A Physician Associate (PA) is healthcare professional with generalist medical education. They work under the supervision of doctors but are not doctors themselves. PAs are able to are trained to perform various tasks, including taking medical histories and conducting physical examinations – they can order scans, but they cannot prescribe medication. The role of a PA is intended to complement healthcare teams and ease workloads.
There is often confusion from the public when they are seen by a PA as many believe they are being seen by a qualified doctor whereas in reality, the qualifications that Physician Associates have are very different. This confusion, along with safety concerns around misdiagnosis from PAs, led to the calls for an independent review of the roles, which was conducted by Professor Gillian Leng, with the findings published on 16th July 2025.
What did The Leng Review look at?
Professor Leng is the President of the Royal Society of Medicine and a non-executive for the Department of Science Innovation and Technology. In 2024 the Government asked her to lead an independent review into the roles of Physician and Anaesthesia Associates.
The question at the very heart of the review was whether the roles of PAs and Anaesthesia Associates (Aas), as part of a multi-disciplinary team, were safe and effective.
What did The Leng Review conclude?
The Leng Review has concluded that the “Physician Associate” title should be changed to “Physician Assistant” – providing more clarity, and helping the patient understand that they are to assist qualified doctors, not to replace them.
The review also established that the safety concerns raised in relation to PAs were frequently raised surrounding making a diagnosis and deciding the initial treatment, particularly in primary care or the Emergency Department, where patients first present with new symptoms – and that crucially, the risk of missing an unusual disease or condition is highest in these circumstances. This could lead to an incorrect diagnosis being made and the patients could be put on an inappropriate pathway. The true diagnosis could be delayed or not made until it is too late for that condition to be treatable.
The review has therefore recommended that PAs should not see patients with previously undiagnosed conditions, unless triaged into adult patients with minor ailments and within clearly defined clinical protocols, as agreed by the Royal College of Emergency Medicine and the Royal College of General Practitioners.
What will change?
NHS England has already begun to make changes, following the recommendations made in the Leng Review.
On the 16th July it was announced that, with immediate effect;
- New role titles of Physician Assistant must be adopted
- Pas currently working in Primary Care, Emergency Departments, or any other setting must:
- Not triage patients
- Not see undifferentiated patients
There are also a number of longer-term recommendations that will be implemented at a later stage, surrounding clinical protocols and training and development for the roles.
How can we help?
If you feel you or a loved one have been misdiagnosed by a Physician Associate, then please contact us to arrange a discussion with one of our specialist clinical negligence team.
