learning, and improvement. One where staff and patients are treated with respect, compassion, and collaboration, so that our colleagues can thrive and our patients receive the safest and highest quality care.
A key part of building productive multidisciplinary teams that are fit for a future-facing NHS is continuing to listen, learn, and act on the full range of insights available. This is essential to ensuring patient safety, staff wellbeing, and public confidence.
Our 10 Year Health Plan, based on the largest listening exercise in NHS history, has given us a renewed opportunity to focus on the future and deliver meaningful change. It sets clear standards for how we recruit, retain, and support staff, and how we reform education and training to reflect the realities of multidisciplinary working and the increasing demands on our health and care system.
Thank you, not only for your continued service, but for your hard work and commitment to delivering the very best care for patients.
Yours sincerely,
Dr Claire Fuller, Co-National Medical Director, (Primary Care), NHS England
Professor Meghana Pandit, Co-National Medical Director (Secondary Care), NHS England