Review calls for physician associates to be renamed and restricted to supportive clinical roles

Physician associates (PAs) and anaesthesia associates (AAs) working across NHS hospitals and GP surgeries should be renamed “assistants” and wear clearly distinguishable uniforms to avoid confusion with doctors, according to an independent review published today.

Commissioned by the health secretary Wes Streeting amid growing concerns over role clarity and patient safety, the review found “a lack of clear vision” when the roles were introduced in the early 2000s, with limited integration into medical teams. Author Professor Gillian Leng reported that gaps in staffing were often filled by PAs without sufficient oversight, resulting in risks to patients due to their more limited training.

The review recommends:

• renaming PAs to “physician assistants” and AAs to “physician assistants in anaesthesia” (PAAs)

• requiring assistants to wear badges and clothing that visibly differentiate them from doctors

• prohibiting assistants from diagnosing patients or seeing new cases in emergency or primary care settings

• requiring at least two years’ hospital experience before working in GP or mental health settings

• ensuring assistants work within teams led by senior doctors

• providing patients with clear information about assistant roles

The British Medical Association (BMA) welcomed the name change as progress but said key reforms were still needed. Patients and families affected by misidentified care also supported efforts to improve clarity, including the use of distinct uniforms and clearer communication.

PAs and AAs have been regulated by the General Medical Council since December 2024, though the BMA warns that blurred boundaries and growing reliance on these roles risk undermining professional standards and training.

There are currently over 3,000 PAs and AAs in England, with projections to quadruple by 2036 under NHS workforce plans.

Dr Hilary Williams, incoming vice president of the Royal College of Physicians, called the review “thoughtful and thorough,” adding that reform is urgently needed to safeguard safe teamworking within the NHS.

Responding to Professor Gillian Leng’s independent review of the physician associate (PA) and anaesthesia associate (AA) professions in England, Charlie Massey, Chief Executive and Registrar of the General Medical Council said:

‘My thanks to Professor Gillian Leng and her team for their detailed and thoughtful work on this important Review. The Review brings much-needed clarity and offers a timely opportunity for a reset across healthcare.

‘As the regulator for PAs and AAs we work with them to ensure good, safe patient care. Our regulation has been helping provide assurance to patients, employers – and doctors that PAs and AAs have the right level of education and training, meet the standards that we expect, and that they can be held to account if serious concerns are raised.

‘The findings of the Review will be pivotal to how we work with others and continue to improve our regulatory practices. We look forward to working on the aspects of the report that relate to the GMC and with others where there is a shared responsibility to deliver change.

‘As always, patient safety remains our absolute focus and priority.’

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