Health secretary launches independent review into safety of physician associates

Health secretary Wes Streeting has launched an independent review into the scope and safety of physician associates (PAs).

Having previously recognised the ‘legitimate concerns’ of doctors, Mr Streeting has now commissioned a review into PAs and anaesthesia associates (AAs) which will cover recruitment and training, scope of practice, supervision, and regulation. 

Mr Streeting said the review will ‘establish the facts’ and ‘take the heat out of the issue’, which he said has become a ‘toxic debate’. 

It will be led by Professor Gillian Leng, a former consultant in public health medicine and chief executive of NICE who is now president of the Royal Society of Medicine. 

The Department of Health and Social Care (DHSC) said Professor Leng will look at ‘how effectively these roles are deployed in the NHS’ in England only, and offer recommendations to inform the Government’s future workforce plans.

But the BMA has called on NHS England to implement ‘immediate safety measures’ in the meantime, saying ‘you do not fly a plane under safety review, you ground it’.

The independent review and next steps are due to be published in spring 2025, which will coincide with the expected publication of DHSC’s 10-year plan for the NHS and pre-empt a planned update to the NHS Long-term Workforce Plan next year.

Patients, NHS employers, professional bodies and academics will be invited to share views on PAs, and Professor Leng said she aims to gather evidence from both the UK and abroad to ‘reach a shared understanding of these roles’.

The review will examine the safety and effectiveness of the 3,500 PAs who currently work across the NHS in England, over half of whom are based in GP practices. 

It will also seek to ‘increase transparency’ around PAs and AAs, looking at measures to ensure patients know when they are interacting with these roles.

The health secretary hinted at a possible review last week, saying he needs to ‘take stock’ of concerns around PAs before putting ‘the foot down on the accelerator’ to expand the role. And, according to a report in The Telegraph, the review will look at whether PAs should be allowed to see undifferentiated patients.

Today, Mr Streeting said that many PAs are ‘providing great care’ and ‘freeing up’ doctors’ time, but that there are ‘legitimate concerns over transparency for patients, scope of practice, and the substituting of doctors’. 

‘These concerns have been ignored for too long, leading to a toxic debate where physicians feel ignored and PAs feel demoralised,’ Mr Streeting added. 

Of the review, he said: ‘This independent review, led by one of the UK’s most experienced healthcare leaders will establish the facts, take the heat out of the issue, and make sure that we get the right people, in the right place, doing the right thing.’

The Academy of Royal Colleges last month called on the health secretary to order a ‘rapid review’ of the safety and efficiency of PAs, arguing that the current debate around the roles is ‘almost devoid of factual information’. 

Other medical organisations, such as the RCGP and the BMA‘s GP Committee, have taken a stance in complete opposition to PAs working in general practice.

Responding to the review launch today, Professor Leng said: ‘To promote patient safety and strengthen the NHS workforce, it’s crucial that we have a comprehensive review of the role of PAs and AAs. This will cover recruitment and training, scope of practice, supervision and professional regulation.’

NHS England chief executive Amanda Pritchard said PAs are ‘important members of NHS staff’ and they ‘deserve to be treated with the same respect as anyone else coming to work in the NHS’. 

She continued: ‘While we have always been clear that they are not replacements for doctors, there are clear and ongoing concerns which we are listening to carefully and taking action to address – this independent review marks our pledge, together with the government, to getting this right.’

BMA council chair Professor Phil Banfield said the NHS must set out ‘how they are going to keep patients safe while this review is carried out’.

He said: ‘You do not fly a plane under safety review, you ground it. So we need to know what immediate safety measures NHSE will put in place, how quickly they will pause their PA expansion plans, and in the meantime if they will adopt the BMA’s own guidelines to start protecting patients now.’

Professor Banfield also said the review ‘must lead’ to a ‘nationally agreed scope of practice’ for PAs which ‘will clear up this mess’.

The RCGP said that a ‘comprehensive and evidence-based review’ of PAs is ‘necessary and welcome’ given doctors’ concerns and NHS England’s goal to expand the role to 10,000 by 2036.

College chair Professor Kamila Hawthorne pointed to the RCGP’s recent scope for PAs, which severely limits their current practice, and said the college recognised ‘this has been a challenging situation for all involved’.

She continued: ‘This is why it is vital to have a transparent and thorough review, which must focus on the best interests of patients and their safety, and draw on the experiences of GPs, and other doctors working across the health service. The College looks forward to feeding into it.’

The Doctors’ Association UK welcomed the review ‘at such a critical moment’ and ‘so soon’ after the health secretary has come into post.

DAUK chair Ms Helen Fernandes said they were ‘early advocates for pausing’ PAs and AAs, and that their rollout ‘must now be stopped while the review is conducted’.

She continued: ‘The review needs to address concerns that the scope of medical associates should be nationally standardised, led by the regulator and not delegated to NHS trusts that have consistently failed to engage [medical associate professionals] safely.’

‘This process may be unsettling to many PAs and AAs, the teams they work for, and the patients they are seeing, which is why we want to see it conducted and concluded in a timely manner without affecting the quality and depth of the review,’ Ms Fernandes added.

NHS Employers chief executive Danny Mortimer also welcomed the review, arguing that NHS leaders and medical representative bodies have ‘struggled to find constructive and coherent ways to respond to the public’s concerns’ about PAs.

‘At times, the responses have lacked courtesy and compassion, particularly for those in these professions,’ he said. 

Mr Mortimer continued: ‘Professor Gillian Leng has widely respected credentials as an evidence-based clinician and leader, and her review provides an opportunity to take a careful examination of these roles, particularly in light of their forthcoming regulation by the General Medical Council.’

GMC chief executive Charlie Massey said the discussion around PA and AA roles and deployment ‘needs to be addressed’ and the independent review ‘is an important step towards achieving that’.

He added: ‘We are also pleased the government has reaffirmed its commitment to bringing PAs and AAs into regulation, following its request to us in 2019  to take on this essential role.

‘These roles are an important part of the health system, but they are currently unregulated. Regulation is a vital step towards strengthening both patient safety and public trust in these professions.’

This week, the BMA called for ‘full transparency’ from the GMC regarding their position on PA scopes of practice.

There is currently no nationally-agreed scope of practice for PAs, with multiple organisations – including the BMA, the RCGP, and the Royal College of Physicians (RCP) – producing their own versions. 

The GMC has been clear that it will not itself set out a scope for PAs once they come under regulation next month. About other bodies’ scopes of practice, the GMC has told Pulse PAs will require ‘individual’ scopes, although its fitness-to-practice proceedings will ‘have reference’ to scopes produced by royal colleges.