The Leng review: recommendations provide a constructive way forward

Abstract

After an extensive period of debate and examination of evidence about physician and anaesthesia associate roles, my review can provide clarity, says Gillian Leng It was a privilege to be asked by Wes Streeting, the secretary of state for health and social care, to review the safety and effectiveness of anaesthesia associates (AAs) and physician associates (PAs). It probably represents the biggest review of any staff group that has ever been conducted. It was evident early on that the longstanding, impassioned views on both sides of the debate would make navigating the task challenging. At the heart of the matter was that AA and PA roles are closer to that of doctors than any other professional, generating frustration, particularly among resident doctors. They raised concerns about PAs operating at unsafe levels, unsupported by adequate training, that took away their training opportunities, and also that—at the extreme—doctors were being quietly replaced by cheaper members of staff. The review has undertaken intensive investigation to consider safety and effectiveness and the surrounding problems.1 There was a comprehensive review of international literature, plus national data on patient safety, local …