Report shows Leng review impact on PAs and AAs

A new survey of physician associates (PAs) working across NHS England indicates that the recommendations arising from the Leng Review have led to significant changes in how PAs are deployed, supervised and utilised in clinical settings. The findings, published by UMAPs, outline reported effects on patient access, departmental workload and continuity of care.

The survey, conducted between December 2025 and January 2026, gathered responses from 459 PAs across general practice, urgent and emergency care, and secondary care. According to the data, 76% of respondents said their scope of practice had been restricted since the review’s publication in July. Many reported a reduction in the number of patients they were able to see per shift, with a marked increase in PAs reporting only one to five patient interactions compared with pre‑review levels.

Respondents linked these changes to longer waiting times. Two in five PAs said waiting times had worsened in their departments, with those in urgent and emergency care reporting delays in clinical review. In general practice, the proportion of PAs reporting average waiting times of under a week fell from 40% to 26%. Several respondents described situations in which they were unable to assess patients despite being available, citing revised supervision requirements.

The survey also suggests an impact on doctors’ workloads. Just over half of respondents said their supervising consultant or GP had experienced an increase in workload as tasks previously undertaken by PAs were redirected. Some PAs reported that increased supervision requirements had reduced efficiency within teams.

Beyond operational pressures, respondents highlighted effects on continuity of care and administrative processes. Several PAs said that established patient relationships had been disrupted due to changes in booking protocols and restrictions on follow‑up appointments. Others noted confusion among administrative staff regarding which patients could be booked with PAs under the revised arrangements.

UMAPs General Secretary Stephen Nash said the findings demonstrate the scale of the impact on the PA and AA workforce, as well as on patient access. He argued that the recommendations were implemented without adequate assessment of their consequences and confirmed that the organisation will use the evidence to support its ongoing judicial review against the Health Secretary, NHS England and Professor Leng.

UMAPs expects a permission‑to‑proceed hearing in the spring, with the full case anticipated later in the year. The organisation said the survey results will also inform its wider engagement with policymakers and NHS England.

The survey sample included PAs from all NHS England regions, with 47% working in general practice and 27% in urgent and emergency care. More than half of respondents had over five years’ experience in the role. Fieldwork took place between 17 December 2025 and 14 January 2026.

The conditions imposed require the trust to:

• Ensure appropriate staffing and the presence of qualified educators able to deliver effective clinical supervision and maintain safe rotas.
• Establish a culture that enables trainees to raise concerns about patient safety, wellbeing, and training openly and safely, while supporting adherence to clinical standards and continuous improvement.
• Put in place mechanisms that protect trainees from sexual misconduct, misogyny, and undermining behaviours, in line with equality, diversity and inclusion principles.
• Implement governance systems that demonstrate board‑level accountability for patient safety, education and training, including appointing an executive lead responsible for delivering the required improvements.

The programme has been under enhanced monitoring since July 2025, following intelligence gathered through the GMC’s national training survey and its regional outreach teams. Enhanced monitoring is used when significant risks to training or patient care are identified, and may escalate to conditions or removal of trainee approval if concerns persist.

The GMC has stated that conditions will remain in place until the trust provides robust evidence of improvement across culture, supervision, staffing and governance.

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