Farewell, associates. Welcome back assistants

Abstract

On 20 November 2024, Wes Streeting, the UK’s Secretary of State for Health and Social Care, commissioned Gillian Leng to undertake an independent review of physician associates and anaesthesia associates. The rationale, in his words, was that “…there are legitimate concerns over transparency for patients, scope of practice and the substituting of doctors. These concerns have been ignored for too long, leading to a toxic debate where physicians feel ignored and [physician associates] feel demoralised.” 1 Leng was asked to consider two main questions. Were these staff roles (as currently deployed in England) safe? Were they clinically effective? Today, less than eight months later, the 134 page Leng Review has been published.2 It draws on academic research from within and beyond the UK, as well as a survey of over 8000 healthcare staff and consultation with additional individuals and groups, including patients and the public. The review makes 18 recommendations, 12 of which relate directly or indirectly to patient safety. Physician associates, the review proposes, should be renamed “physician assistants.” They should be required to wear nationally standardised clothing, lanyards, and badges to distinguish them from doctors. They should not be allowed to see undifferentiated patients, nor should they be permitted to work in primary care until they have at least two years’ …