High Court considers challenge to implementation of Leng Review

A High Court judge is considering whether a legal challenge to the implementation of the Leng Review should proceed to a full judicial review, following an oral hearing held this week. A decision is expected in the coming weeks.

The case concerns decisions taken by the Government, NHS England and Professor Gillian Leng following publication of the independent review into physician associates (PAs) and anaesthesia associates (AAs). The review’s recommendations, which were accepted in full by ministers, have reshaped the future direction of the associate professions across the NHS.

The court hearing was not a substantive examination of the review itself. Instead, it focused on whether there are sufficient legal grounds for a judicial review to proceed. If permission is granted, a later hearing would examine the lawfulness of the decisions made in response to the review and the process by which they were adopted.

Published in 2025, the Leng Review was commissioned amid growing debate about the role of physician associates and anaesthesia associates within clinical teams. It examined issues including patient safety, professional responsibilities, supervision arrangements and public understanding of the roles. Among its recommendations were proposals to restrict the circumstances in which associates can see undifferentiated patients and to introduce new role titles intended to improve clarity for patients. The recommendations were accepted by the Government on the day the review was published.

The legal challenge argues that the decisions to accept and implement the recommendations were flawed and questions the evidence and decision-making processes underpinning them. Supporters of the challenge maintain that the review did not identify evidence demonstrating associates were unsafe and have raised concerns over consultation, stakeholder influence and the absence of a published impact assessment before implementation.

Those defending the review have argued that it was an independent and evidence-based exercise intended to strengthen patient safety and provide greater clarity around the deployment of associate professionals. In an earlier decision refusing permission on the papers, the High Court found the review had been produced through an independent exercise of judgement and rejected allegations that its conclusions were influenced by efforts to appease particular stakeholder groups.

The dispute has become one of the most significant legal tests arising from the long-running national debate over the role of associate professions in healthcare. The outcome of the current proceedings could determine whether the courts undertake a more detailed examination of how the review’s recommendations were developed, accepted and implemented.

Mr Justice Sheldon has reserved judgment, with a ruling on whether the case can proceed expected in the coming weeks.