Independent Review of Physician Associates and Anaesthesia Associates

Wes Streeting Excerpts

Wednesday 16th July 2025 Written Statements

[The Secretary of State for Health and Social Care (Wes Streeting)]

In November 2024, I asked Professor Gillian Leng CBE to undertake an independent review of physician associates and anaesthesia associates in England, and to set out recommendations to ensure the safety of the roles and their contributions to multidisciplinary healthcare teams.

Today I want to update the House on next steps following the publication of the review.

Professor Leng sets out 18 recommendations that will give much-needed clarity, certainty and confidence to staff and patients. The Government are accepting these recommendations in full.

The overarching recommendations include: renaming the role of “physician associate” to “physician assistant” and “anaesthesia associate” to “physician assistant in anaesthesia” to reflect their position as a supportive, complementary member of the medical team; providing ongoing opportunities for training and career development; making it easier for others to identify these roles; establishing permanent faculties to provide professional leadership and set clear professional standards; greater clarity in the differences between the regulatory requirements of doctors and assistant roles; training in line management and leadership for doctors, with additional time allocated; redesigning models of multidisciplinary working; and improvements in safety reporting.

For physician assistants specifically, Professor Leng has recommended that their initial practice is clearly defined in line with job descriptions; they do not see undifferentiated patients (except within clear national clinical protocols); that newly qualified physician assistants should gain at least two years’ experience in secondary care, to enhance clinical skills, prior to taking a role in primary care or a mental health trust; and that they should form part of a clear team structure and have a named supervisor.

For physician assistants in anaesthesia, the review recommends full compliance with the existing Royal College of Anaesthetists scope of practice; that any further expansion of the role should be taken forward in conjunction with the Royal College of Anaesthetists; and that there should be an ongoing national audit of safety outcomes in anaesthesia, to gain assurance around the safety of the physician assistants in anaesthesia role.

Implementing the recommendations will require organisations to work together and take action. Some actions will be implemented immediately, while others will require wider input, with benefits being fully realised over time. I have asked NHS England to move with immediate effect to implement those recommendations which most directly affect patient safety, including moving to the use of physician assistants and physician assistants in anaesthesia titles and ensuring that physician assistants do not see undifferentiated patients, except within clearly defined national clinical protocols.

The NHS is its people, and physician assistants and physician assistants in anaesthesia can play a vital role in the delivery of the shifts set out in the 10-year health plan for England. The findings in this report demonstrate that, when integrated appropriately, physician assistants can improve access, enhance capacity, and provide continuity of care, while physician assistants in anaesthesia can help expand theatre capacity and flexibility in anaesthesia services.

However, the review is clear that change is needed. It sets out the fundamental issues that need to be tackled to effectively and consistently embed change into the NHS workforce. These recommendations provide a practical way forward on title, ongoing development and practice that we can all have confidence in.

I would like to express my immense gratitude to Professor Leng and her team for their effort and dedication in carrying out this considered, complex and comprehensive review. I also want to extend my thanks to all those who have engaged constructively with the review, including those resident doctors who have respectfully raised concerns, and physician assistants and physician assistants in anaesthesia who make valuable contributions across the NHS and have been subject to intense scrutiny.

We will consider Professor Leng’s findings and recommendation in detail in conjunction with the 10-year health plan. The lessons learned in the review will be embedded into the upcoming workforce plan to improve how we effect change in the NHS, and ensure the mistakes of the past are not repeated in the future. We will work with key partners, including NHS England in advance of publishing a fuller response, setting out a clear implementation plan to make the required changes in due course.

[HCWS830]