The Government has accepted all the recommendations made by Professor Gillian Leng following her independent review into the safety and effectiveness of physician associates (PAs).
The review called for physician associates (PAs) to be renamed physician assistants and work for two years in secondary care before moving to primary care.
The Leng Review, published yesterday, added that the role did not need to be scrapped, but did suggest putting in place more development opportunities for PAs.
It concluded with eight recommendations for PAs (below), alongside an additional six for anaesthesia associates and four for the wider system.
Health secretary Wes Streeting said the NHS in England will now begin work to bring all the proposed the changes in ‘as quickly as possible’.
‘Patients should always know who they are being treated by and should always receive appropriate care.
‘Legitimate concerns about patient safety have been ignored for too long – that’s why I sought out the very best clinical advice to review physician associates and anaesthesia associates’ roles in the NHS.
‘We’re accepting all of the recommendations of the Leng review, which will provide clarity for the public and make sure we’ve got the right staff, in the right place, doing the right thing. Patients can be confident that those who treat them are qualified to do so.
‘Physician assistants, as they will now be known, will continue to play an important role in the NHS. They should assist doctors, but they should never be used to replace doctors,’ he said.
NHS England will be asked to write to system leaders setting out the ‘immediate actions’ for them to take, he said.
Implementing the review’s recommendations ‘will provide clarity for the public’ and ‘improve patient safety and quality of care,’ the Government added.
It stressed that PAs will ‘still have a vital role to play’ in wider teams and that these recommendations ‘will provide certainty and options for their career development’.
The review said abolishing the role of PA would be a ‘significant, unprecedented intervention’, and that there was not ‘convincing’ evidence that this needed to happen.
‘Considering all the factors, there is no convincing reason to abolish the roles of AA or PA,’ the review said.
But it added that there was a ‘mixed picture’ of safety and effectiveness based on poor data, as well as a lack of satisfaction among PAs of the role, and a lack of confidence in the roles from the medical profession. The review suggested that the roles were important for future workforce planning, but that there could not be full trust from the public in the profession while there were ‘issues about lack of clarity’.
It said that while the roles should not be abolished, they also should not remain as they are.
‘There is also no case for continuing with the roles unchanged, as there are a number of significant issues that need to be addressed to effectively embed the PA and AA roles in the NHS workforce,’ it said.
It recommended the name of PA be changed in order to ‘give immediate clarity’ to PAs, patients and other healthcare professionals.
On their deployment in primary care, the review added: ‘In the same way that doctors do not immediately work in primary care after qualification, neither should newly qualified PAs.
‘Initial employment in secondary care provides an environment with much greater supervision, where any safety issues can be identified promptly and further training and development provided.’
In a proposed job description for newly qualified PAs joining general practice, it said they should ‘play a central role in all aspects of preventative care, including undertaking NHS health checks and provide lifestyle support and support the administration of basic therapeutic procedure.’
Other recommendations in the report include clearer marking of who is a doctor and who is a PA, and the requirement of a named supervisor. It added that there should be more support to the doctors taking on the supervisory role.
The review also suggested a ‘dedicated’ fast-track training route for the current cohort of PAs ‘who may wish to retrain as doctors’ should be considered, with the aim of retaining ‘motivated staff’ within the NHS.
The chair of the review, Professor Gillian Leng, said the recommendations represent a ‘pragmatic solution that aims to bring cohesion and clarity’.
She added that they ‘would not be universally popular’, but that debate must now be closed.
The RCGPs reaffirmed its opposition to the role of PAs in general practice, in a response to the review.
College chair Professor Kamila Hawthorne said that the RCGP’s position is that it ‘opposes a role for PAs in general practice’, following the review’s findings.
Professor Hawthorne added that the college is now ‘considering’ the Leng review’s findings and recommendations but any change to their position ‘would need to be agreed by college council’.
The RCGP voted to oppose the role of PAs in general practice last year, and went on to set out a clear scope for the 2,000 PAs who currently work in practices, which severely limited their roles.
In May, the GMC approved 33 PA courses after it became the regulator for the profession.
It comes as the decline in the number of PAs has slowed, according to the most recent monthly workforce statistics.
Physician associates: Leng recommendations
Recommendation 1: positioning of the role
The role of physician associate should be renamed as ‘physician assistant’, positioning the role as a supportive, complementary member of the medical team.
Recommendation 2: credentialling
Physician assistants should have the opportunity for ongoing training and development in the context of a formal certification and credentialling programme. This should include the ability to take on added responsibilities that are commensurate with that training, including the potential to prescribe and order non-ionising radiation.
Recommendation 3: career development
Physician assistants should have the opportunity to become an ‘advanced’ physician assistant, which should be one Agenda for Change band higher and developed in line with national job profiles.
Recommendation 4: undifferentiated patients
Physician assistants should not see undifferentiated patients except within clearly defined national clinical protocols.
Recommendation 5: initial deployment in secondary care
Newly qualified physician assistants should gain at least 2 years’ experience in secondary care prior to taking a role in primary care or a mental health trust.
Recommendation 6: teamworking and oversight
The physician assistant role should form part of a clear team structure, led by a senior clinician, where all are aware of their roles, responsibilities and accountability. A named doctor should take overall responsibility for each physician assistant as their formal line manager (‘named supervisor’).
Recommendation 7: identifying the role.
Standardised measures, including national clothing, lanyards, badges and staff information, should be employed to distinguish physician assistants from doctors.
Recommendation 8: professional standards
A permanent faculty should be established to provide professional leadership for physician assistants, with standards for training and credentialling set by relevant medical royal colleges or the Academy of Medical Royal Colleges.
Source: Leng Review
A version of this article was first published by our sister title Pulse.
